1. Benjamin D. Roye, MD, MPH* 2. Joshua Hyman, MD† 3. David P. Roye Jr, MD‡ 1. *Attending, Division of Pediatric Orthopaedics, Beth Israel Medical Center, New York, NY 2. †Assistant Professor, Children’s Hospital of New York 3. ‡Livingston Professor of Pediatric Orthopaedics, Children’s Hospital of New York, New York, NY After completing this article, readers should be able to: 1. Describe congenital idiopathic talipes equinovarus (CTEV). 2. Differentiate CTEV from metatarsus adductus clinically. 3. Discuss how to rule out comorbid conditions such as torticollis and hip dysplasia when considering CTEV. 4. Describe the initial treatment of CTEV. 5. Discuss the genetic pattern of CTEV. CTEV, commonly known as clubfoot, has been a recognized deformity since the time of the ancient Egyptians and was described independently by Hippocrates and the Aztecs. As implied by its name, the underlying deformity consists of a hind foot in equinus (plantarflexed) and varus (inverted). Additionally, there often is a cavus (abnormally high arch) and adductus component to the midfoot (Figs. 1 to 3⇓⇓). Essentially, the foot appears as though it was rotated inward and, in severe cases, as though it is on backwards. Historically, initial treatments were variations on the theme of manipulation (sometimes forceful and violent) and splinting. Surgical intervention began in the late 18th century with Lorenz’s Achilles tenotomy, but effective soft-tissue releases, osteotomies, and tendon releases did not evolve until the late 19th century with the advent of anesthesia and aseptic technique. Hiram Kite popularized gentle manipulation and serial casting in 1930, a technique championed and refined by Ignacio Ponseti in the 1950s. This remains the initial treatment of choice today. Although the basic concepts remain the same, surgical and nonsurgical techniques for the treatment of resistant CTEV continue to evolve, promising improved outcomes for children born with this condition. This article addresses primarily the more common idiopathic form of this condition, and unless otherwise stated, CTEV refers to idiopathic CTEV. Figure 1. Clinical photograph of an 8-month-old boy who has bilateral CTEV. Figure 2. Clinical photograph of a clubfoot from the medial aspect. Note the prominent crease in the midfoot. Figure 3. Clinical photograph of a clubfoot with the child …