At birth the infants are severely deformed causing great family distress. Fortunately with time the deformities tend to improve.Furthermore, orthopedic procedures can be very effective in reducing deformity and facilitating independence. The objectives of management include improving mobility in the upper extremities and stability and symmetry in the lower limbs. Operative procedures are often combined to limit periods of immobilization. Correct lower extremity deformities during the first 18 months. Encourage progressive ambulation. Upper extremity correction is usually delayed until early childhood when function is limited by deformity.

Maintain an optimistic approach as the potential for these children is far greater than expected considering the severity of deformity initially present.

Clubfeet: Manage by initial casting (2-3 months) then percutaneous tenotomies. This procedure is combined with open reduction of coexisting hip dislocations and quadraceps lengthening. Continue to cast. Night splint until about 12 months and perform posteromedial release if necessary.

Continue night splinting well into childhood to prevent recurrent deformity. If deformity recurs after surgery, correct with serial casting.  Delay operating on refractory recurrence until late childhood. Correct then with bony procedures. If deformity very severe, early talectomy is an option with night splinting to prevent recurrence.

Hip dislocations: Reduce all (except in very severely affected children) by medial approach open reduction during the first year. Avoid extensive dissections. Combine with clubfoot procedures. Immobilize only 5-6 weeks.

Yazışma Adresi / Correspondence: Lynn T. STAHELI, e-mail: staheli@u.washington.edu