For a 2-month-old with club foot needing intervention, which is the recommended initial approach?

• A. Casting
• B. Surgery
• C. Wait and see
• D. Bracing only

Answer: (A)

Early nonoperative management with serial casting is the preferred initial approach for infantile clubfoot. The Ponseti method uses gentle manipulation and long-leg casts changed weekly to gradually correct the four components of clubfoot: cavus, adduction, varus, and equinus. This nonoperative path is favored because infants’ bones are still malleable, allowing correction without major surgery and with high success when started early. Often, after initial casting, a minor procedure called an Achilles tenotomy is needed to fully correct the equinus. Once correction is achieved, long-term bracing (boots and bar) is used to prevent relapse. Surgery is considered only if casting fails or in neglected cases, and waiting without intervention can allow the deformity to worsen and complicate future treatment.