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Introduction: Parents of an infant with an idiopathic clubfoot deformity are often urged by their primary care physician to seek treatment as soon as possible. This advice frequently appears in many general pediatric and pediatric orthopaedic textbooks and monographs on the subject. This recommendation has not changed since the wide acceptance of the minimally invasive Ponseti method to treat clubfoot. We determined the correlations among patient-related variables, early treatment variables, and the age at which the patient was first seen to begin treatment., Methods: Infants with moderate to very severe idiopathic clubfoot deformity were invited to participate. Age at which the patient presented to begin treatment was correlated against early treatment-related variables, including number of casts required, cast slippage, cast-related skin problems, brace-related skin problems, early noncompliance with brace wearing, and relapse before 1 year. Patient-related variables were also correlated against age at first visit., Results: Over 7 years, 176 infants met the inclusion criteria. There were no significant differences in the aspects of the early management as a function of age at first visit, with the exception of cast slippage (P=0.05)., Conclusions: The age at first visit influenced the incidence of cast slippage, but otherwise did not affect the early treatment of clubfoot., Clinical Relevance: The treatment of idiopathic clubfoot deformity should not be considered an orthopaedic emergency, and parents whose infants are born with this deformity should be counseled accordingly.

The incidence of orthopaedic surgery for young people with childhood onset of orthopaedic disabilities is not well documented. This study tabulated that incidence in the past two decades in California. Trauma, tumors, and hand surgery were not included in the study. Common pediatric orthopaedic diagnoses by ICD-9 code requiring CPT orthopaedic surgical procedures were tabulated in three years: 1983, 1990, and 1999. The most common procedures in each of these years studied were, in order of incidence, scoliosis, congenital hip problems, slipped femoral capital epiphyses, and clubfeet. The incidence of surgery for scoliosis and slipped femoral capital epiphyses increased over the past two decades. These data should be helpful in planning for future inpatient services for orthopaedically handicapped children.