During conservative treatment the foot will be monitored and it may become necessary to perform an operation to correct any remaining problems. Although the foot has proved too resistant for conservative treatments alone the skin will have been well prepared for surgery as it will have been made more supple by the stretching processes.

There are four main types of surgery:

The most common ones are:

';Soft tissue release - lengthening or cutting the Achilles tendon and releasing other ligaments and capsules at the back and inside border of the foot which are preventing the positioning required because they are too tight.
';Tendon transfers - (e.g. the tibialis anterior transfer) to move the tendons to a different position, so the function of the foot can be improved.

Less frequently there may be:
';Surgery on the bones of the foot - bony procedures such as osteotomies that divide or remove bone to correct deformities, or, very occasionally, arthrodeses which surgically stabilize joints to enable the bones to grow solidly together. This is usually carried out after the child has stopped growing.
';Use of a circular frame such as the Ilizarov - a number of metal rings held together with rods and fixed to the bone from several directions by thin wires under tension. By adjusting different components of the frame over a period of time bones can be lengthened, thickened or shortened and soft tissue can be stretched.
Occasionally, a combination of these procedures may be necessary.

written 21/3/06. We gratefully acknowledge the steps medical panel for their assistance in putting this information together