While early diagnosis and persistent treatment of congenital foot deformities improve the ultimate function and appearance of the limb, they by no means reduce the difficulties of the surgeon, and open operation must often play a part in the course of the most carefully directed and most conservative treatment. The writer suggests that in the case of a severe club foot a careful dissection along anatomical lines will enable the bones to develop more completely and normally thereafter, so that this measure must not be condemned offhand as a "mutilating procedure" like the bone wedges that have to be removed in old neglected cases. On the other hand, such an operation does not exclude the need for prolonged conservative treatment following it,—that is, it has not the final and dramatic effects of correction of a thoroughly deformed case which has reached a stationary stage.