Treatment is with casting immediately on initial diagnosis; 2 to 4 months of manipulation and casting is usually required for correction. Recurrence is common after correction by manipulation alone; therefore prolonged casting is usually required. Recurrence after casting is most common within the first 2 to 3 years but may still happen up to age 5 to 7 years. Surgical correction (tenotomies, muscle transplants, and arthrodeses) may be required in severe cases, when conservative management fails or as a result of recurrence when the child is older. Recurrence is much less likely after surgical correction. Even with successful treatment the affected foot will be smaller and less mobile than a normal foot. Early initiation of therapy will increase the success rate of manipulative or conservative management and will therefore decrease the need for surgical intervention. Functional deformities are self-correcting and require no treatment.