[目的]通过15例先天性马蹄内翻足(CTEV)婴儿采用不同的康复训练策略,观察其治疗前后的足踝形态发展趋势,探讨先天性马蹄内翻足早期治疗的可行性。按照先天性马蹄内翻足的诊断标准制定入选标准。从2008年1月~2013年1月共15例26足,其中男性13例,女性2例;年龄最小为出生后10 d,最大为出生后92 d。[方法]康复治疗策略包括康复控制性训练、支具辅助治疗和跟腱有限手术。康复控制性训练包括:早期持续手法矫形,通过被动关节活动逐渐矫正外观畸形。中期强化弱势肌群,通过反复有序刺激弱势肌群收缩,促进弱势肌群肌纤维的发育,配合支具辅助维持足部正常外观。后期控制性引导负重,逐步在成人协助下进行步态训练,引导患儿形成正常的步行功能。如果超过12个月,外观无明显改善,行跟腱松解术。[结果]所有患者均获得随访,随访时间最长为60个月,最短为18个月,平均31.4个月。根据足外观和步态功能设计《马蹄内翻足功能评价分级评价标准》,评价治疗前后的足踝形态变化。其中12例18足恢复良好,1例2足轻度内翻,2例4足仍有跟腱挛缩,1例2足未能完成康复训练,3个月后行手术治疗,功能良好。治疗前后根据足外观和步态功能进行分级统计,采用配对设计资料秩和检验,结果显示P<0.001,治疗前后有显著差异,具有统计学意义。[结论](1)马蹄内翻足早期治疗疗效值得肯定,婴儿期进行康复训练能够促使踝足功能的正常发育,有效改善马蹄内翻足的异常形态,获得正常的运动能力;(2)本康复干预策略的特点是外观矫形与功能恢复并重,既要矫正足踝的外观矫形,降低跟腱痉挛,又强化胫前肌肉等弱势肌群的发育,确保足踝关节运动功能中肌肉的主动及拮抗的有效协调与均衡。 [Objective] To evaluate the feasibility of early treatment of congenital clubfoot by observing the trend of ankle and ankle development before and after treatment with different rehabilitation training strategies in 15 cases of congenital clubfoot (CTEV) infants. Congenital clubfoot in accordance with the diagnostic criteria to develop selection criteria. From January 2008 to January 2013 a total of 15 cases 26 feet, 13 males and 2 females; the youngest was 10 days after birth, the maximum 92 days after birth. [Methods] Rehabilitation strategies include rehabilitation control training, brace support and limited Achilles tendon surgery. Rehabilitation control training includes: early continuous manipulation of orthopedic, gradually corrected the appearance of deformity through passive joint activities. Mid-term strengthening of the disadvantaged muscles, through repeated orderly stimulation of weak muscle contraction, and promote weak muscular muscle fiber development, with the support of the foot to maintain the normal appearance of the foot. Late control and guide the weight, and gradually with the help of adult gait training, guide children to form a normal walking function. If more than 12 months, no significant improvement in appearance, line Achilles tendon release surgery. [Results] All patients were followed up for up to 60 months, the shortest of 18 months, an average of 31.4 months. According to the foot appearance design and gait function design “evaluation criteria for evaluation of clubfoot function evaluation criteria”, evaluation of foot and ankle before and after treatment morphological changes. Among them, 18 cases recovered well in 12 cases, one case had mild varus of 2 feet, and the remaining 4 cases had contracture of Achilles tendon in 2 cases. One case, 2 feet failed to complete rehabilitation training, and 3 months after operation, the function was good. Before and after treatment according to foot appearance and gait function grading statistics, using paired design data rank sum test, the results showed that P <0.001, before and after treatment were significantly different, with statistical significance. [Conclusion] (1) The early curative effect of clubfoot is worthy of affirmation. The rehabilitation training in infancy can promote the normal development of ankle-foot function, effectively improve the abnormal shape of clubfoot and obtain the normal exercise capacity. (2) Rehabilitation intervention strategy is characterized by the appearance of both orthopedic and functional recovery, it is necessary to correct the appearance of the ankle orthopedic, reduce Achilles tendon spasm, but also to strengthen the development of anterior tibial muscle and other weak muscles to ensure that the ankle motor function in the active muscle and Effective coordination and balance of antagonism.