The author's experience with 865 clubfoot patients and 540 cases of one-stage posteromedial release (PMR) for resistant clubfoot is reported. Many patients were followed from birth to skeletal maturity. The author's current management is presented. A true end-result study of congenital skeletal disorders requires follow-up to skeletal maturity. As reported here, enough patients were followed to skeletal maturity to allow for modification of both operative and nonoperative treatment. In this study, a subgroup of idiopathic clubfeet with distinguishing characteristics was identified. This subgroup was referred to as “atypical” idiopathic clubfeet. At birth, atypical talipes equinovarus (TEV) may be indistinguishable from common idiopathic clubfoot. However, patients with atypical TEV are prone to severe flat-foot deformity after early surgery. Retrospective and prospective studies and treatment of atypical idiopathic TEV are reported.