The author presents his experience over twenty three years as visiting orthopaedic specialist in the early management of neonatal and infantile clubfoot with annual visits to the Kingdom of Tonga, S.W. Pacific. This has involved three hundred and seventy two infants with five hundred and fifty eight feet. The relative ease of assisting surgically those least able to afford treatment overseas in their own country where such treatment may not be available in their own country is discussed. The equipment required; the surgical skills needed; the importance of safe anaesthesia; the importance in gaining the confidence of family, local medical, nursing and administration staff is emphasized. The high incidence of clubfoot in Polynesians is noted. The incidence in Tonga approaches one per hundred live births ie. 1% so for Tonga where there are approximately 2500 live births per annum – this means an annual case load of 25 babies with upto 40 feet to correct on an annual basis: a formidable annual caseload. Three orthopaedic visiting surgeons with one visiting anaesthetist plus another local anaesthetist utilizing two theatres can successfully complete this caseload in 3–4 days of operating. In the absence of such visiting teams many of these babies would remain untreated or inadequately treated and would commence walking at 12–18 months on uncorrected feet with disastrous results. Early soft tissue correction in a baby under 12 months of age is highly desirable to ensure a corrected plantargrade foot before walking commences. Clubfoot is therefore especially common in Tonga; Samoa; Tahiti; Hawaii and amongst Maoris in New Zealand yet it still occurs in Melanesians in Fiji; Papua New Guinea; Solomon Islands; Vanuatu; New Caledonia and in the Micronesian states in the Caroline Islands; Marshall and Mariana Islands. There is a need for visiting orthopaedic teams to visit and surgically treat clubfoot on an annual basis. The author in co-operation seeks to establish an Asian Pacific Foundation to ensure this important surgery is delivered annually to our near neighbours.
