Introduction and Aims: To illustrate complete, single chance correction, of congenital clubfoot in 89 cases in the Pacific Islands, from a humanitarian, scientific, and surgical perspective. To identify the unique Polynesian clubfoot gene, its particular characteristics, and the environmental factor suspected to trigger its activation.

Method: A rolling surgical procedure commencing with Turco operation and progressing as far as lateral border decancellation, is used. Tripple arthrodesis is not done, obsessive and meticulous after care is required for two weeks.

Results: Return clinic visits through inter-islands hospitals, aid post and villages, have revealed excellent long-term corrections. There have been no reoccurences and the surgical team have received no negative feedback.

Genetic studies suggest a single dominant gene of variable penetrants. Seventeen comfirmed perterdries from Vanawatu indicate a recessive inheritance in the population. The frequency varies from Island to Island, eg. Efate 0.26, Tanna 0.13. Seven cases gave a history of at least one other family member being affected. However, there was no vertical transmission in any degrees we conclude in a recessive mode of inheritance for ITEV in South Pacific Polynesian people. The desired surgical protocol is determined by an incremental combination of current surgical procedures with careful placement of incisions. Associated bone procedures are carefully selected. A rigorous and disciplined post-operative protocol has avoided known complications to date.

Conclusion: Single stage ITEV correction in adverse surgical conditions is successful and straightforward. The recipient is given a chance to avoid life-long degradation.

Genetic studies indicate a simple environmental cause activating a single dominant gene with 33% penetrants.