Individuals with severe varus feet often have the appearance of severe untreated clubfeet and when treatment is desired often require very extensive decompression. Because of the large magnitude of the surgery, caretakers should be offered the options of making well-padded protective orthotics and using wheelchair protective foot buckets instead of footrests. An equinovarus deformity renders the foot and ankle in an unsuitable posture for gaiting, wearing shoes and bracing, as well as resulting in formations of callosities. This deformity is attributed to the imbalance of the ankle invertor, including the anterior tibialis (AT), posterior tibialis (PT) and evertor muscles. A combination of a split tibialis anterior or tibilais posterior transfer of the tendon and lengthening of the ankle plantar flexor muscles have been proposed to position the plantigrade foot. Biomechanically, split tibilais anterior tendon transfer is an appealing procedure. The function of the tibilais anterior is to maintain the neutral position when the hindfoot is corrected and therefore many authors prefer the split tibilais anterior tendon transfer procedure.