Twenty years on the edge of his foot, then a first step with his heel down

A 21-year-old man from Bắc Trạch had never in his life set a heel on the ground. In Huế, a team of three surgeons spent a single operation undoing what two decades had hardened, and four days later he walked out of the hospital evenly.

At the Hospital of Hue University of Medicine and Pharmacy, Dr Lê Hồng Phúc operated with Dr Đặng Lê Hoàng Nam and Dr Nguyễn Anh Quốc Tài. The work was patient and additive. They lengthened each Achilles tendon by about 5 centimetres. They extended the flexor hallucis longus — the tendon that runs behind the inner ankle to the base of the big toe and holds it clawed — and the posterior tibial tendon, which twists the foot inward, by roughly 3 centimetres each. Contracted muscles in the sole were cut away.

Then the ankles were brought round to 90 degrees, the ordinary angle of a foot standing on a floor. Skin that had spent twenty years accommodating a different shape now fell about 2 centimetres short; a tissue flap was grafted to close the gap. An external frame, wires passing through the tibia and the bones of the foot, was fitted to hold everything where it had been put.

In infancy, none of this would have been necessary. The Ponseti method — five or six weekly plaster casts, a small cut to the Achilles under local anaesthetic, then a brace worn almost around the clock for three months and at night for years afterwards — corrects most clubfoot without opening the foot at all. Ignacio Ponseti published the results in 1963, and surgeons largely ignored them for three decades; the method spread only in the late 1990s, when parents began passing it between themselves on internet mailing lists.

The window closes with skeletal maturity. Bone remodels around a deformity and becomes part of it, and from then on the only routes are open release, osteotomy, or the slow distraction of a ring fixator of the kind Gavriil Ilizarov first built in Kurgan in 1951. Clubfoot appears in about one birth in a thousand, bilateral in roughly half of cases, and four in five of those children are born in low- and middle-income countries, where the casting window is easiest to miss.

He was discharged on the fourth of September. He walked out with a balanced, ordinary gait, both heels meeting the floor — a sensation that, at twenty-one, was entirely new to him.