The Ponseti method has largely replaced extensive surgical release as the first-line treatment for idiopathic clubfoot, but high-quality long-term comparative data are uncommon. This prospective randomized trial compared Ponseti treatment with surgical correction and followed children for approximately 10 years. The study assessed morphology, function, radiographic findings, overall health and gait, providing a longer-term perspective than many short series. The results support Ponseti treatment as the preferred initial strategy and demonstrate that early conservative correction can translate into durable functional outcomes. The study is particularly relevant because it compares treatments over a time horizon long enough to capture late functional differences and the potential consequences of more extensive surgery. Clinically, the success of Ponseti does not depend on casting alone: careful serial manipulation, Achilles tenotomy when indicated and prolonged bracing are integral components. Families need realistic counselling about the importance of follow-up and the possibility of relapse. The broader lesson for HCPs is that successful clubfoot management is a longitudinal care pathway, not a single procedure. When recurrence occurs, early recognition and repeat Ponseti-based treatment can often avoid major reconstructive surgery.