BACKGROUND: It has been demonstrated that an important component of clubfoot deformity is related to pathologic external rotation of the talus with respect to the remainder of the foot. The purpose of the present study was to review the long-term results for a cohort of patients with idiopathic clubfoot who were managed by a single surgeon with a uniform surgical protocol consisting of extensive posterior medial-lateral release in addition to the use of a temporary Kirschner wire to derotate the talus prior to fixation. METHODS: Eighty patients (120 clubfeet) with idiopathic clubfoot without previous surgery were managed with posterior medial-lateral release. At an average of twenty-one years postoperatively, patients underwent a detailed physical examination and completed four quality-of-life surveys (the Short Form-36, the Laaveg and Ponseti scale, the Foot Function Index, and the modified Atar scale). RESULTS: Thirty-two clubfeet (27%) had required additional procedures at the time of follow-up, with only one patient requiring complete revision posterior medial-lateral release and none requiring subtalar or triple arthrodesis. In patients with unilateral clubfoot, clinical examination demonstrated a significant decrease in the range of motion (p < 0.001), foot length (p = 0.045), and calf circumference (p = 0.008) on the affected side as compared with the unaffected, contralateral side. The results on all four quality-of-life scales remained durable, with no decline in relation to the time from the index procedure (p >/= 0.48). Significantly worse scores were found for patients who required additional surgical procedures (p = 0.03). CONCLUSIONS: Previous studies have demonstrated inconsistent long-term results following the treatment of clubfoot with extensive soft-tissue releases. With our technique, thirty-two clubfeet (27%) required additional procedures and only one clubfoot required revision posterior medial-lateral release. We demonstrate that our technique, which involves aggressive posterior medial-lateral soft-tissue release in addition to manual derotation of the talus with a Kirschner wire to correct pathologic external rotation, produces acceptable results.