Four children with distal tibiofibular diastasis associated to talipes equinovarus deformity are described. Tibial hypoplasia resulting in tibiofibular diastasis is believed to be the underlying cause of the deformity. This complex deformity is usually associated with other congenital malformations including congenital cardiac defects and other limb anomalies. Surgical therapy has centered on establishment of an ankle mortise; however, several authors believe that the best treatment is early ankle disarticulation rather than reconstructive surgery. Radiographs should be made of all apparent clubfoot deformities in order to rule out the more serious distal tibiofibular diastasis deformity.