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Along with syndromic or neuromuscular clubfoot, complex (“atypical”) clubfoot represents a category of clubfoot that is difficult to treat using the Ponseti method. It is important to identify this type of foot early because the treatment and prognosis are different from that of idiopathic clubfoot. Some cases can be seen from birth while other cases are iatrogenically caused, but in both instances the anatomic features and treatment are the same. In infantile cases, consideration to complex idiopathic clubfeet should be given with the anatomic presence of a deep plantar crease and hyperextended first toe. In iatrogenic cases, the provider may be alerted by cast failure and slippage. Parents should be made aware of the increased difficulty in treating complex clubfoot, and be prepared for additional cast time, early or repeat Achilles tenotomy, or difficulty with brace wear.