What Is Pes Echinovarus (Back Foot) and How Is It Treated?

es equinovarus (PEV) is an inherited disease, also known as clubfoot syndrome. How to treat pes equinovarus, which is possible to get a successful result if diagnosed early? In which cases is surgery required? We explained all the details in our article.

What is pes equinovarus (PEV)?

Pes equinovarus, a congenital disease, is a condition known as clubfoot syndrome. In some sources, it is also referred to as clubfoot.

Pes equinovarus occurs when the baby’s feet, which are crooked in the mother’s womb, do not straighten as the birth approaches and remain crooked. It can be on one or both feet.

The probability of clubfoot syndrome in boys is twice that of girls.

What causes pes equinovarus?

Currently, it is not possible to talk about a definite factor that causes congenital clubfoot syndrome. However, although it has not been proven yet, the most commonly suggested reason among the causes of pes equinovarus is genetic factors. Considering the regional distribution of the disease in the world, another factor is thought to be environmental factors.

90% of the pes equinovarus deformity is made up of the idiopathic group, the cause of which is unknown. In this group, the treatment of pes equinovarus is easier. However, extensive surgical interventions may be needed for the treatment of foot deformities in pes equinovarus, which develops due to any muscle or spinal condition.

What are the signs of clubfoot in babies?

• Turning inward on the front of the foot,
• Softening and turning in the heel,
• Inward deviation in the middle part of the foot,
• The size of the deformed foot is smaller than the other and there is thinness in the calf on the same side.

Does pes equinovarus recover in the womb?

Although the position of the baby in the mother’s womb was among the causes of pes equinovarus in the past, it is now known that the disease has nothing to do with it.

Clubfoot syndrome is seen in every baby in the womb, and this appearance of the feet improves as the birth approaches. If it does not improve while in the mother’s womb, the baby is born with the soles of the feet facing each other.

How is clubfoot diagnosed?

The diagnosis of clubfoot can be made by ultrasonography while the baby is in the womb or clinically after birth. Babies with clubfoot syndrome must also be checked for congenital hip dislocation.

How is pes equinovarus treated?

It is very important to act early in the treatment of pes equinovarus. The most ideal time is the 7th and 15th days after birth. In the neonatal period, plaster treatment is applied in accordance with the Ponseti technique.

• Corrective plaster treatment, which allows the foot to flex, is applied weekly, thus shaping the foot.
• In order to preserve the shape, the knees are kept bent and a plaster cast is applied up to the groin with a special technique.
• Plaster is applied 5-9 times in total, depending on the severity of the disease.
• After casting, the muscles are strengthened with orthotic treatment and pes equinovarus exercises.
• If the heel has not descended to the level of the sole of the foot at the end of 9 weeks, a minor surgical procedure is performed under general anesthesia and the Achilles tendon is cut.
• Then, a 3-week cast is applied for the last time, while the cut Achilles tendon is re-formed.
• The child is dressed with a Ponseti device until the age of 2 and regular controls are continued until the age of 8-10. This device consists of a special pair of orthopedic boots and Dennis Brown bar.
• When the child starts walking, he can switch from pes equinovarus shoes to normal shoes.

The Ponseti device is an important part of the treatment. If you do not make your child use this device, their feet will start to deform again and you may get an unsuccessful result from the treatment. Thanks to early treatments, it is possible to get near perfect results from foot deformities.

In which cases is pes equinovarus surgery necessary?

In the treatment of clubfoot, surgery is not required under normal conditions. As we explained above, surgery may be required in a very small part of the treatment. The success rate of recovery and returning to an active life after pes equinovarus surgery is 95%.

However, if clubfoot syndrome has developed due to muscle or spine diseases, wider surgical interventions may be required in the treatment.

What problems does clubfoot syndrome cause if left untreated?

Feet carry all the weight of the body in a balanced way. However, in babies with pes equinovarus, this balance is disturbed and all the load is on the outer edges of the foot. For this reason, if clubfoot is not treated in babies, it leads to lameness. In the future, surgeries may become more difficult.

Children cannot wear the shoes they want due to their discomfort. Especially in adolescence and later period, psychological problems may occur in children due to this problem. Therefore, pes equinovarus should be treated before it reaches adulthood.

Does pes equinovarus recur?

Yes, pes equinovarus can recur. Especially quitting orthosis use early can trigger recurrence. In such cases, plastering treatment is applied again in the recurrences that occur within the first year of the child.

Is Pev equinovarus an obstacle to military service?

There is no situation that can prevent children who have good results from pes equinovarus surgery and can walk and walk properly like a healthy person from doing military service in the future.