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Congenital Crooked Foot-Pes Equinovarus (PEV) is a congenital abnormality that occurs in about 1 out of every 1000 births, mostly in boys, sometimes on both feet. Turkey Medicals, “We discussed the details of the subject and treatment alternatives with Antalya Medicalpark Hospital,” Op. Dr. Pediatric Orthopedist…

1- When is PEV diagnosed and when should treatment start?

Nowadays, it is an orthopedic problem that can be diagnosed during a period when regular ultrasonography follow-ups are performed during pregnancy in Turkey. There is no delay in diagnosis. Treatment should be started as soon as the baby is born. The reason for the deformity of the foot is complete introversion in the foot due to the short and tense muscles in the calf and the relations between the bones in the joints in the foot.

2- Can you tell us about the old and new treatment approaches in PEV?

In the treatment, it is to correct the dislocated deterioration that occurs in the foot joints by bringing the foot to certain positions, to stretch the calf muscles at this time, to bring them to normal length. It is not possible to do it at once, and ambulatory circulation problems may occur with excessive exertion. For this reason, correction and decontamination are performed 4-5 times with a break of one week.

In the past, casts were performed 10-15 times, although major operations were required.

With the Ponseti technique in Antalya, which has been popular in the world for more than the last 10 years, improvement is achieved both in a shorter time and close to complete improvement can be achieved with an extremely simple surgical technique, even if surgery is required.

Improvement after the fourth cast is evaluated by examination and, if necessary, by X-ray control. In some feet, the heel bone may not fully recover. The muscles in the calf and the structure known as the Achilles tendon prevent this improvement. In such a case, it may be necessary to perform a small surgical procedure. This procedure, which is performed under light anesthesia in hospital conditions, is performed with a very small surgical knife. By relaxing the Achilles tendon, the position of the heel bone is corrected and the foot can take its normal shape. After the procedure, no stitches are made, the leg is again taken to the laptop cast like the previous casts.

After 15 days, the plaster is replaced. After staying for another 15 days, the plaster treatment is terminated and the device application is started. At this stage, the goal is to maintain the improvement provided in the feet. Various devices can be used under names such as AFO, Saint-Germain splint, Ponseti device. The main characteristic of the congenital crooked foot problem is the recurrence of the distortion immediately if the device is not used. The baby should be followed very closely until at least 2 years of age. When he reaches the walking stage, he may need to use custom-made shoes. It happens after the foot starts to take its full shape and recover in such a way that it does not relapse again. As a general rule of pediatric orthopedics, the patient’s growth and development should be monitored until the end of childhood. Although the foot takes its final shape at the age of 12, monitoring should be continued until the age of 15-16 in girls and 17-18 in boys.

Sometimes it may be necessary to perform some additional operations during this follow-up.

As a result; in congenital crooked foot disease, an almost completely normal foot can be obtained by starting its treatment within 1-2 days immediately after birth and using the right method well. The soles of the feet are exactly on the ground, he wears normal shoes, and most of the time he may not even be distinguishable from an outpatient treatment. In unilateral cases, the problematic foot may remain 1 smaller than the other, 1-2 cm in the calf muscles. there may be a difference in thickness up to. This asymmetry is not found in bilateral cases.



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President of Organ Transplant Center at MedicalPark Hospital Antalya

Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.

Physician's Resume:

Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.

Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.

In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.


Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.


Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .

Professional Members:

American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.


Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.
Medically Reviewed by Professor Doctor Alper Demirbaş
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