Family Factor, Treatment Options and Evaluation of Results in Pes Equinovarus Disease

Abstract

In this study, we analyzed the patients who had applied to Yüzüncü Yıl University Medical Faculty due to pes equinovarus between 2011 and 2013 and treated with the Ponseti method. Thus we evaluated 56 feet of 38 patients in the early-treatment period and the factors affecting the treatment. All of the patients were systematically examined before and after the treatment. For the feet that had anomaly we used the scale that was used by Dimeglo et.al. Averagely 7.5 plaster casts were applied to the feet of the patients (range: 3-16). In patients with PEV, after the recovery of hindfoot varus and forefoot adduction in 48 feet in which equine deformity, achillotomy operation was applied under local anesthesia with mini open technique. After plastering, Steenbeek orthosis was applied to the feet. Average follow-up time was 14 months (range 5-28 months). In patients with PEV, the most commonly recurred component was metatarsus adductus. While this rate was 36% in idiopathic PEVs, in complex PEVs it was 83%. The plantigrade walking ratio in patients with idiopathic PEV was 92%. In patients with idiopathic PEV, the compliance with orthosis was 81% whereas in patients with complex PEV it was 33%. In addition to this, except one patient, in all patients with complex PEV recurrence was observed and additional treatments were made for these patients. The final Dimeglio score of the patients with idiopathic PEV was very good in 16 feet, good in 6 feet. On the other hand, in patients with complex PEV, this score was very good in 4 feet, good in 3 feet, and bad in 1 foot. The most important recurrence reason for PEV was non-compliance with orthosis. The reasons for non-compliance with foot abduction orthosis are as follows: long processing time the negative psychological effects of orthosis on families and considering orthosis as unnecessary since the correction in the feet was seen by the family. The education level of the family is an important risk factor for the development of recurrence. In this sense, it was determined that the recurrence risk was 10 times higher in the families whose education level was high school and below in comparison to the families with university degree. We achieved success at a rate of 92% in manipulation and plastering treatment of PEV which was materialized by Ponseti method. The most important factor affecting the treatment was the continuity of the treatment and the compliance with orthosis. © 2015, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.