Pes Equinovarus

Pes Equinovarus (clubfoot / talipes): is a congenital foot deformity. This foot deformity may be either standalone or accompanied by some other problems. The affected foot is rotated internally, the heel is rotated outwards, and the patient is unable to bend the ankle. It occurs in every 1-2 children out of one thousand. It occurs in males twice as frequently as in females. Mechanical pressure inside the mother’s womb, foot cartilage development disorders and nerve lesions are the common reasons. Clubfoot is easily diagnosed. The deformity is evident at birth. It’s important to identify if it’s congenital or positional. The baby should receive treatment from an orthopedist immediately after the birth. Because a delay in treatment can lead to significant problems. The deformities should be classified by evaluating X-Rays and corrective plaster applications should start immediately. Some rigid cases may require surgery after corrective plaster application. Follow up of patients is very important. The patient needs to be under doctor control until bone development is complete. Today the most effective and successful treatment results are obtained with Ponseti method.


Ponseti Method is a treatment technique for Pes Equinovarus making use of plastering and then achilloplasty of which the success ratio is quite high. The risk of recurrence is very low. In this method, an experienced orthopedist master in plastering increases the success ratio.


In recent years, orthopedics has been progressing rapidly in parallel with technological progress… We see that the improved implants and recent surgical techniques have led to a mechanization in the approach towards human being and human bone.

It brings many advantages as well as many undesirable conditions. In the simplest term, it should not be forgotten that the human is a living organism and the entire operation system of this living organism should always be considered. I believe that we need to discipline our surgical courage. I can say that as I gained more professional experience, I’m alienated from scalpel which compromise the integrity of the organism. I expect my major colleagues’ understanding for saying: “First, do no harm.” (Hippocrates)

Congenital Dislocation of the Hip

1: Congenital dislocation of the hip (CDH)

Developmental dysplasia of the hip (DDH): is a problem with the way that the hip joint develops. In DDH, there is an anatomical mismatch between the femur head (the highest part of the thigh bone) and the acetabulum (concave surface that the head of the thigh bone meets with). There are two types of dislocation:

a. Teratological dislocation: covers 2-5% of the CDH. There is a dislocation of the hip in intrauterine life. The prognosis is poor. The treatment is more problematic.

b. Typical dislocation: covers 95-98% of the CDH. Generally, there is no dislocation in intrauterine life.

The normal anatomy of the hips. Side view of the hip joint.

Congenital dislocation of the hip is seen in every 1-1.5 of 1000 newborns. Female children are affected 6-9 times more often than males. The reason is unknown. Intrauterine malposition (bad posture inside mother’s womb), ligamentous laxity (loose ligaments), genetic factors, postnatal environmental factors (environmental factors after birth) are the most common reasons known. Approximately 60% of hip dislocations are seen in firstborns. It’s common in breech presentation.

Families should pay attention to:

Families need to consult and orthopedist if the baby is too much crying during diaper change, if one leg is lazy, moving less than the other, there is a difference between the folds of both legs and if there is dislocation of the hip in any other family member. Generally, the diagnosis is made by a physical examination of the orthopedist. However, ultrasound for children younger than 9 months, plain radiography for elders are sufficient for diagnosis. Early diagnosis and treatment is very important. The success ratio for those who are diagnosed before walking is almost 100%, but a delay in diagnosis and treatment reduces the success ratio.


Osteoporosis is:

Decrease in bone mineral content

Decrease in bone strength

Decrease in bone quality

There are two types of bones in the human body:

80% cortical bone

20% trabecular bone

It’s the type of bone which is soft, located at the end points, has honeycomb-like appearance, and which absorbs the load and weight.

Mostly the trabecular bone is affected by the fractures due to osteoporosis.

Osteoporosis affects mainly the weight bearing bones.

Osteoporosis occurs

47% in spine

20% in hipbone

13% in wrists

20% in other bones

Osteoporosis is more common in females than males.

A study in our country amongst 1560 patients over the age of 65 visiting policlinic during 12-months period in 1998:

1026 females

534 males

Gonarthrosis 33%

Osteoarthritis 19.99%

Osteoporosis 14%

Source: Journal of Geriatrics

Risk Groups for Osteoporosis

Advanced age


Fine bone structure


Ovarian ablation

Nutritional factors (low consumption of calcium, milk and milk products)

No regular exercise


Excessive alcohol consumption

The use of cortisone


Osteoporosis is detected by x-ray amongst 21% of women over age 70, even if they have no complaint.

The risk of hip fracture starts to increase in 10-15 years after menopause.

Approximately 15% of these fractures result in death in the first 3 months. And 50% of them result in disability.


You may not notice the symptoms of osteoporosis until you break your bone, become hunchbacked and get shorter.

You may spend a silent period until there are evident symptoms.

If you’re in the risk group:

Physical examination


Blood and urine analysis

Bone mineral density scan (DEXA)

Establish a final diagnosis


Treatment is based on the prevention of bone mineral loss:

During menopause:


Calcium 1000mg/day



Regular exercise and walking

Vitamin D and sunbath

The Course of Osteoporosis

With proper treatment the progression of the disease can be stopped or slowed.

Though osteoporosis does not affect the life expectancy, it affects the quality of life.


With proper treatment, the progression of the disease can be slowed down or stopped.

Osteoporosis does not affect the life expectancy, but it greatly affects the quality of life.


Bone health is not difficult to maintain:

To quit alcohol and smoking

To take food rich in calcium

To sunbath 10 minutes a day

To sport (walking, exercise)


Not taking soft drinks

Not consuming excess phosphorus

Reducing animal proteins

Increasing vegetable proteins (legumes)

Consuming milk and milk products


As we get older, the risk of falling and breaking a bone increases.

Muscle weakness

Visual impairment

Chronic diseases

Dizziness due to drugs taken continuously may cause falling.


Do muscle strength exercises

Wear low-heeled, non-slip shoes

Have regular eye examinations

Watch out the sudden rise and fall of your blood pressure and sugar

Most falls occur in the bathroom. Have handles in the bathroom, kitchen and stairs for the elders.

Set the lighting of the house with an eye to the elders. Make night lighting in necessary places.

Avoid laying small sliding carpets

Secure the rugs

Use non-slip varnishes

Remove electrical cords out of your path

Keep kitchen tools in easily accessible places.



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