Klumpfoot is also called PEVA, which is an abbreviation of the Latin name pes equino varus adductus. It is a congenital malformation which means that the heel is turned inwards and the forefoot is directed downwards towards the body’s midline. The heel is also high up while the foot and toes point downwards, so-called tip foot.

It is very unusual to be born with PEVA in many countries. Half of the children who have PEVA suffer from both feet. The cause of PEVA is largely unknown, but it is more common if the child has a sibling or a relative with PEVA. It is also more common among boys.

Symptoms of PEVA

The deformity can be anything from soft and easy to adjust to completely firm and immobile.

The muscles on the inside tend to be very tight and the muscles on the outside of the lower leg tend to be weakened. This prevents the child from tilting the foot upwards. When the child tightens the muscles, the foot bends obliquely inward.

When and where should I seek care

PEVA is already detected at birth. The children born with PEVA many countries receive care at birth.

Contact BVC if a child has PEVA for which they have not received treatment of PEVA. Contact a health care center if the child has started school and no longer has contact with BVC.

Contact a health care center if you, as an adult, have a lumpy foot for which you have not received treatment. You can contact many receptions by logging in.


The child’s foot does not usually X-ray because the various bones in the skeleton of the foot are not yet calcified at birth and therefore not visible in a regular X-ray examination.

Important to understand

In order to be able to participate in the care and to make decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you do not understand, or ask to have the information printed in order to read it peacefully.

Treatment of PEVA

The connective tissue in the tendons and joint capsules of the newborn baby is not yet fully mature. It is, therefore, possible to influence it with stretch and plaster.

The treatment of PEVA is called Ponseti’s method and usually starts within the first week of life or as soon as possible after that.

The treatment may seem laborious and lengthy, but you can get good support and information at the orthopedic clinic where the child is being treated.

Drywall Treatment of PEVA

The doctor gently pulls in the direction of the wrong posture in the front foot and rests on the outside of the spring leg. She then fixes the position of the foot with plaster. The plaster is around the entire leg.

The knee joint bends in 90 degrees. In this position, a couple of the muscles that cause the miscarriage to relax. In addition, this position prevents the plaster from slipping off. At intervals of seven to ten days, the foot is plastered and the doctor stretches the foot to reduce the position of the error. In most cases, a clear improvement can already be seen after some rips.

After six rounds, most of the errors have usually been adjusted. Then only the tip foot is usually left. This is because the heel is not as easy to stretch as other tendons and ligaments.

Extension of the heel

The health tendon needs to be extended if the foot is at the tip of the foot after six rounds.

The child is given local anesthesia or is anesthetized during anesthesia. The doctor cuts off the heel a few centimeters above the bracket on the heel bone. The tendon can then strain the tendon into place and change the tip foot position. Then the foot and the entire leg are plastered in the same way as before. The plaster is then left for three weeks. Meanwhile, the ends of the tendons grow together so that the gap between the ends fills in and the tendon is extended.

Shoes and rails

When the plaster has been removed after three weeks, the child receives special shoes that are joined together with an adjustable metal rail. The shoes and rail should be used around the clock for three months after the plaster is removed. After three months, the shoes should be used for twelve hours at night and two to four hours in the day until the child is three or four years. The shoes can then be used if the child sleeps during the day.

The result will be better if the child has used the rail in the way the doctor advises.

Follow-up after surgery

Until the child is eight years old, there is a risk that the foot will return to its original position. Therefore, children with PEVA are checked regularly.

Some children need to be operated on again, usually at four to six years of age. Then a tendon attaches to the back of the foot to prevent the foot from being pulled inwards.

After such an operation, the foot is plastered up to the knee joint. A week after the operation, the child can walk with the plaster. The child may only walk for a short time at a time as the tendon risks loosening from its new attachment.

Complications and sequelae

The foot usually gets good with Ponseti’s method. The treatment of PEVA usually does not affect the time when the child starts to want to stand and walk.

The child will be able to walk, run, jump and participate in sports without major problems in the future if they have no other physical disabilities.

The foot may have a slightly different appearance with thin skin around the outer tuber. If the child has only had PEVA on one foot, it may be slightly smaller than the other foot.

PEVA can also make the musculature develop slightly worse and make the leg one to two centimeters shorter. It is unusual for the difference in length between the legs to be so large that some surgery is needed.

Ehtisham Nadeem

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