Re: Dr Ponsetis reply KORI!

[Guest guest]

> > >

> > > Thx for email ­ see below. I will also answer your email

> > >

> > >

> > >

> > > L. Frick, MD

> > >

> > > Residency Program Director

> > >

> > > Dept. of Orthopaedic Surgery

> > >

> > > Carolinas Medical Center

> > >

> > >

> > >

> > > 3 yo clubfoot patient

> > >

> > > Dear Dr Ponseti, and - hope you are well and enjoying

the

> > > holiday season. I met Grace Boothe yesterday, who is now about

3

> >and

> > > a half years old. She has bilat clubfoot, initially treated

with

> > > below knee casts in army system for 5 months, then by

in

> > > Chapel Hill with a few casts and right tenotomy, then by Dr

Ponseti

> > > with casts and bilateral tenotomies. She was in orthotic full

time

> > > but then was cut back because of concerns about ligamentous

laxity

> > > and overcorrection. She had a few followup visits with

> > > Herzenberg around age 2, and mom says she was worried then

about

> >the

> > > heels not being down but she said she was given assurance that

it

> > > was ok and would not be a problem.

> > >

> > >

> > >

> > > She has had delayed milestones and is very short for her age-

seems

> > > to be barrel chested to me with disproportionately large head

and I

> > > wonder if she might have mild SED congenita- work up beginning

now.

> > >

> > >

> > >

> > > Her feet show bilateral rocker bottom deformity, right worse

than

> > > left, with empty heel pads and abnormal contour of the heel.

She

> > > walks with a stiff knee gait, wide abduction of limbs, and with

> > > midfoot and forefoot contact but no heel contact with the

ground.

> > > She cannot run or jump.

> > >

> > >

> > >

> > > I have attached copies of xrays of her feet. I would appreciate

> >(and

> > > her parents would also) your thoughts/ comments about her feet

and

> > > what to do now. My thoughts are that in some cases where

children

> > > have ligamentous laxity, the midfoot/forefoot ligaments give

way

> > > during casting before the tighter hindfoot ligaments and rocker

> > > bottom develops. I have observed a few of these children after

> > > emailing Dr Ponseti, and some have improved after beginning to

> >walk,

> > > with the heel dropping down into the heel pad and ankle

> >dorsiflexion

> > > improving (rather than only dorsifelxing through the midfoot).

In a

> > > few cases, the rockerbottom did not improve after a few months

of

> > > walking, and I have done limited posterior tibiotalar and

> > > talocalcaneal arthrotomies with very little to no addition

> > > lengthening of the Achilles. These few cases seem to be doing

ok,

> > > and maybe have retained some motion at the ankle/ST joint

because

> >of

> > > their global propensity for laxity.

> > >

> > >

> > >

> > > Should I proceed with posterior arthrotomy in Grace? Right side

> >only

> > > or both? Can we work on providing Ponseti method practitioners

with

> > > some guidelines for when (if ever) you believe it is

appropriate to

> > > proceed with surgery? The group (esp Internet parents) are so

set

> > > against any surgery that it is often difficult to even discuss

with

> > > them. In addition, there is a current " rage " of concern

> > > about `whether or not my child has an atypical clubfoot " . I

think

> >of

> > > the atypical foot as the ones that are short, broad and have

> > > plantaris instead of only first ray cavus.

> > >

> > >

> > >

> > > Any thoughts/ideas appreciated. Thanks.

> > >

> > >

> > >

> > > Steve

> > >

> > >

> > >

> > > L. Frick, MD

> > >

> > > Residency Program Director

> > >

> > > Dept. of Orthopaedic Surgery

> > >

> > > Carolinas Medical Center

> > >

> > >

> > >

> > >

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[Guest guest]

Kori,

No, I haven't emailed him yet- things have been so crazy around my

house lately... I'm juggling my pregnancy doc appointments, Livi's

feet appointments, my work schedule, DH's school schedule, also DH

broke his hand so he's having more appointments for treating that.

Not to mention I'm overly emotional and pregnant. It's just getting

to be too much.

I saw Dr. Schmale today and just scheduled the surgery for 2/15. It

will only be another tenotomy, unless they decide once they're in

there that the tenotomy will not do as much as they want it to -

then they'll do the capsulectomy. I'm really at a point where

hearing so many different things is making me too stressed. And it

isn't feasible to for us to go see Dr. Ponseti any time soon- I

cannot take any time off work (I'm not getting any paid maternity

leave when the baby comes and I'm the sole income for my family).

Even if we got an angel flight and stayed somewhere free - I cannot

miss any more work than I already am.

I'm just ready to put Livi's feet in Dr. Schmales hands and hope for

the best - he's very optimistic, and Mosca did support him on the

surgery - so I am fairly confident it will be fine. I know I should

email dr. ponseti, but at this point, hearing another conflicting

opinion would be so overwhelming. I really want what's best for my

baby's feet, but she also needs a sane mommy to be there for her.

If it turns out the surgery is a bad idea, we'll just have to go

from there I guess...

I had no idea signing a surgery consent for for my baby would be so

traumatic - I cried all the way home! But I have faith everything

will work itself out.

Darby

> > Darby,

> >

> > Did you consult Dr. Ponseti about this yet? If so, what did he

> have to say?

> >

> > Kori

> >

> > At 10:56 AM 1/12/2005, you wrote:

> >

> >

> > >,

> > >

> > >You poor thing! I can TOTALLY empathize with you here...

reading

> the

> > >letters and responses absolutely made my head spin - I am

reading

> > >with particular interest because my Ponseti doc is talking

about

> the

> > >posterior capsulectomy as well, and I'm having some concerns.

> There

> > >is so much info to take in and you don't know who to listen to

or

> > >what the best solution is. AAAAAAARRRGH!

> > >

> > >We are both completely frustrated and in about the same boat...I

> > >don't know about you, but I'm so overwhelmed at what I should

do,

> who

> > >I should talk to, where I should go - the stress itself is

making

> it

> > >hard to figure out how to handle it.

> > >

> > >Good luck!

> > >Darby

> > >Livi dbb 12/7 bi cf

> > >EDD #2 5/12/05

> >