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

> > >

> > >

> > >

> > >

> > > ---------------------------------------------------------------

-----

> >-

> > > -----------

> > >

> > > This electronic message may contain information that is

> >confidential

> > > and/or legally privileged. It is intended only for the use of

the

> > > individual(s) and entity named as recipients in the message.

If you

> > > are not an intended recipient of this message, please notify

the

> > > sender immediately and delete the material from any computer.

Do

> >not

> > > deliver, distribute or copy this message, and do not disclose

its

> > > contents or take any action in reliance on the information it

> > > contains. Thank you.

> > >

> > >

> > >

> > > ---------------------------------------------------------------

-----

> >-

> > > -----------

> > >

> > >

> > > This electronic message may contain information that is

> >confidential

> > > and/or legally privileged. It is intended only for the use of

the

> > > individual(s) and entity named as recipients in the message.

If you

> > > are not an intended recipient of this message, please notify

the

> > > sender immediately and delete the material from any computer.

Do

> >not

> > > deliver, distribute or copy this message, and do not disclose

its

> > > contents or take any action in reliance on the information it

> > > contains. Thank you.

> > >

> > >

> > >

> > > | | | | | Inbox

> > >

> > > Get the latest updates from MSN

> > > MSN Home | My MSN | Hotmail | Search |

Shopping

> > > | Money | People & Chat

> > > Feedback | Help

> > > © 2004 Microsoft Corporation. All rights reserved. TERMS OF

USE

> > > Advertise TRUSTe Approved Privacy Statement Anti-Spam Policy

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

, I have no advice for you whatsoever, but I just wanted to say best of

luck and you're in my prayers! GO TO IOWA, surgery is so final, no going back

after that!

Hugs,

boothejennifer boothejennifer@...> wrote:

> > >

> > > 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

> > >

> > >

> > >

> > >

> > > ---------------------------------------------------------------

-----

> >-

> > > -----------

> > >

> > > This electronic message may contain information that is

> >confidential

> > > and/or legally privileged. It is intended only for the use of

the

> > > individual(s) and entity named as recipients in the message.

If you

> > > are not an intended recipient of this message, please notify

the

> > > sender immediately and delete the material from any computer.

Do

> >not

> > > deliver, distribute or copy this message, and do not disclose

its

> > > contents or take any action in reliance on the information it

> > > contains. Thank you.

> > >

> > >

> > >

> > > ---------------------------------------------------------------

-----

> >-

> > > -----------

> > >

> > >

> > > This electronic message may contain information that is

> >confidential

> > > and/or legally privileged. It is intended only for the use of

the

> > > individual(s) and entity named as recipients in the message.

If you

> > > are not an intended recipient of this message, please notify

the

> > > sender immediately and delete the material from any computer.

Do

> >not

> > > deliver, distribute or copy this message, and do not disclose

its

> > > contents or take any action in reliance on the information it

> > > contains. Thank you.

> > >

> > >

> > >

> > > | | | | | Inbox

> > >

> > > Get the latest updates from MSN

> > > MSN Home | My MSN | Hotmail | Search |

Shopping

> > > | Money | People & Chat

> > > Feedback | Help

> > > © 2004 Microsoft Corporation. All rights reserved. TERMS OF

USE

> > > Advertise TRUSTe Approved Privacy Statement Anti-Spam Policy

> >

> >

> >

> >

> >

> >

> >