Re: What I learned at the symposium

[Guest guest]

, was there discussion about the ATTT - problems, long term results, etc?

I swear the more I learn the more I think had atypical (he ended with the

ATTT that Dietz and Ponseti are not happy with). When I hear the little girl is

getting success at age 3 it makes me wonder if they shouldn't have worked harder

or longer on before opting for the surgery. Guess I'll never know. I " m

glad your dh liked Dietz, personally I have a hard time communicating with him.

s.

What I learned at the symposium

Where to start? I will try not to ramble on forever, I will probably

have to do this in pieces as I don't have a lot of time right now to

tell you everything I saw and learned.

First of all, it was a great experience, I got to see everything,

casting, a tenotomy, I got to manipulate little rubber baby feet with

bones inside them, I even got to practice doing a cast! I sucked at

keeping my hands in the right places while doing the cast, I don't

know how the docs who mold and hold at the same time do it! I really

enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

so this is the baby from St. Louis. " He was so gentle and sweet, it

was just fantastic meeting him. He looked at Sammy's brace and said,

" Are you going to be here this afternoon? I want my orthotist ()

to see this. " I guess I'll start there. I know that and Dr.

Dobbs talked, said they had a long talk. also told me that

he has already made a couple prototypes with articulating bars. He

did look at Sammy's brace as well as a couple other models that Dr.

Dobbs showed him, including some with stops to prevent plantar flexion

and one with a quick release bar (snaps apart in the middle). My

husband has some really interesting ideas too, I just need him to

sketch out what he has thought up so I can give it to Dr. Dobbs and

.

I really liked Fred Dietz, he has a really great personality. He was

the instructor for our little group doing the practice casting. He

was a very good speaker and I felt he did a great job of presenting

the info on both short-term and long-term surgical results (as

compared to Ponseti). The thing that I found really interesting was

his discussion on atypical feet. He is of the " school of thought " I

guess you could say, that atypical feet are not born, they are made.

He thinks (and this is still just conjecture of course, they are all

still learning about atypical) that they are caused by slipping casts

and/or improper manipulations. He has had a couple cases in which the

cast has slipped once or twice and the emerging foot is starting to

look atypical. He has tried a " let it lie " approach - if he sees a

foot starting to look like this, he lets it stay out of the cast a few

weeks and start relapsing. In these cases he has seen the foot go

back to looking like a " normal " clubfoot and then he starts over. He

obviously doesn't have enough data to back this up yet, but it is an

interesting theory.

Next, I was always told that the reason they over correct is so that

the foot can gradually return to a normal position. This is one of

the reasons, however, not the main reason - the main reason is to get

the full range of motion, i.e. if you only correct to neutral the foot

will never have good abduction range of motion like a normal foot does.

Another interesting thing I found out about is in the tissues of the

ligaments themselves. Angel talked a little about this in a post

recently on the CF board. The tissues in the ligaments (collagen

fibers) in a clubfoot are actually contracted with a " crimp " , the

gentle stretching pulls out the crimp, then when casted and held for

5-7 days, the newly stretched tissues quickly regain their " crimp " in

their new position, thus allowing them to be stretched again. Pretty

interesting, huh? (This is all in the Global-Health book, but I

hadn't really followed this part of things before.)

Okay, I've got lots more to say, but I have to go for now. I will try

to write more tonight.

Later,

[Guest guest]

Holly I don't mind you asking any questions, I'm just not sure I have enough

answers to them. is now 7 1/2 years old. From birth to age 20 months he

was treated by a doctor who casted the hell out of him for six solid months but

nevr achieved any results. From there wore the AFO style brace and had

physical therapy twice a week from age 6 months to age 20 months. At that point

his feet hadn't changed much since the casting was stopped and the doc wanted to

do a surgery. Have you ever heard of the old Chinese custom of binding a

woman's feet so they grew in to a ball shape and she coudlnt' walk (it was a

sign of royalty)...that is what 's feet were like, these curled up balls he

tried to walk on, it was a mess.

This is when I discovered the Ponseti Method and switched to Dr. Ponseti / Dr.

Dietz in Iowa City. Ponseti tried re-casting who was just approaching his

2nd birthday. He wore them about 3 weeks then we tried going in to the FAB

which tore his feet up, so back for more casting but by then they had already

decided to perform the ATTT on him - this was just a preperation-cast aiming at

doing surgery, then he had the surgery.

All this was five years ago you realize, and there appears to be leaps and

bounds of progress made in these past few years regarding re-casting techniques

on older kids and on atypical kids. If Dietz is correct and bad casting leads

to atypical feet, my would be a prime candidate - he had bad casting for

six months, kwim? I just can't help but wonder if they knew then what they

knew now if he'd be better today.

As much as I love, support and defend the work of Dr. Ponseti at the University

of Iowa - when it comes to 's case I always leave my appointments feeling

like they are nto telling me everything. It's a bad feeling, like they screwed

something up and are hiding that information from me as they watch his feet

progress over the years. At our last visit Dietz and Ponseti huddled over his

feet talking in low voices and Doctor Lingo I couldn't understand or even quite

hear and I just left really frustrated. Making it worse they did both my kid's

appointments simotainiously (sp?) in different rooms so I was running back and

forth between rooms and well, then so were my kids and i couldn't concentrate on

either appointment.

Today 's feet are very flat-footed and very in-toed / pigeon-toed. His

feet are in a C shape with the big toes poinnting drastically at each other even

if the heel portion of his foot is standing straight. He trips over his own

toes; his knees knock together something awful and all this is getting worse

with age when they assured me 5 years ago it would improve with age. Also,

has no range of motion in his ankles, his legs from his knee to his feet

move like fence posts. He has to go down stairs side ways because his ankles

won't bend; he can't squat down or bend at the waste and touch the ground

because his heels don't stretch/bend; he has terrible balance.

It was mentioned vaguely once on here that for a brief spell Dr. Dietz was

" experimenting " with the ATTT surgery and I am pretty curious if my son was one

of his guinie pigs. Again, I really doubt if they'd tell me or if I " ll ever

really know for sure. I think Dr Ponseti would take the time to explain it all

if he could, but it is my experience any more that he's so darn popular and so

darn busy he always has fourteen people in the exam room with us and he's

talking to them more than to me; complicate that with his accent and my

hard-of-hearing and having to contend with little kids w ho want to monkey

around I always leave frustrated.

Sorry this is long and probably doesn't answer a thing for you. I guess if they

think the FAB can help, then wear the fab and post pone surgery as long as you

can. On the bright side can walk now, and he couldn't before the ATTT - I

give them that much adn I " m thankful for that much, truely - but in our

situation, the ATTT wasn't the cure they promsied me it would be.

s.

What I learned at the symposium

>

>

> Where to start? I will try not to ramble on forever, I will

probably

> have to do this in pieces as I don't have a lot of time right now to

> tell you everything I saw and learned.

>

> First of all, it was a great experience, I got to see everything,

> casting, a tenotomy, I got to manipulate little rubber baby feet

with

> bones inside them, I even got to practice doing a cast! I sucked at

> keeping my hands in the right places while doing the cast, I don't

> know how the docs who mold and hold at the same time do it! I

really

> enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> so this is the baby from St. Louis. " He was so gentle and sweet, it

> was just fantastic meeting him. He looked at Sammy's brace and

said,

> " Are you going to be here this afternoon? I want my orthotist

()

> to see this. " I guess I'll start there. I know that and Dr.

> Dobbs talked, said they had a long talk. also told me

that

> he has already made a couple prototypes with articulating bars. He

> did look at Sammy's brace as well as a couple other models that Dr.

> Dobbs showed him, including some with stops to prevent plantar

flexion

> and one with a quick release bar (snaps apart in the middle). My

> husband has some really interesting ideas too, I just need him to

> sketch out what he has thought up so I can give it to Dr. Dobbs and

> .

> I really liked Fred Dietz, he has a really great personality. He

was

> the instructor for our little group doing the practice casting. He

> was a very good speaker and I felt he did a great job of presenting

> the info on both short-term and long-term surgical results (as

> compared to Ponseti). The thing that I found really interesting was

> his discussion on atypical feet. He is of the " school of thought " I

> guess you could say, that atypical feet are not born, they are

made.

> He thinks (and this is still just conjecture of course, they are all

> still learning about atypical) that they are caused by slipping

casts

> and/or improper manipulations. He has had a couple cases in which

the

> cast has slipped once or twice and the emerging foot is starting to

> look atypical. He has tried a " let it lie " approach - if he sees a

> foot starting to look like this, he lets it stay out of the cast a

few

> weeks and start relapsing. In these cases he has seen the foot go

> back to looking like a " normal " clubfoot and then he starts over.

He

> obviously doesn't have enough data to back this up yet, but it is an

> interesting theory.

> Next, I was always told that the reason they over correct is so that

> the foot can gradually return to a normal position. This is one of

> the reasons, however, not the main reason - the main reason is to

get

> the full range of motion, i.e. if you only correct to neutral the

foot

> will never have good abduction range of motion like a normal foot

does.

> Another interesting thing I found out about is in the tissues of the

> ligaments themselves. Angel talked a little about this in a post

> recently on the CF board. The tissues in the ligaments (collagen

> fibers) in a clubfoot are actually contracted with a " crimp " , the

> gentle stretching pulls out the crimp, then when casted and held for

> 5-7 days, the newly stretched tissues quickly regain their " crimp "

in

> their new position, thus allowing them to be stretched again.

Pretty

> interesting, huh? (This is all in the Global-Health book, but I

> hadn't really followed this part of things before.)

>

> Okay, I've got lots more to say, but I have to go for now. I will

try

> to write more tonight.

>

> Later,

>

>

>

>

>

>

>

>

[Guest guest]

-what an exciting experience! I would find it so fascinating to be able

to see it firsthand from the legend himself.

Krishna

wrote:

Where to start? I will try not to ramble on forever, I will probably

have to do this in pieces as I don't have a lot of time right now to

tell you everything I saw and learned.

First of all, it was a great experience, I got to see everything,

casting, a tenotomy, I got to manipulate little rubber baby feet with

bones inside them, I even got to practice doing a cast! I sucked at

keeping my hands in the right places while doing the cast, I don't

know how the docs who mold and hold at the same time do it! I really

enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

so this is the baby from St. Louis. " He was so gentle and sweet, it

was just fantastic meeting him. He looked at Sammy's brace and said,

" Are you going to be here this afternoon? I want my orthotist ()

to see this. " I guess I'll start there. I know that and Dr.

Dobbs talked, said they had a long talk. also told me that

he has already made a couple prototypes with articulating bars. He

did look at Sammy's brace as well as a couple other models that Dr.

Dobbs showed him, including some with stops to prevent plantar flexion

and one with a quick release bar (snaps apart in the middle). My

husband has some really interesting ideas too, I just need him to

sketch out what he has thought up so I can give it to Dr. Dobbs and

.

I really liked Fred Dietz, he has a really great personality. He was

the instructor for our little group doing the practice casting. He

was a very good speaker and I felt he did a great job of presenting

the info on both short-term and long-term surgical results (as

compared to Ponseti). The thing that I found really interesting was

his discussion on atypical feet. He is of the " school of thought " I

guess you could say, that atypical feet are not born, they are made.

He thinks (and this is still just conjecture of course, they are all

still learning about atypical) that they are caused by slipping casts

and/or improper manipulations. He has had a couple cases in which the

cast has slipped once or twice and the emerging foot is starting to

look atypical. He has tried a " let it lie " approach - if he sees a

foot starting to look like this, he lets it stay out of the cast a few

weeks and start relapsing. In these cases he has seen the foot go

back to looking like a " normal " clubfoot and then he starts over. He

obviously doesn't have enough data to back this up yet, but it is an

interesting theory.

Next, I was always told that the reason they over correct is so that

the foot can gradually return to a normal position. This is one of

the reasons, however, not the main reason - the main reason is to get

the full range of motion, i.e. if you only correct to neutral the foot

will never have good abduction range of motion like a normal foot does.

Another interesting thing I found out about is in the tissues of the

ligaments themselves. Angel talked a little about this in a post

recently on the CF board. The tissues in the ligaments (collagen

fibers) in a clubfoot are actually contracted with a " crimp " , the

gentle stretching pulls out the crimp, then when casted and held for

5-7 days, the newly stretched tissues quickly regain their " crimp " in

their new position, thus allowing them to be stretched again. Pretty

interesting, huh? (This is all in the Global-Health book, but I

hadn't really followed this part of things before.)

Okay, I've got lots more to say, but I have to go for now. I will try

to write more tonight.

Later,

[Guest guest]

Wow, that makes sense, seeing how GAbe's first casts slipped about every other

day. Then when we got to HA they sliped nearly every week, at least once, till

Gabe had his tenotomies. However, how does this explain the excess connective

tissue prevalent with atypical feet...? Even if it does explain the plantaris

problem.

wrote:Where to start? I will try not to ramble on

forever, I will probably

have to do this in pieces as I don't have a lot of time right now to

tell you everything I saw and learned.

First of all, it was a great experience, I got to see everything,

casting, a tenotomy, I got to manipulate little rubber baby feet with

bones inside them, I even got to practice doing a cast! I sucked at

keeping my hands in the right places while doing the cast, I don't

know how the docs who mold and hold at the same time do it! I really

enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

so this is the baby from St. Louis. " He was so gentle and sweet, it

was just fantastic meeting him. He looked at Sammy's brace and said,

" Are you going to be here this afternoon? I want my orthotist ()

to see this. " I guess I'll start there. I know that and Dr.

Dobbs talked, said they had a long talk. also told me that

he has already made a couple prototypes with articulating bars. He

did look at Sammy's brace as well as a couple other models that Dr.

Dobbs showed him, including some with stops to prevent plantar flexion

and one with a quick release bar (snaps apart in the middle). My

husband has some really interesting ideas too, I just need him to

sketch out what he has thought up so I can give it to Dr. Dobbs and

.

I really liked Fred Dietz, he has a really great personality. He was

the instructor for our little group doing the practice casting. He

was a very good speaker and I felt he did a great job of presenting

the info on both short-term and long-term surgical results (as

compared to Ponseti). The thing that I found really interesting was

his discussion on atypical feet. He is of the " school of thought " I

guess you could say, that atypical feet are not born, they are made.

He thinks (and this is still just conjecture of course, they are all

still learning about atypical) that they are caused by slipping casts

and/or improper manipulations. He has had a couple cases in which the

cast has slipped once or twice and the emerging foot is starting to

look atypical. He has tried a " let it lie " approach - if he sees a

foot starting to look like this, he lets it stay out of the cast a few

weeks and start relapsing. In these cases he has seen the foot go

back to looking like a " normal " clubfoot and then he starts over. He

obviously doesn't have enough data to back this up yet, but it is an

interesting theory.

Next, I was always told that the reason they over correct is so that

the foot can gradually return to a normal position. This is one of

the reasons, however, not the main reason - the main reason is to get

the full range of motion, i.e. if you only correct to neutral the foot

will never have good abduction range of motion like a normal foot does.

Another interesting thing I found out about is in the tissues of the

ligaments themselves. Angel talked a little about this in a post

recently on the CF board. The tissues in the ligaments (collagen

fibers) in a clubfoot are actually contracted with a " crimp " , the

gentle stretching pulls out the crimp, then when casted and held for

5-7 days, the newly stretched tissues quickly regain their " crimp " in

their new position, thus allowing them to be stretched again. Pretty

interesting, huh? (This is all in the Global-Health book, but I

hadn't really followed this part of things before.)

Okay, I've got lots more to say, but I have to go for now. I will try

to write more tonight.

Later,

[Guest guest]

All I can say is WOW!

Mom to (BL CF - 23 hrs P/M)

wrote:

Where to start? I will try not to ramble on forever, I will probably

have to do this in pieces as I don't have a lot of time right now to

tell you everything I saw and learned.

First of all, it was a great experience, I got to see everything,

casting, a tenotomy, I got to manipulate little rubber baby feet with

bones inside them, I even got to practice doing a cast! I sucked at

keeping my hands in the right places while doing the cast, I don't

know how the docs who mold and hold at the same time do it! I really

enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

so this is the baby from St. Louis. " He was so gentle and sweet, it

was just fantastic meeting him. He looked at Sammy's brace and said,

" Are you going to be here this afternoon? I want my orthotist ()

to see this. " I guess I'll start there. I know that and Dr.

Dobbs talked, said they had a long talk. also told me that

he has already made a couple prototypes with articulating bars. He

did look at Sammy's brace as well as a couple other models that Dr.

Dobbs showed him, including some with stops to prevent plantar flexion

and one with a quick release bar (snaps apart in the middle). My

husband has some really interesting ideas too, I just need him to

sketch out what he has thought up so I can give it to Dr. Dobbs and

.

I really liked Fred Dietz, he has a really great personality. He was

the instructor for our little group doing the practice casting. He

was a very good speaker and I felt he did a great job of presenting

the info on both short-term and long-term surgical results (as

compared to Ponseti). The thing that I found really interesting was

his discussion on atypical feet. He is of the " school of thought " I

guess you could say, that atypical feet are not born, they are made.

He thinks (and this is still just conjecture of course, they are all

still learning about atypical) that they are caused by slipping casts

and/or improper manipulations. He has had a couple cases in which the

cast has slipped once or twice and the emerging foot is starting to

look atypical. He has tried a " let it lie " approach - if he sees a

foot starting to look like this, he lets it stay out of the cast a few

weeks and start relapsing. In these cases he has seen the foot go

back to looking like a " normal " clubfoot and then he starts over. He

obviously doesn't have enough data to back this up yet, but it is an

interesting theory.

Next, I was always told that the reason they over correct is so that

the foot can gradually return to a normal position. This is one of

the reasons, however, not the main reason - the main reason is to get

the full range of motion, i.e. if you only correct to neutral the foot

will never have good abduction range of motion like a normal foot does.

Another interesting thing I found out about is in the tissues of the

ligaments themselves. Angel talked a little about this in a post

recently on the CF board. The tissues in the ligaments (collagen

fibers) in a clubfoot are actually contracted with a " crimp " , the

gentle stretching pulls out the crimp, then when casted and held for

5-7 days, the newly stretched tissues quickly regain their " crimp " in

their new position, thus allowing them to be stretched again. Pretty

interesting, huh? (This is all in the Global-Health book, but I

hadn't really followed this part of things before.)

Okay, I've got lots more to say, but I have to go for now. I will try

to write more tonight.

Later,

[Guest guest]

, thanks so much for sharing all this interesting information. I so wish

we could have gone but, well there is always next year! Thanks for sharing!

wrote:

Where to start? I will try not to ramble on forever, I will probably

have to do this in pieces as I don't have a lot of time right now to

tell you everything I saw and learned.

First of all, it was a great experience, I got to see everything,

casting, a tenotomy, I got to manipulate little rubber baby feet with

bones inside them, I even got to practice doing a cast! I sucked at

keeping my hands in the right places while doing the cast, I don't

know how the docs who mold and hold at the same time do it! I really

enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

so this is the baby from St. Louis. " He was so gentle and sweet, it

was just fantastic meeting him. He looked at Sammy's brace and said,

" Are you going to be here this afternoon? I want my orthotist ()

to see this. " I guess I'll start there. I know that and Dr.

Dobbs talked, said they had a long talk. also told me that

he has already made a couple prototypes with articulating bars. He

did look at Sammy's brace as well as a couple other models that Dr.

Dobbs showed him, including some with stops to prevent plantar flexion

and one with a quick release bar (snaps apart in the middle). My

husband has some really interesting ideas too, I just need him to

sketch out what he has thought up so I can give it to Dr. Dobbs and

.

I really liked Fred Dietz, he has a really great personality. He was

the instructor for our little group doing the practice casting. He

was a very good speaker and I felt he did a great job of presenting

the info on both short-term and long-term surgical results (as

compared to Ponseti). The thing that I found really interesting was

his discussion on atypical feet. He is of the " school of thought " I

guess you could say, that atypical feet are not born, they are made.

He thinks (and this is still just conjecture of course, they are all

still learning about atypical) that they are caused by slipping casts

and/or improper manipulations. He has had a couple cases in which the

cast has slipped once or twice and the emerging foot is starting to

look atypical. He has tried a " let it lie " approach - if he sees a

foot starting to look like this, he lets it stay out of the cast a few

weeks and start relapsing. In these cases he has seen the foot go

back to looking like a " normal " clubfoot and then he starts over. He

obviously doesn't have enough data to back this up yet, but it is an

interesting theory.

Next, I was always told that the reason they over correct is so that

the foot can gradually return to a normal position. This is one of

the reasons, however, not the main reason - the main reason is to get

the full range of motion, i.e. if you only correct to neutral the foot

will never have good abduction range of motion like a normal foot does.

Another interesting thing I found out about is in the tissues of the

ligaments themselves. Angel talked a little about this in a post

recently on the CF board. The tissues in the ligaments (collagen

fibers) in a clubfoot are actually contracted with a " crimp " , the

gentle stretching pulls out the crimp, then when casted and held for

5-7 days, the newly stretched tissues quickly regain their " crimp " in

their new position, thus allowing them to be stretched again. Pretty

interesting, huh? (This is all in the Global-Health book, but I

hadn't really followed this part of things before.)

Okay, I've got lots more to say, but I have to go for now. I will try

to write more tonight.

Later,

[Guest guest]

May I jump in and ask how old your son was when he got the ATTT

surgery? My daughter is now 5 1/2 and we are trying to avoid the ATTT

by prolonged wear of the FAB. She is still in the FAB and is doing

well, but has been referred to by Dr. Morcuende as a-typical upon our

last visit in Iowa in the spring. Dr. Ponseti had never previously

referred to her as that before, so I'm not quite sure.

Is the ATTT less effective for a-typical feet or harder in any way?

What problems did your son have with the ATTT and why is Dr. Ponseti

not happy with his results if you don't mind me asking?

Holly and (born: 2-11-00 mod. severe Ponseti method at 5 mo's.

7 Ponseti casts and tenotomy on each foot.)

>

> , was there discussion about the ATTT - problems, long term

results, etc? I swear the more I learn the more I think had

atypical (he ended with the ATTT that Dietz and Ponseti are not happy

with). When I hear the little girl is getting success at age 3 it

makes me wonder if they shouldn't have worked harder or longer on

before opting for the surgery. Guess I'll never know. I " m

glad your dh liked Dietz, personally I have a hard time communicating

with him.

> s.

>

> What I learned at the symposium

>

>

> Where to start? I will try not to ramble on forever, I will

probably

> have to do this in pieces as I don't have a lot of time right now to

> tell you everything I saw and learned.

>

> First of all, it was a great experience, I got to see everything,

> casting, a tenotomy, I got to manipulate little rubber baby feet

with

> bones inside them, I even got to practice doing a cast! I sucked at

> keeping my hands in the right places while doing the cast, I don't

> know how the docs who mold and hold at the same time do it! I

really

> enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> so this is the baby from St. Louis. " He was so gentle and sweet, it

> was just fantastic meeting him. He looked at Sammy's brace and

said,

> " Are you going to be here this afternoon? I want my orthotist

()

> to see this. " I guess I'll start there. I know that and Dr.

> Dobbs talked, said they had a long talk. also told me

that

> he has already made a couple prototypes with articulating bars. He

> did look at Sammy's brace as well as a couple other models that Dr.

> Dobbs showed him, including some with stops to prevent plantar

flexion

> and one with a quick release bar (snaps apart in the middle). My

> husband has some really interesting ideas too, I just need him to

> sketch out what he has thought up so I can give it to Dr. Dobbs and

> .

> I really liked Fred Dietz, he has a really great personality. He

was

> the instructor for our little group doing the practice casting. He

> was a very good speaker and I felt he did a great job of presenting

> the info on both short-term and long-term surgical results (as

> compared to Ponseti). The thing that I found really interesting was

> his discussion on atypical feet. He is of the " school of thought " I

> guess you could say, that atypical feet are not born, they are

made.

> He thinks (and this is still just conjecture of course, they are all

> still learning about atypical) that they are caused by slipping

casts

> and/or improper manipulations. He has had a couple cases in which

the

> cast has slipped once or twice and the emerging foot is starting to

> look atypical. He has tried a " let it lie " approach - if he sees a

> foot starting to look like this, he lets it stay out of the cast a

few

> weeks and start relapsing. In these cases he has seen the foot go

> back to looking like a " normal " clubfoot and then he starts over.

He

> obviously doesn't have enough data to back this up yet, but it is an

> interesting theory.

> Next, I was always told that the reason they over correct is so that

> the foot can gradually return to a normal position. This is one of

> the reasons, however, not the main reason - the main reason is to

get

> the full range of motion, i.e. if you only correct to neutral the

foot

> will never have good abduction range of motion like a normal foot

does.

> Another interesting thing I found out about is in the tissues of the

> ligaments themselves. Angel talked a little about this in a post

> recently on the CF board. The tissues in the ligaments (collagen

> fibers) in a clubfoot are actually contracted with a " crimp " , the

> gentle stretching pulls out the crimp, then when casted and held for

> 5-7 days, the newly stretched tissues quickly regain their " crimp "

in

> their new position, thus allowing them to be stretched again.

Pretty

> interesting, huh? (This is all in the Global-Health book, but I

> hadn't really followed this part of things before.)

>

> Okay, I've got lots more to say, but I have to go for now. I will

try

> to write more tonight.

>

> Later,

>

>

>

>

>

>

>

>

[Guest guest]

You have quite a story and I really feel for your situation. I know I

have always wished that once the feet are corrected properly that

relapse would not be possible, but as we all know, that sometimes is

just not the case. I remember when was first treated I worried

that because she was not still a newborn (although still only 5

months old) that maybe even though she was fully corrected, we had

still lost valuable time in her correction. I thought maybe it might

be harder for us to retain her correction because she was not " just

born " at the time we took her to Iowa. I don't know if that has

anything to do with her having to wear the brace longer (I think she

is holding the record for it so far at 5 1/2 yrs) or more because she

has more stubborn feet. I keep waiting for the day that I don't see

any changes while out of the brace and then maybe I can breath that

sigh of relief. was born Moderately severe, she actually had

good movement of her feet and ankles but she had those very short,

puffy feet with practically no heals showing. At the time that was

referred to as " true clubfoot " meaning all the components of clubfoot

were present, not just the turning in and twisting at the ankle. I am

assuming that the term " A-typical " has taken the place of that old

term now and that's why I am hearing it used on the group. had

a total of 7 Ponseti casts and a tenotomy on each foot. She had

previously had 10 below the knee casts locally that could only bring

her feet pointing straight down. She was then out of casts altogether

for two months where we watched her feet relapse back and that is

when we found Dr. Ponseti and decided to head to Iowa.

Do you know what the next step for your son is now? Are they saying

that his feet could get better still with age since the ATTT? Would

physical therapy help him regain some movement in his ankles, etc? I

know Dr. Ponseti does not think physical therapy is usually needed

for clubfoot children but your son's case is different at this point

and at his age.

My 8 1/2 yr. old daughter was very knock kneed (non clubfoot but had

mild metatarsus adductus)for years and still has sort of knobby knees

but she indeed has out grown most of it the last 2 years and her legs

look very good now.My youngest (born with clubfoot) is also knock

kneed but I am HOPING she too will grow out of it, but with clubfoot

I guess everything is wait and see. It's just a different ball game

if you ask me. If a child born with normal feet can outgrow certain

things like intoeing and knock knees, I don't necessarily think that

children born with clubfoot will fall into the same catagory always.

So I understand your concerns about waiting and seeing, I would feel

the same way.

Thanks so much for writing me back.

Holly and

> >

> > , was there discussion about the ATTT - problems, long

term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not

happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

> glad your dh liked Dietz, personally I have a hard time

communicating

> with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

> probably

> > have to do this in pieces as I don't have a lot of time right now

to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > bones inside them, I even got to practice doing a cast! I sucked

at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

> really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet,

it

> > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > " Are you going to be here this afternoon? I want my orthotist

> ()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

> that

> > he has already made a couple prototypes with articulating bars.

He

> > did look at Sammy's brace as well as a couple other models that

Dr.

> > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs

and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

> was

> > the instructor for our little group doing the practice casting.

He

> > was a very good speaker and I felt he did a great job of

presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting

was

> > his discussion on atypical feet. He is of the " school of

thought " I

> > guess you could say, that atypical feet are not born, they are

> made.

> > He thinks (and this is still just conjecture of course, they are

all

> > still learning about atypical) that they are caused by slipping

> casts

> > and/or improper manipulations. He has had a couple cases in

which

> the

> > cast has slipped once or twice and the emerging foot is starting

to

> > look atypical. He has tried a " let it lie " approach - if he sees

a

> > foot starting to look like this, he lets it stay out of the cast

a

> few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over.

> He

> > obviously doesn't have enough data to back this up yet, but it is

an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so

that

> > the foot can gradually return to a normal position. This is one

of

> > the reasons, however, not the main reason - the main reason is to

> get

> > the full range of motion, i.e. if you only correct to neutral the

> foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of

the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held

for

> > 5-7 days, the newly stretched tissues quickly regain

their " crimp "

> in

> > their new position, thus allowing them to be stretched again.

> Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will

> try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Faith,

I don't know if it does explain it. Dr. Morcuende gave a presentation

on Atypical feet and how they have been correcting them. His thought

is that there are truly some atypical feet and some that are " caused "

as Dr. Dietz suggests. Dr. Morcuende and Dr. Ponseti said they have

never had a case of atypical that they have treated from the start;

that is, they have never seen a baby's foot from birth that they

classified as atypical - the atypical ones are always brought to them

later in treatment. When they do have a foot that presents with

atypical appearance they have know way of knowing if it was a foot

that was just going to be that way or it if was actually caused by

something.

Where to start? I will try not to

ramble on forever, I will probably

> have to do this in pieces as I don't have a lot of time right now to

> tell you everything I saw and learned.

>

> First of all, it was a great experience, I got to see everything,

> casting, a tenotomy, I got to manipulate little rubber baby feet with

> bones inside them, I even got to practice doing a cast! I sucked at

> keeping my hands in the right places while doing the cast, I don't

> know how the docs who mold and hold at the same time do it! I really

> enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

> so this is the baby from St. Louis. " He was so gentle and sweet, it

> was just fantastic meeting him. He looked at Sammy's brace and said,

> " Are you going to be here this afternoon? I want my orthotist ()

> to see this. " I guess I'll start there. I know that and Dr.

> Dobbs talked, said they had a long talk. also told me that

> he has already made a couple prototypes with articulating bars. He

> did look at Sammy's brace as well as a couple other models that Dr.

> Dobbs showed him, including some with stops to prevent plantar flexion

> and one with a quick release bar (snaps apart in the middle). My

> husband has some really interesting ideas too, I just need him to

> sketch out what he has thought up so I can give it to Dr. Dobbs and

> .

> I really liked Fred Dietz, he has a really great personality. He was

> the instructor for our little group doing the practice casting. He

> was a very good speaker and I felt he did a great job of presenting

> the info on both short-term and long-term surgical results (as

> compared to Ponseti). The thing that I found really interesting was

> his discussion on atypical feet. He is of the " school of thought " I

> guess you could say, that atypical feet are not born, they are made.

> He thinks (and this is still just conjecture of course, they are all

> still learning about atypical) that they are caused by slipping casts

> and/or improper manipulations. He has had a couple cases in which the

> cast has slipped once or twice and the emerging foot is starting to

> look atypical. He has tried a " let it lie " approach - if he sees a

> foot starting to look like this, he lets it stay out of the cast a few

> weeks and start relapsing. In these cases he has seen the foot go

> back to looking like a " normal " clubfoot and then he starts over. He

> obviously doesn't have enough data to back this up yet, but it is an

> interesting theory.

> Next, I was always told that the reason they over correct is so that

> the foot can gradually return to a normal position. This is one of

> the reasons, however, not the main reason - the main reason is to get

> the full range of motion, i.e. if you only correct to neutral the foot

> will never have good abduction range of motion like a normal foot

does.

> Another interesting thing I found out about is in the tissues of the

> ligaments themselves. Angel talked a little about this in a post

> recently on the CF board. The tissues in the ligaments (collagen

> fibers) in a clubfoot are actually contracted with a " crimp " , the

> gentle stretching pulls out the crimp, then when casted and held for

> 5-7 days, the newly stretched tissues quickly regain their " crimp " in

> their new position, thus allowing them to be stretched again. Pretty

> interesting, huh? (This is all in the Global-Health book, but I

> hadn't really followed this part of things before.)

>

> Okay, I've got lots more to say, but I have to go for now. I will try

> to write more tonight.

>

> Later,

>

>

>

>

>

>

>

>

[Guest guest]

That's very interesting... What about our precious little atypical feet that

have such deep creases and the extra tissue? Any comments on that?

Chris

Re: What I learned at the symposium

Faith,

I don't know if it does explain it. Dr. Morcuende gave a presentation

on Atypical feet and how they have been correcting them. His thought

is that there are truly some atypical feet and some that are " caused "

as Dr. Dietz suggests. Dr. Morcuende and Dr. Ponseti said they have

never had a case of atypical that they have treated from the start;

that is, they have never seen a baby's foot from birth that they

classified as atypical - the atypical ones are always brought to them

later in treatment. When they do have a foot that presents with

atypical appearance they have know way of knowing if it was a foot

that was just going to be that way or it if was actually caused by

something.

Where to start? I will try not to

ramble on forever, I will probably

> have to do this in pieces as I don't have a lot of time right now to

> tell you everything I saw and learned.

>

> First of all, it was a great experience, I got to see everything,

> casting, a tenotomy, I got to manipulate little rubber baby feet with

> bones inside them, I even got to practice doing a cast! I sucked at

> keeping my hands in the right places while doing the cast, I don't

> know how the docs who mold and hold at the same time do it! I really

> enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

> so this is the baby from St. Louis. " He was so gentle and sweet, it

> was just fantastic meeting him. He looked at Sammy's brace and said,

> " Are you going to be here this afternoon? I want my orthotist ()

> to see this. " I guess I'll start there. I know that and Dr.

> Dobbs talked, said they had a long talk. also told me that

> he has already made a couple prototypes with articulating bars. He

> did look at Sammy's brace as well as a couple other models that Dr.

> Dobbs showed him, including some with stops to prevent plantar flexion

> and one with a quick release bar (snaps apart in the middle). My

> husband has some really interesting ideas too, I just need him to

> sketch out what he has thought up so I can give it to Dr. Dobbs and

> .

> I really liked Fred Dietz, he has a really great personality. He was

> the instructor for our little group doing the practice casting. He

> was a very good speaker and I felt he did a great job of presenting

> the info on both short-term and long-term surgical results (as

> compared to Ponseti). The thing that I found really interesting was

> his discussion on atypical feet. He is of the " school of thought " I

> guess you could say, that atypical feet are not born, they are made.

> He thinks (and this is still just conjecture of course, they are all

> still learning about atypical) that they are caused by slipping casts

> and/or improper manipulations. He has had a couple cases in which the

> cast has slipped once or twice and the emerging foot is starting to

> look atypical. He has tried a " let it lie " approach - if he sees a

> foot starting to look like this, he lets it stay out of the cast a few

> weeks and start relapsing. In these cases he has seen the foot go

> back to looking like a " normal " clubfoot and then he starts over. He

> obviously doesn't have enough data to back this up yet, but it is an

> interesting theory.

> Next, I was always told that the reason they over correct is so that

> the foot can gradually return to a normal position. This is one of

> the reasons, however, not the main reason - the main reason is to get

> the full range of motion, i.e. if you only correct to neutral the foot

> will never have good abduction range of motion like a normal foot

does.

> Another interesting thing I found out about is in the tissues of the

> ligaments themselves. Angel talked a little about this in a post

> recently on the CF board. The tissues in the ligaments (collagen

> fibers) in a clubfoot are actually contracted with a " crimp " , the

> gentle stretching pulls out the crimp, then when casted and held for

> 5-7 days, the newly stretched tissues quickly regain their " crimp " in

> their new position, thus allowing them to be stretched again. Pretty

> interesting, huh? (This is all in the Global-Health book, but I

> hadn't really followed this part of things before.)

>

> Okay, I've got lots more to say, but I have to go for now. I will try

> to write more tonight.

>

> Later,

>

>

>

>

>

>

>

>

[Guest guest]

ee,

They didn't really talk about the ATTT that much. Most of the studies

on surgical results were presented to show the difference between kids

treated w/ Ponseti method vs. the PMR or PR. I do think they are

getting more and more conservative on doing any surgery, or even

further casting w/ older kids. They talked to a parent who had

resumed bracing for a mild relapse when their child was older, like 5

or 6 I think, and they had good results with just going back into the

brace. Likewise with a child of 3 I believe who was showing some

relapse, they talked about just casting instead of the ATTT.

I guess you will never know w/ , but in the end, you will still

know that you went to the best and got the best treatment available

with their knowledge at the time.

I did like Dietz, I thought he was easy to talk to and

straightforward. Perhaps he is different when he is talking to

patient's parents?

>

> , was there discussion about the ATTT - problems, long term

results, etc? I swear the more I learn the more I think had

atypical (he ended with the ATTT that Dietz and Ponseti are not happy

with). When I hear the little girl is getting success at age 3 it

makes me wonder if they shouldn't have worked harder or longer on

before opting for the surgery. Guess I'll never know. I " m glad

your dh liked Dietz, personally I have a hard time communicating with him.

> s.

>

> What I learned at the symposium

>

>

> Where to start? I will try not to ramble on forever, I will probably

> have to do this in pieces as I don't have a lot of time right now to

> tell you everything I saw and learned.

>

> First of all, it was a great experience, I got to see everything,

> casting, a tenotomy, I got to manipulate little rubber baby feet with

> bones inside them, I even got to practice doing a cast! I sucked at

> keeping my hands in the right places while doing the cast, I don't

> know how the docs who mold and hold at the same time do it! I really

> enjoyed meeting Dr. Ponseti, he came up to me and Sammy and said, " Ah,

> so this is the baby from St. Louis. " He was so gentle and sweet, it

> was just fantastic meeting him. He looked at Sammy's brace and said,

> " Are you going to be here this afternoon? I want my orthotist ()

> to see this. " I guess I'll start there. I know that and Dr.

> Dobbs talked, said they had a long talk. also told me that

> he has already made a couple prototypes with articulating bars. He

> did look at Sammy's brace as well as a couple other models that Dr.

> Dobbs showed him, including some with stops to prevent plantar flexion

> and one with a quick release bar (snaps apart in the middle). My

> husband has some really interesting ideas too, I just need him to

> sketch out what he has thought up so I can give it to Dr. Dobbs and

> .

> I really liked Fred Dietz, he has a really great personality. He was

> the instructor for our little group doing the practice casting. He

> was a very good speaker and I felt he did a great job of presenting

> the info on both short-term and long-term surgical results (as

> compared to Ponseti). The thing that I found really interesting was

> his discussion on atypical feet. He is of the " school of thought " I

> guess you could say, that atypical feet are not born, they are made.

> He thinks (and this is still just conjecture of course, they are all

> still learning about atypical) that they are caused by slipping casts

> and/or improper manipulations. He has had a couple cases in which the

> cast has slipped once or twice and the emerging foot is starting to

> look atypical. He has tried a " let it lie " approach - if he sees a

> foot starting to look like this, he lets it stay out of the cast a few

> weeks and start relapsing. In these cases he has seen the foot go

> back to looking like a " normal " clubfoot and then he starts over. He

> obviously doesn't have enough data to back this up yet, but it is an

> interesting theory.

> Next, I was always told that the reason they over correct is so that

> the foot can gradually return to a normal position. This is one of

> the reasons, however, not the main reason - the main reason is to get

> the full range of motion, i.e. if you only correct to neutral the foot

> will never have good abduction range of motion like a normal foot

does.

> Another interesting thing I found out about is in the tissues of the

> ligaments themselves. Angel talked a little about this in a post

> recently on the CF board. The tissues in the ligaments (collagen

> fibers) in a clubfoot are actually contracted with a " crimp " , the

> gentle stretching pulls out the crimp, then when casted and held for

> 5-7 days, the newly stretched tissues quickly regain their " crimp " in

> their new position, thus allowing them to be stretched again. Pretty

> interesting, huh? (This is all in the Global-Health book, but I

> hadn't really followed this part of things before.)

>

> Okay, I've got lots more to say, but I have to go for now. I will try

> to write more tonight.

>

> Later,

>

>

>

>

>

>

>

>

[Guest guest]

ee,

Here is my recommendation for you, I know you are going soon, are you

leaving today? Call and tell them ahead of time that you want to have

a little extra time to talk to Dr. P or Dr. Dietz if it would be too

hard to get the extra time w/ Dr. P. I think Dietz might be the best

person (no accent) and like I said I thought he kind of talked in a

way that cut through the BS (you can even tell him I said so). And

then when you get there, sit down and tell him you want the straight

scoop, no BS on what he thinks about 's feet. If you can get

help from some other parent at RM house (I bet little 's mom,

Joyce would do it in a heartbeat) or someone to watch the kids while

you talk to him that would be even better. I know how difficult it is

to have an adult conversation with the doctors when your rugrats are

demanding your attention.

> >

> > , was there discussion about the ATTT - problems, long term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

> glad your dh liked Dietz, personally I have a hard time communicating

> with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

> probably

> > have to do this in pieces as I don't have a lot of time right now to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > bones inside them, I even got to practice doing a cast! I sucked at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

> really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet, it

> > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > " Are you going to be here this afternoon? I want my orthotist

> ()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

> that

> > he has already made a couple prototypes with articulating bars. He

> > did look at Sammy's brace as well as a couple other models that Dr.

> > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

> was

> > the instructor for our little group doing the practice casting. He

> > was a very good speaker and I felt he did a great job of presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting was

> > his discussion on atypical feet. He is of the " school of thought " I

> > guess you could say, that atypical feet are not born, they are

> made.

> > He thinks (and this is still just conjecture of course, they are all

> > still learning about atypical) that they are caused by slipping

> casts

> > and/or improper manipulations. He has had a couple cases in which

> the

> > cast has slipped once or twice and the emerging foot is starting to

> > look atypical. He has tried a " let it lie " approach - if he sees a

> > foot starting to look like this, he lets it stay out of the cast a

> few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts over.

> He

> > obviously doesn't have enough data to back this up yet, but it is an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so that

> > the foot can gradually return to a normal position. This is one of

> > the reasons, however, not the main reason - the main reason is to

> get

> > the full range of motion, i.e. if you only correct to neutral the

> foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held for

> > 5-7 days, the newly stretched tissues quickly regain their " crimp "

> in

> > their new position, thus allowing them to be stretched again.

> Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I will

> try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

ee,

Here is my recommendation for you, I know you are going soon, are you

leaving today? Call and tell them ahead of time that you want to have

a little extra time to talk to Dr. P or Dr. Dietz if it would be too

hard to get the extra time w/ Dr. P. I think Dietz might be the best

person (no accent) and like I said I thought he kind of talked in a

way that cut through the BS (you can even tell him I said so). And

then when you get there, sit down and tell him you want the straight

scoop, no BS on what he thinks about 's feet. If you can get

help from some other parent at RM house (I bet little 's mom,

Joyce would do it in a heartbeat) or someone to watch the kids while

you talk to him that would be even better. I know how difficult it is

to have an adult conversation with the doctors when your rugrats are

demanding your attention.

> >

> > , was there discussion about the ATTT - problems, long term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

> glad your dh liked Dietz, personally I have a hard time communicating

> with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

> probably

> > have to do this in pieces as I don't have a lot of time right now to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > bones inside them, I even got to practice doing a cast! I sucked at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

> really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet, it

> > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > " Are you going to be here this afternoon? I want my orthotist

> ()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

> that

> > he has already made a couple prototypes with articulating bars. He

> > did look at Sammy's brace as well as a couple other models that Dr.

> > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

> was

> > the instructor for our little group doing the practice casting. He

> > was a very good speaker and I felt he did a great job of presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting was

> > his discussion on atypical feet. He is of the " school of thought " I

> > guess you could say, that atypical feet are not born, they are

> made.

> > He thinks (and this is still just conjecture of course, they are all

> > still learning about atypical) that they are caused by slipping

> casts

> > and/or improper manipulations. He has had a couple cases in which

> the

> > cast has slipped once or twice and the emerging foot is starting to

> > look atypical. He has tried a " let it lie " approach - if he sees a

> > foot starting to look like this, he lets it stay out of the cast a

> few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts over.

> He

> > obviously doesn't have enough data to back this up yet, but it is an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so that

> > the foot can gradually return to a normal position. This is one of

> > the reasons, however, not the main reason - the main reason is to

> get

> > the full range of motion, i.e. if you only correct to neutral the

> foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held for

> > 5-7 days, the newly stretched tissues quickly regain their " crimp "

> in

> > their new position, thus allowing them to be stretched again.

> Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I will

> try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

I asked Dietz about the deep creases when we were in the casting

clinic and he said that you would correct it the same way as any other

clubfoot although it might take more than one cast to correct the

cavus (which is normally achieved in the first cast). I wonder if

that's another problem with the " atypical " foot, if the doc is not

getting the cavus fully corrected before he starts abducting?

As for the extra tissue, that part was just not brought up so I don't

really have any input on that part.

Where to start? I will try not to

> ramble on forever, I will probably

> > have to do this in pieces as I don't have a lot of time right now to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

with

> > bones inside them, I even got to practice doing a cast! I sucked at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet, it

> > was just fantastic meeting him. He looked at Sammy's brace and

said,

> > " Are you going to be here this afternoon? I want my orthotist

()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

that

> > he has already made a couple prototypes with articulating bars. He

> > did look at Sammy's brace as well as a couple other models that Dr.

> > Dobbs showed him, including some with stops to prevent plantar

flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs and

> > .

> > I really liked Fred Dietz, he has a really great personality.

He was

> > the instructor for our little group doing the practice casting. He

> > was a very good speaker and I felt he did a great job of presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting was

> > his discussion on atypical feet. He is of the " school of thought " I

> > guess you could say, that atypical feet are not born, they are

made.

> > He thinks (and this is still just conjecture of course, they are all

> > still learning about atypical) that they are caused by slipping

casts

> > and/or improper manipulations. He has had a couple cases in

which the

> > cast has slipped once or twice and the emerging foot is starting to

> > look atypical. He has tried a " let it lie " approach - if he sees a

> > foot starting to look like this, he lets it stay out of the cast

a few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over. He

> > obviously doesn't have enough data to back this up yet, but it is an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so that

> > the foot can gradually return to a normal position. This is one of

> > the reasons, however, not the main reason - the main reason is

to get

> > the full range of motion, i.e. if you only correct to neutral

the foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held for

> > 5-7 days, the newly stretched tissues quickly regain their

" crimp " in

> > their new position, thus allowing them to be stretched again.

Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

I asked Dietz about the deep creases when we were in the casting

clinic and he said that you would correct it the same way as any other

clubfoot although it might take more than one cast to correct the

cavus (which is normally achieved in the first cast). I wonder if

that's another problem with the " atypical " foot, if the doc is not

getting the cavus fully corrected before he starts abducting?

As for the extra tissue, that part was just not brought up so I don't

really have any input on that part.

Where to start? I will try not to

> ramble on forever, I will probably

> > have to do this in pieces as I don't have a lot of time right now to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

with

> > bones inside them, I even got to practice doing a cast! I sucked at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet, it

> > was just fantastic meeting him. He looked at Sammy's brace and

said,

> > " Are you going to be here this afternoon? I want my orthotist

()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

that

> > he has already made a couple prototypes with articulating bars. He

> > did look at Sammy's brace as well as a couple other models that Dr.

> > Dobbs showed him, including some with stops to prevent plantar

flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs and

> > .

> > I really liked Fred Dietz, he has a really great personality.

He was

> > the instructor for our little group doing the practice casting. He

> > was a very good speaker and I felt he did a great job of presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting was

> > his discussion on atypical feet. He is of the " school of thought " I

> > guess you could say, that atypical feet are not born, they are

made.

> > He thinks (and this is still just conjecture of course, they are all

> > still learning about atypical) that they are caused by slipping

casts

> > and/or improper manipulations. He has had a couple cases in

which the

> > cast has slipped once or twice and the emerging foot is starting to

> > look atypical. He has tried a " let it lie " approach - if he sees a

> > foot starting to look like this, he lets it stay out of the cast

a few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over. He

> > obviously doesn't have enough data to back this up yet, but it is an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so that

> > the foot can gradually return to a normal position. This is one of

> > the reasons, however, not the main reason - the main reason is

to get

> > the full range of motion, i.e. if you only correct to neutral

the foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held for

> > 5-7 days, the newly stretched tissues quickly regain their

" crimp " in

> > their new position, thus allowing them to be stretched again.

Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

,

has deep creases. Dr. P said that indeed his previous experience is that

when the foot is fully corrected they disappear however with her feet that is

just not happening. Her feet were very OVER corrected and yet they remain.

He's watching them. Hoped they'd disappear when she started walking. Alas she

walks (not by herself yet but behind everything and anything she can push and

using whoever's hand she can find) and they are still just as pronounced. I

wonder what he'll say this next visit in November.

Chris

Re: What I learned at the symposium

I asked Dietz about the deep creases when we were in the casting

clinic and he said that you would correct it the same way as any other

clubfoot although it might take more than one cast to correct the

cavus (which is normally achieved in the first cast). I wonder if

that's another problem with the " atypical " foot, if the doc is not

getting the cavus fully corrected before he starts abducting?

As for the extra tissue, that part was just not brought up so I don't

really have any input on that part.

Where to start? I will try not to

> ramble on forever, I will probably

> > have to do this in pieces as I don't have a lot of time right now to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

with

> > bones inside them, I even got to practice doing a cast! I sucked at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet, it

> > was just fantastic meeting him. He looked at Sammy's brace and

said,

> > " Are you going to be here this afternoon? I want my orthotist

()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

that

> > he has already made a couple prototypes with articulating bars. He

> > did look at Sammy's brace as well as a couple other models that Dr.

> > Dobbs showed him, including some with stops to prevent plantar

flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs and

> > .

> > I really liked Fred Dietz, he has a really great personality.

He was

> > the instructor for our little group doing the practice casting. He

> > was a very good speaker and I felt he did a great job of presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting was

> > his discussion on atypical feet. He is of the " school of thought " I

> > guess you could say, that atypical feet are not born, they are

made.

> > He thinks (and this is still just conjecture of course, they are all

> > still learning about atypical) that they are caused by slipping

casts

> > and/or improper manipulations. He has had a couple cases in

which the

> > cast has slipped once or twice and the emerging foot is starting to

> > look atypical. He has tried a " let it lie " approach - if he sees a

> > foot starting to look like this, he lets it stay out of the cast

a few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over. He

> > obviously doesn't have enough data to back this up yet, but it is an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so that

> > the foot can gradually return to a normal position. This is one of

> > the reasons, however, not the main reason - the main reason is

to get

> > the full range of motion, i.e. if you only correct to neutral

the foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held for

> > 5-7 days, the newly stretched tissues quickly regain their

" crimp " in

> > their new position, thus allowing them to be stretched again.

Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

,

has deep creases. Dr. P said that indeed his previous experience is that

when the foot is fully corrected they disappear however with her feet that is

just not happening. Her feet were very OVER corrected and yet they remain.

He's watching them. Hoped they'd disappear when she started walking. Alas she

walks (not by herself yet but behind everything and anything she can push and

using whoever's hand she can find) and they are still just as pronounced. I

wonder what he'll say this next visit in November.

Chris

Re: What I learned at the symposium

I asked Dietz about the deep creases when we were in the casting

clinic and he said that you would correct it the same way as any other

clubfoot although it might take more than one cast to correct the

cavus (which is normally achieved in the first cast). I wonder if

that's another problem with the " atypical " foot, if the doc is not

getting the cavus fully corrected before he starts abducting?

As for the extra tissue, that part was just not brought up so I don't

really have any input on that part.

Where to start? I will try not to

> ramble on forever, I will probably

> > have to do this in pieces as I don't have a lot of time right now to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

with

> > bones inside them, I even got to practice doing a cast! I sucked at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet, it

> > was just fantastic meeting him. He looked at Sammy's brace and

said,

> > " Are you going to be here this afternoon? I want my orthotist

()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

that

> > he has already made a couple prototypes with articulating bars. He

> > did look at Sammy's brace as well as a couple other models that Dr.

> > Dobbs showed him, including some with stops to prevent plantar

flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs and

> > .

> > I really liked Fred Dietz, he has a really great personality.

He was

> > the instructor for our little group doing the practice casting. He

> > was a very good speaker and I felt he did a great job of presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting was

> > his discussion on atypical feet. He is of the " school of thought " I

> > guess you could say, that atypical feet are not born, they are

made.

> > He thinks (and this is still just conjecture of course, they are all

> > still learning about atypical) that they are caused by slipping

casts

> > and/or improper manipulations. He has had a couple cases in

which the

> > cast has slipped once or twice and the emerging foot is starting to

> > look atypical. He has tried a " let it lie " approach - if he sees a

> > foot starting to look like this, he lets it stay out of the cast

a few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over. He

> > obviously doesn't have enough data to back this up yet, but it is an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so that

> > the foot can gradually return to a normal position. This is one of

> > the reasons, however, not the main reason - the main reason is

to get

> > the full range of motion, i.e. if you only correct to neutral

the foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held for

> > 5-7 days, the newly stretched tissues quickly regain their

" crimp " in

> > their new position, thus allowing them to be stretched again.

Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Well, it certainly does make sense in our case. Gabe was casted badly for a

whole 7- nearly 8 months before we made it to Ponseti. But as I recall, Gabe

always had the excess tissue. I believe he had a visible crease till he was

casted initially, then it kinda disappeared (like Lilee's ) although the

pantaris was still very much an issue. Maybe I am remembering wrong though... I

only got to see his crooked little feetees for 2 days before they wrapped them

up... I do remember the " swelling " or excess tissue seemed much more obvoius

after a few castings... I hate to think that's what happened. MAkes me what to

fly back to Hawaii and ... I don't know... yell at...his first doctor. I should

have yanked him out of military health care before he was 5 months old....

shelbytru wrote:You have quite a story and I really feel for

your situation. I know I

have always wished that once the feet are corrected properly that

relapse would not be possible, but as we all know, that sometimes is

just not the case. I remember when was first treated I worried

that because she was not still a newborn (although still only 5

months old) that maybe even though she was fully corrected, we had

still lost valuable time in her correction. I thought maybe it might

be harder for us to retain her correction because she was not " just

born " at the time we took her to Iowa. I don't know if that has

anything to do with her having to wear the brace longer (I think she

is holding the record for it so far at 5 1/2 yrs) or more because she

has more stubborn feet. I keep waiting for the day that I don't see

any changes while out of the brace and then maybe I can breath that

sigh of relief. was born Moderately severe, she actually had

good movement of her feet and ankles but she had those very short,

puffy feet with practically no heals showing. At the time that was

referred to as " true clubfoot " meaning all the components of clubfoot

were present, not just the turning in and twisting at the ankle. I am

assuming that the term " A-typical " has taken the place of that old

term now and that's why I am hearing it used on the group. had

a total of 7 Ponseti casts and a tenotomy on each foot. She had

previously had 10 below the knee casts locally that could only bring

her feet pointing straight down. She was then out of casts altogether

for two months where we watched her feet relapse back and that is

when we found Dr. Ponseti and decided to head to Iowa.

Do you know what the next step for your son is now? Are they saying

that his feet could get better still with age since the ATTT? Would

physical therapy help him regain some movement in his ankles, etc? I

know Dr. Ponseti does not think physical therapy is usually needed

for clubfoot children but your son's case is different at this point

and at his age.

My 8 1/2 yr. old daughter was very knock kneed (non clubfoot but had

mild metatarsus adductus)for years and still has sort of knobby knees

but she indeed has out grown most of it the last 2 years and her legs

look very good now.My youngest (born with clubfoot) is also knock

kneed but I am HOPING she too will grow out of it, but with clubfoot

I guess everything is wait and see. It's just a different ball game

if you ask me. If a child born with normal feet can outgrow certain

things like intoeing and knock knees, I don't necessarily think that

children born with clubfoot will fall into the same catagory always.

So I understand your concerns about waiting and seeing, I would feel

the same way.

Thanks so much for writing me back.

Holly and

> >

> > , was there discussion about the ATTT - problems, long

term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not

happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

> glad your dh liked Dietz, personally I have a hard time

communicating

> with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

> probably

> > have to do this in pieces as I don't have a lot of time right now

to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > bones inside them, I even got to practice doing a cast! I sucked

at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

> really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet,

it

> > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > " Are you going to be here this afternoon? I want my orthotist

> ()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

> that

> > he has already made a couple prototypes with articulating bars.

He

> > did look at Sammy's brace as well as a couple other models that

Dr.

> > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs

and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

> was

> > the instructor for our little group doing the practice casting.

He

> > was a very good speaker and I felt he did a great job of

presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting

was

> > his discussion on atypical feet. He is of the " school of

thought " I

> > guess you could say, that atypical feet are not born, they are

> made.

> > He thinks (and this is still just conjecture of course, they are

all

> > still learning about atypical) that they are caused by slipping

> casts

> > and/or improper manipulations. He has had a couple cases in

which

> the

> > cast has slipped once or twice and the emerging foot is starting

to

> > look atypical. He has tried a " let it lie " approach - if he sees

a

> > foot starting to look like this, he lets it stay out of the cast

a

> few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over.

> He

> > obviously doesn't have enough data to back this up yet, but it is

an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so

that

> > the foot can gradually return to a normal position. This is one

of

> > the reasons, however, not the main reason - the main reason is to

> get

> > the full range of motion, i.e. if you only correct to neutral the

> foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of

the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held

for

> > 5-7 days, the newly stretched tissues quickly regain

their " crimp "

> in

> > their new position, thus allowing them to be stretched again.

> Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will

> try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Well, it certainly does make sense in our case. Gabe was casted badly for a

whole 7- nearly 8 months before we made it to Ponseti. But as I recall, Gabe

always had the excess tissue. I believe he had a visible crease till he was

casted initially, then it kinda disappeared (like Lilee's ) although the

pantaris was still very much an issue. Maybe I am remembering wrong though... I

only got to see his crooked little feetees for 2 days before they wrapped them

up... I do remember the " swelling " or excess tissue seemed much more obvoius

after a few castings... I hate to think that's what happened. MAkes me what to

fly back to Hawaii and ... I don't know... yell at...his first doctor. I should

have yanked him out of military health care before he was 5 months old....

shelbytru wrote:You have quite a story and I really feel for

your situation. I know I

have always wished that once the feet are corrected properly that

relapse would not be possible, but as we all know, that sometimes is

just not the case. I remember when was first treated I worried

that because she was not still a newborn (although still only 5

months old) that maybe even though she was fully corrected, we had

still lost valuable time in her correction. I thought maybe it might

be harder for us to retain her correction because she was not " just

born " at the time we took her to Iowa. I don't know if that has

anything to do with her having to wear the brace longer (I think she

is holding the record for it so far at 5 1/2 yrs) or more because she

has more stubborn feet. I keep waiting for the day that I don't see

any changes while out of the brace and then maybe I can breath that

sigh of relief. was born Moderately severe, she actually had

good movement of her feet and ankles but she had those very short,

puffy feet with practically no heals showing. At the time that was

referred to as " true clubfoot " meaning all the components of clubfoot

were present, not just the turning in and twisting at the ankle. I am

assuming that the term " A-typical " has taken the place of that old

term now and that's why I am hearing it used on the group. had

a total of 7 Ponseti casts and a tenotomy on each foot. She had

previously had 10 below the knee casts locally that could only bring

her feet pointing straight down. She was then out of casts altogether

for two months where we watched her feet relapse back and that is

when we found Dr. Ponseti and decided to head to Iowa.

Do you know what the next step for your son is now? Are they saying

that his feet could get better still with age since the ATTT? Would

physical therapy help him regain some movement in his ankles, etc? I

know Dr. Ponseti does not think physical therapy is usually needed

for clubfoot children but your son's case is different at this point

and at his age.

My 8 1/2 yr. old daughter was very knock kneed (non clubfoot but had

mild metatarsus adductus)for years and still has sort of knobby knees

but she indeed has out grown most of it the last 2 years and her legs

look very good now.My youngest (born with clubfoot) is also knock

kneed but I am HOPING she too will grow out of it, but with clubfoot

I guess everything is wait and see. It's just a different ball game

if you ask me. If a child born with normal feet can outgrow certain

things like intoeing and knock knees, I don't necessarily think that

children born with clubfoot will fall into the same catagory always.

So I understand your concerns about waiting and seeing, I would feel

the same way.

Thanks so much for writing me back.

Holly and

> >

> > , was there discussion about the ATTT - problems, long

term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not

happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

> glad your dh liked Dietz, personally I have a hard time

communicating

> with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

> probably

> > have to do this in pieces as I don't have a lot of time right now

to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > bones inside them, I even got to practice doing a cast! I sucked

at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

> really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet,

it

> > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > " Are you going to be here this afternoon? I want my orthotist

> ()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

> that

> > he has already made a couple prototypes with articulating bars.

He

> > did look at Sammy's brace as well as a couple other models that

Dr.

> > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs

and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

> was

> > the instructor for our little group doing the practice casting.

He

> > was a very good speaker and I felt he did a great job of

presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting

was

> > his discussion on atypical feet. He is of the " school of

thought " I

> > guess you could say, that atypical feet are not born, they are

> made.

> > He thinks (and this is still just conjecture of course, they are

all

> > still learning about atypical) that they are caused by slipping

> casts

> > and/or improper manipulations. He has had a couple cases in

which

> the

> > cast has slipped once or twice and the emerging foot is starting

to

> > look atypical. He has tried a " let it lie " approach - if he sees

a

> > foot starting to look like this, he lets it stay out of the cast

a

> few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over.

> He

> > obviously doesn't have enough data to back this up yet, but it is

an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so

that

> > the foot can gradually return to a normal position. This is one

of

> > the reasons, however, not the main reason - the main reason is to

> get

> > the full range of motion, i.e. if you only correct to neutral the

> foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of

the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held

for

> > 5-7 days, the newly stretched tissues quickly regain

their " crimp "

> in

> > their new position, thus allowing them to be stretched again.

> Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will

> try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Hi ,

You mentioned that Dr. Ponseti had mentioned he had talked to a

parent who had success going back into the brace after a mild

relapse. Unless he was talking directly to a parent at the symposium

(I wasn't sure if that's what you meant) he may have been referring

to me and my daughter. has gone back into the brace twice now.

At 2 years old they were talking about releasing her from the brace

because she had been doing so well, no problems. I requested that we

leave her in the FAB until she was at least 3. Dr. Ponseti said that

would be fine and provide more insurance since she had never had any

problems with the brace wear. At 3 she was relased, 2 months later we

put her back in because her feet were turning in again. She wore for

another year and we went back for another check up. Dr. Ponseti

suggested another 9-10 months because he was beginning to see

relapses in children who had discontinued the brace early, before the

age of 3. She went out again on her 5th birthday, again, I continued

the brace even longer than suggested. 3 months out of the brace I

once again began to possibly notice *something*. We went back for

another check up and Dr. Morcuende suggested *if* she would wear the

brace, another 10-12 months. I told him that basically she new she

had to wear it as long as they were telling her to so that her feet

wouldn't go back. She is at the age where she completely understands

what's going on with why she's in the shoes so long. She's seen

pictures of her feet before and I know she doesn't want them to look

that way again, it's almost easier now that she's older, strange huh!

Anyway,for anyone interested on this subject of relapse, I think the

key to the brace working so well and *fixing* a possible change was

early detection. I honestly wasn't sure if I was really seeing

something or not. Her feet just seemed a little different to me. Once

another family member agreed, it was off to Iowa for another check to

see if I was wrong or right.The window I was told for a relapse that

was going to happen quickly was 1-5 months for her age (5 yrs old) we

noticed at 3 months after the brace was discontinued. I think

unfortunately that many times the impending relapse is so gradual

that it is almost impossible to notice until it has gone farthur than

just the brace alone can help. This must be the reason for furthur

casting.

Dr. Morcuende had suggested to us that if the shoes did not show an

improvement in 's feet within one month that we would need to

address the ATTT as early as this fall.(we did not get to see Dr.

Ponseti for the first time on this trip because he was too ill to

come into the hospital that day.I really missed his opinion on the

matter so I emailed him when we got home.) Her feet improved within a

few weeks back to exactly were they were. My fear is that this cycle

is going to continue and we can't wear these shoes forever, so I

guess we'll see.

Thanks for all the imformation, it really helps those of us who

couldn't attend.

~Holly and

> >

> > , was there discussion about the ATTT - problems, long term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not

happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

glad

> your dh liked Dietz, personally I have a hard time communicating

with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

probably

> > have to do this in pieces as I don't have a lot of time right now

to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

with

> > bones inside them, I even got to practice doing a cast! I sucked

at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet,

it

> > was just fantastic meeting him. He looked at Sammy's brace and

said,

> > " Are you going to be here this afternoon? I want my orthotist

()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

that

> > he has already made a couple prototypes with articulating bars.

He

> > did look at Sammy's brace as well as a couple other models that

Dr.

> > Dobbs showed him, including some with stops to prevent plantar

flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs

and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

was

> > the instructor for our little group doing the practice casting.

He

> > was a very good speaker and I felt he did a great job of

presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting

was

> > his discussion on atypical feet. He is of the " school of

thought " I

> > guess you could say, that atypical feet are not born, they are

made.

> > He thinks (and this is still just conjecture of course, they are

all

> > still learning about atypical) that they are caused by slipping

casts

> > and/or improper manipulations. He has had a couple cases in

which the

> > cast has slipped once or twice and the emerging foot is starting

to

> > look atypical. He has tried a " let it lie " approach - if he sees

a

> > foot starting to look like this, he lets it stay out of the cast

a few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over. He

> > obviously doesn't have enough data to back this up yet, but it is

an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so

that

> > the foot can gradually return to a normal position. This is one

of

> > the reasons, however, not the main reason - the main reason is to

get

> > the full range of motion, i.e. if you only correct to neutral the

foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of

the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held

for

> > 5-7 days, the newly stretched tissues quickly regain

their " crimp " in

> > their new position, thus allowing them to be stretched again.

Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Hi ,

You mentioned that Dr. Ponseti had mentioned he had talked to a

parent who had success going back into the brace after a mild

relapse. Unless he was talking directly to a parent at the symposium

(I wasn't sure if that's what you meant) he may have been referring

to me and my daughter. has gone back into the brace twice now.

At 2 years old they were talking about releasing her from the brace

because she had been doing so well, no problems. I requested that we

leave her in the FAB until she was at least 3. Dr. Ponseti said that

would be fine and provide more insurance since she had never had any

problems with the brace wear. At 3 she was relased, 2 months later we

put her back in because her feet were turning in again. She wore for

another year and we went back for another check up. Dr. Ponseti

suggested another 9-10 months because he was beginning to see

relapses in children who had discontinued the brace early, before the

age of 3. She went out again on her 5th birthday, again, I continued

the brace even longer than suggested. 3 months out of the brace I

once again began to possibly notice *something*. We went back for

another check up and Dr. Morcuende suggested *if* she would wear the

brace, another 10-12 months. I told him that basically she new she

had to wear it as long as they were telling her to so that her feet

wouldn't go back. She is at the age where she completely understands

what's going on with why she's in the shoes so long. She's seen

pictures of her feet before and I know she doesn't want them to look

that way again, it's almost easier now that she's older, strange huh!

Anyway,for anyone interested on this subject of relapse, I think the

key to the brace working so well and *fixing* a possible change was

early detection. I honestly wasn't sure if I was really seeing

something or not. Her feet just seemed a little different to me. Once

another family member agreed, it was off to Iowa for another check to

see if I was wrong or right.The window I was told for a relapse that

was going to happen quickly was 1-5 months for her age (5 yrs old) we

noticed at 3 months after the brace was discontinued. I think

unfortunately that many times the impending relapse is so gradual

that it is almost impossible to notice until it has gone farthur than

just the brace alone can help. This must be the reason for furthur

casting.

Dr. Morcuende had suggested to us that if the shoes did not show an

improvement in 's feet within one month that we would need to

address the ATTT as early as this fall.(we did not get to see Dr.

Ponseti for the first time on this trip because he was too ill to

come into the hospital that day.I really missed his opinion on the

matter so I emailed him when we got home.) Her feet improved within a

few weeks back to exactly were they were. My fear is that this cycle

is going to continue and we can't wear these shoes forever, so I

guess we'll see.

Thanks for all the imformation, it really helps those of us who

couldn't attend.

~Holly and

> >

> > , was there discussion about the ATTT - problems, long term

> results, etc? I swear the more I learn the more I think had

> atypical (he ended with the ATTT that Dietz and Ponseti are not

happy

> with). When I hear the little girl is getting success at age 3 it

> makes me wonder if they shouldn't have worked harder or longer on

> before opting for the surgery. Guess I'll never know. I " m

glad

> your dh liked Dietz, personally I have a hard time communicating

with him.

> > s.

> >

> > What I learned at the symposium

> >

> >

> > Where to start? I will try not to ramble on forever, I will

probably

> > have to do this in pieces as I don't have a lot of time right now

to

> > tell you everything I saw and learned.

> >

> > First of all, it was a great experience, I got to see everything,

> > casting, a tenotomy, I got to manipulate little rubber baby feet

with

> > bones inside them, I even got to practice doing a cast! I sucked

at

> > keeping my hands in the right places while doing the cast, I don't

> > know how the docs who mold and hold at the same time do it! I

really

> > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

said, " Ah,

> > so this is the baby from St. Louis. " He was so gentle and sweet,

it

> > was just fantastic meeting him. He looked at Sammy's brace and

said,

> > " Are you going to be here this afternoon? I want my orthotist

()

> > to see this. " I guess I'll start there. I know that and Dr.

> > Dobbs talked, said they had a long talk. also told me

that

> > he has already made a couple prototypes with articulating bars.

He

> > did look at Sammy's brace as well as a couple other models that

Dr.

> > Dobbs showed him, including some with stops to prevent plantar

flexion

> > and one with a quick release bar (snaps apart in the middle). My

> > husband has some really interesting ideas too, I just need him to

> > sketch out what he has thought up so I can give it to Dr. Dobbs

and

> > .

> > I really liked Fred Dietz, he has a really great personality. He

was

> > the instructor for our little group doing the practice casting.

He

> > was a very good speaker and I felt he did a great job of

presenting

> > the info on both short-term and long-term surgical results (as

> > compared to Ponseti). The thing that I found really interesting

was

> > his discussion on atypical feet. He is of the " school of

thought " I

> > guess you could say, that atypical feet are not born, they are

made.

> > He thinks (and this is still just conjecture of course, they are

all

> > still learning about atypical) that they are caused by slipping

casts

> > and/or improper manipulations. He has had a couple cases in

which the

> > cast has slipped once or twice and the emerging foot is starting

to

> > look atypical. He has tried a " let it lie " approach - if he sees

a

> > foot starting to look like this, he lets it stay out of the cast

a few

> > weeks and start relapsing. In these cases he has seen the foot go

> > back to looking like a " normal " clubfoot and then he starts

over. He

> > obviously doesn't have enough data to back this up yet, but it is

an

> > interesting theory.

> > Next, I was always told that the reason they over correct is so

that

> > the foot can gradually return to a normal position. This is one

of

> > the reasons, however, not the main reason - the main reason is to

get

> > the full range of motion, i.e. if you only correct to neutral the

foot

> > will never have good abduction range of motion like a normal foot

> does.

> > Another interesting thing I found out about is in the tissues of

the

> > ligaments themselves. Angel talked a little about this in a post

> > recently on the CF board. The tissues in the ligaments (collagen

> > fibers) in a clubfoot are actually contracted with a " crimp " , the

> > gentle stretching pulls out the crimp, then when casted and held

for

> > 5-7 days, the newly stretched tissues quickly regain

their " crimp " in

> > their new position, thus allowing them to be stretched again.

Pretty

> > interesting, huh? (This is all in the Global-Health book, but I

> > hadn't really followed this part of things before.)

> >

> > Okay, I've got lots more to say, but I have to go for now. I

will try

> > to write more tonight.

> >

> > Later,

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Our daughter did not start walking until 17 1/2 months. (Our first

walked at 12 months) She went right from walking to running! Nothing

inbetween. Beware, once they realize they can, there is no stopping

them :-)

Holly and

Where to start? I will try

not to

> > ramble on forever, I will probably

> > > have to do this in pieces as I don't have a lot of time

right now to

> > > tell you everything I saw and learned.

> > >

> > > First of all, it was a great experience, I got to see

everything,

> > > casting, a tenotomy, I got to manipulate little rubber baby

feet

> with

> > > bones inside them, I even got to practice doing a cast! I

sucked at

> > > keeping my hands in the right places while doing the cast,

I don't

> > > know how the docs who mold and hold at the same time do

it! I

> really

> > > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > > so this is the baby from St. Louis. " He was so gentle and

sweet, it

> > > was just fantastic meeting him. He looked at Sammy's brace

and

> said,

> > > " Are you going to be here this afternoon? I want my

orthotist

> ()

> > > to see this. " I guess I'll start there. I know that

and Dr.

> > > Dobbs talked, said they had a long talk. also

told me

> that

> > > he has already made a couple prototypes with articulating

bars. He

> > > did look at Sammy's brace as well as a couple other models

that Dr.

> > > Dobbs showed him, including some with stops to prevent

plantar

> flexion

> > > and one with a quick release bar (snaps apart in the

middle). My

> > > husband has some really interesting ideas too, I just need

him to

> > > sketch out what he has thought up so I can give it to Dr.

Dobbs and

> > > .

> > > I really liked Fred Dietz, he has a really great

personality.

> He was

> > > the instructor for our little group doing the practice

casting. He

> > > was a very good speaker and I felt he did a great job of

presenting

> > > the info on both short-term and long-term surgical results

(as

> > > compared to Ponseti). The thing that I found really

interesting was

> > > his discussion on atypical feet. He is of the " school of

thought " I

> > > guess you could say, that atypical feet are not born, they

are

> made.

> > > He thinks (and this is still just conjecture of course,

they are all

> > > still learning about atypical) that they are caused by

slipping

> casts

> > > and/or improper manipulations. He has had a couple cases in

> which the

> > > cast has slipped once or twice and the emerging foot is

starting to

> > > look atypical. He has tried a " let it lie " approach - if

he sees a

> > > foot starting to look like this, he lets it stay out of the

cast

> a few

> > > weeks and start relapsing. In these cases he has seen the

foot go

> > > back to looking like a " normal " clubfoot and then he starts

> over. He

> > > obviously doesn't have enough data to back this up yet, but

it is an

> > > interesting theory.

> > > Next, I was always told that the reason they over correct

is so that

> > > the foot can gradually return to a normal position. This

is one of

> > > the reasons, however, not the main reason - the main reason

is

> to get

> > > the full range of motion, i.e. if you only correct to

neutral

> the foot

> > > will never have good abduction range of motion like a

normal foot

> > does.

> > > Another interesting thing I found out about is in the

tissues of the

> > > ligaments themselves. Angel talked a little about this in

a post

> > > recently on the CF board. The tissues in the ligaments

(collagen

> > > fibers) in a clubfoot are actually contracted with

a " crimp " , the

> > > gentle stretching pulls out the crimp, then when casted and

held for

> > > 5-7 days, the newly stretched tissues quickly regain their

> " crimp " in

> > > their new position, thus allowing them to be stretched

again.

> Pretty

> > > interesting, huh? (This is all in the Global-Health book,

but I

> > > hadn't really followed this part of things before.)

> > >

> > > Okay, I've got lots more to say, but I have to go for now.

I

> will try

> > > to write more tonight.

> > >

> > > Later,

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Our daughter did not start walking until 17 1/2 months. (Our first

walked at 12 months) She went right from walking to running! Nothing

inbetween. Beware, once they realize they can, there is no stopping

them :-)

Holly and

Where to start? I will try

not to

> > ramble on forever, I will probably

> > > have to do this in pieces as I don't have a lot of time

right now to

> > > tell you everything I saw and learned.

> > >

> > > First of all, it was a great experience, I got to see

everything,

> > > casting, a tenotomy, I got to manipulate little rubber baby

feet

> with

> > > bones inside them, I even got to practice doing a cast! I

sucked at

> > > keeping my hands in the right places while doing the cast,

I don't

> > > know how the docs who mold and hold at the same time do

it! I

> really

> > > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > > so this is the baby from St. Louis. " He was so gentle and

sweet, it

> > > was just fantastic meeting him. He looked at Sammy's brace

and

> said,

> > > " Are you going to be here this afternoon? I want my

orthotist

> ()

> > > to see this. " I guess I'll start there. I know that

and Dr.

> > > Dobbs talked, said they had a long talk. also

told me

> that

> > > he has already made a couple prototypes with articulating

bars. He

> > > did look at Sammy's brace as well as a couple other models

that Dr.

> > > Dobbs showed him, including some with stops to prevent

plantar

> flexion

> > > and one with a quick release bar (snaps apart in the

middle). My

> > > husband has some really interesting ideas too, I just need

him to

> > > sketch out what he has thought up so I can give it to Dr.

Dobbs and

> > > .

> > > I really liked Fred Dietz, he has a really great

personality.

> He was

> > > the instructor for our little group doing the practice

casting. He

> > > was a very good speaker and I felt he did a great job of

presenting

> > > the info on both short-term and long-term surgical results

(as

> > > compared to Ponseti). The thing that I found really

interesting was

> > > his discussion on atypical feet. He is of the " school of

thought " I

> > > guess you could say, that atypical feet are not born, they

are

> made.

> > > He thinks (and this is still just conjecture of course,

they are all

> > > still learning about atypical) that they are caused by

slipping

> casts

> > > and/or improper manipulations. He has had a couple cases in

> which the

> > > cast has slipped once or twice and the emerging foot is

starting to

> > > look atypical. He has tried a " let it lie " approach - if

he sees a

> > > foot starting to look like this, he lets it stay out of the

cast

> a few

> > > weeks and start relapsing. In these cases he has seen the

foot go

> > > back to looking like a " normal " clubfoot and then he starts

> over. He

> > > obviously doesn't have enough data to back this up yet, but

it is an

> > > interesting theory.

> > > Next, I was always told that the reason they over correct

is so that

> > > the foot can gradually return to a normal position. This

is one of

> > > the reasons, however, not the main reason - the main reason

is

> to get

> > > the full range of motion, i.e. if you only correct to

neutral

> the foot

> > > will never have good abduction range of motion like a

normal foot

> > does.

> > > Another interesting thing I found out about is in the

tissues of the

> > > ligaments themselves. Angel talked a little about this in

a post

> > > recently on the CF board. The tissues in the ligaments

(collagen

> > > fibers) in a clubfoot are actually contracted with

a " crimp " , the

> > > gentle stretching pulls out the crimp, then when casted and

held for

> > > 5-7 days, the newly stretched tissues quickly regain their

> " crimp " in

> > > their new position, thus allowing them to be stretched

again.

> Pretty

> > > interesting, huh? (This is all in the Global-Health book,

but I

> > > hadn't really followed this part of things before.)

> > >

> > > Okay, I've got lots more to say, but I have to go for now.

I

> will try

> > > to write more tonight.

> > >

> > > Later,

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

So was originally treated by Dr. P? And does he consider her

" atypical " ?

Where to start? I will try

not to

> > ramble on forever, I will probably

> > > have to do this in pieces as I don't have a lot of time

right now to

> > > tell you everything I saw and learned.

> > >

> > > First of all, it was a great experience, I got to see

everything,

> > > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > > bones inside them, I even got to practice doing a cast! I

sucked at

> > > keeping my hands in the right places while doing the cast, I

don't

> > > know how the docs who mold and hold at the same time do it! I

> really

> > > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > > so this is the baby from St. Louis. " He was so gentle and

sweet, it

> > > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > > " Are you going to be here this afternoon? I want my orthotist

> ()

> > > to see this. " I guess I'll start there. I know that

and Dr.

> > > Dobbs talked, said they had a long talk. also told me

> that

> > > he has already made a couple prototypes with articulating

bars. He

> > > did look at Sammy's brace as well as a couple other models

that Dr.

> > > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > > and one with a quick release bar (snaps apart in the

middle). My

> > > husband has some really interesting ideas too, I just need

him to

> > > sketch out what he has thought up so I can give it to Dr.

Dobbs and

> > > .

> > > I really liked Fred Dietz, he has a really great personality.

> He was

> > > the instructor for our little group doing the practice

casting. He

> > > was a very good speaker and I felt he did a great job of

presenting

> > > the info on both short-term and long-term surgical results (as

> > > compared to Ponseti). The thing that I found really

interesting was

> > > his discussion on atypical feet. He is of the " school of

thought " I

> > > guess you could say, that atypical feet are not born, they are

> made.

> > > He thinks (and this is still just conjecture of course, they

are all

> > > still learning about atypical) that they are caused by slipping

> casts

> > > and/or improper manipulations. He has had a couple cases in

> which the

> > > cast has slipped once or twice and the emerging foot is

starting to

> > > look atypical. He has tried a " let it lie " approach - if he

sees a

> > > foot starting to look like this, he lets it stay out of the cast

> a few

> > > weeks and start relapsing. In these cases he has seen the

foot go

> > > back to looking like a " normal " clubfoot and then he starts

> over. He

> > > obviously doesn't have enough data to back this up yet, but

it is an

> > > interesting theory.

> > > Next, I was always told that the reason they over correct is

so that

> > > the foot can gradually return to a normal position. This is

one of

> > > the reasons, however, not the main reason - the main reason is

> to get

> > > the full range of motion, i.e. if you only correct to neutral

> the foot

> > > will never have good abduction range of motion like a normal

foot

> > does.

> > > Another interesting thing I found out about is in the

tissues of the

> > > ligaments themselves. Angel talked a little about this in a

post

> > > recently on the CF board. The tissues in the ligaments

(collagen

> > > fibers) in a clubfoot are actually contracted with a

" crimp " , the

> > > gentle stretching pulls out the crimp, then when casted and

held for

> > > 5-7 days, the newly stretched tissues quickly regain their

> " crimp " in

> > > their new position, thus allowing them to be stretched again.

> Pretty

> > > interesting, huh? (This is all in the Global-Health book, but I

> > > hadn't really followed this part of things before.)

> > >

> > > Okay, I've got lots more to say, but I have to go for now. I

> will try

> > > to write more tonight.

> > >

> > > Later,

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

So was originally treated by Dr. P? And does he consider her

" atypical " ?

Where to start? I will try

not to

> > ramble on forever, I will probably

> > > have to do this in pieces as I don't have a lot of time

right now to

> > > tell you everything I saw and learned.

> > >

> > > First of all, it was a great experience, I got to see

everything,

> > > casting, a tenotomy, I got to manipulate little rubber baby feet

> with

> > > bones inside them, I even got to practice doing a cast! I

sucked at

> > > keeping my hands in the right places while doing the cast, I

don't

> > > know how the docs who mold and hold at the same time do it! I

> really

> > > enjoyed meeting Dr. Ponseti, he came up to me and Sammy and

> said, " Ah,

> > > so this is the baby from St. Louis. " He was so gentle and

sweet, it

> > > was just fantastic meeting him. He looked at Sammy's brace and

> said,

> > > " Are you going to be here this afternoon? I want my orthotist

> ()

> > > to see this. " I guess I'll start there. I know that

and Dr.

> > > Dobbs talked, said they had a long talk. also told me

> that

> > > he has already made a couple prototypes with articulating

bars. He

> > > did look at Sammy's brace as well as a couple other models

that Dr.

> > > Dobbs showed him, including some with stops to prevent plantar

> flexion

> > > and one with a quick release bar (snaps apart in the

middle). My

> > > husband has some really interesting ideas too, I just need

him to

> > > sketch out what he has thought up so I can give it to Dr.

Dobbs and

> > > .

> > > I really liked Fred Dietz, he has a really great personality.

> He was

> > > the instructor for our little group doing the practice

casting. He

> > > was a very good speaker and I felt he did a great job of

presenting

> > > the info on both short-term and long-term surgical results (as

> > > compared to Ponseti). The thing that I found really

interesting was

> > > his discussion on atypical feet. He is of the " school of

thought " I

> > > guess you could say, that atypical feet are not born, they are

> made.

> > > He thinks (and this is still just conjecture of course, they

are all

> > > still learning about atypical) that they are caused by slipping

> casts

> > > and/or improper manipulations. He has had a couple cases in

> which the

> > > cast has slipped once or twice and the emerging foot is

starting to

> > > look atypical. He has tried a " let it lie " approach - if he

sees a

> > > foot starting to look like this, he lets it stay out of the cast

> a few

> > > weeks and start relapsing. In these cases he has seen the

foot go

> > > back to looking like a " normal " clubfoot and then he starts

> over. He

> > > obviously doesn't have enough data to back this up yet, but

it is an

> > > interesting theory.

> > > Next, I was always told that the reason they over correct is

so that

> > > the foot can gradually return to a normal position. This is

one of

> > > the reasons, however, not the main reason - the main reason is

> to get

> > > the full range of motion, i.e. if you only correct to neutral

> the foot

> > > will never have good abduction range of motion like a normal

foot

> > does.

> > > Another interesting thing I found out about is in the

tissues of the

> > > ligaments themselves. Angel talked a little about this in a

post

> > > recently on the CF board. The tissues in the ligaments

(collagen

> > > fibers) in a clubfoot are actually contracted with a

" crimp " , the

> > > gentle stretching pulls out the crimp, then when casted and

held for

> > > 5-7 days, the newly stretched tissues quickly regain their

> " crimp " in

> > > their new position, thus allowing them to be stretched again.

> Pretty

> > > interesting, huh? (This is all in the Global-Health book, but I

> > > hadn't really followed this part of things before.)

> > >

> > > Okay, I've got lots more to say, but I have to go for now. I

> will try

> > > to write more tonight.

> > >

> > > Later,

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >