Guest guest Posted October 16, 2005 Report Share Posted October 16, 2005 The informaiton that Dr Dietz presented is very interesting. It could explain why there is what seems like a rash of atypical clubfoot cases, and it might explain why they are doing so well with proper treatment. Unfortunately, it doesnt explain why Kai's foot, and Sadie's foot for that fact (another of Dr Mosca's pts) turned out atypical. Neither ever slipped in a cast, and both were casted correctly. I have (old) information from Dr Colburn in CA to the same ... he had seen 3-4 cases over the years, but none of them slipped in casts ... rather they came out of the tenotomy cast that way. I wonder if there is the " birth " atypical, and then a " created " atypical. At any rate, before I took Kai to see Dr P, he was out of his shoes for a month. We saw no point in tourturing him with badly fitting shoes when he was going to be casted shortly. Angel > > > > Hi there, I have made a folder for Hayden and uploaded some photos. > > As you can see from the 12th casts, his left foot is still quite > > sloped at the heel, much more than the right, even though the rotation > > appears to be 70 degrees. But when you see his feet after just a few > > weeks out of the casts, and supposedly in the shoes, you can see the > > left one already wanting to turn back in. Arrgh! > > > > I'm going to collect my thoughts and see if I can compose something > > coherent to Dr. Ponseti. I am not sure if the photos I have taken are > > good enough for him to see what's happening, though. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2005 Report Share Posted October 16, 2005 The informaiton that Dr Dietz presented is very interesting. It could explain why there is what seems like a rash of atypical clubfoot cases, and it might explain why they are doing so well with proper treatment. Unfortunately, it doesnt explain why Kai's foot, and Sadie's foot for that fact (another of Dr Mosca's pts) turned out atypical. Neither ever slipped in a cast, and both were casted correctly. I have (old) information from Dr Colburn in CA to the same ... he had seen 3-4 cases over the years, but none of them slipped in casts ... rather they came out of the tenotomy cast that way. I wonder if there is the " birth " atypical, and then a " created " atypical. At any rate, before I took Kai to see Dr P, he was out of his shoes for a month. We saw no point in tourturing him with badly fitting shoes when he was going to be casted shortly. Angel > > > > Hi there, I have made a folder for Hayden and uploaded some photos. > > As you can see from the 12th casts, his left foot is still quite > > sloped at the heel, much more than the right, even though the rotation > > appears to be 70 degrees. But when you see his feet after just a few > > weeks out of the casts, and supposedly in the shoes, you can see the > > left one already wanting to turn back in. Arrgh! > > > > I'm going to collect my thoughts and see if I can compose something > > coherent to Dr. Ponseti. I am not sure if the photos I have taken are > > good enough for him to see what's happening, though. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2005 Report Share Posted October 16, 2005 There really has been tons more atypical kids popping up onthe boards lately. I posted Gabe's photos onteh Clubfoot site. After looking at his feet again, I thik if you took the picture of his feet and abducted and everted them, he'd still have wound up with cavus issues. They were definitely chubby enough from the get-go. His big toes were already stuck out/up. It is true that in 3 months of Gabe's casting we probably went through over 25 sets of cast due to slipage... Until his tenotomies, he was often casted 2x a week. I dont know... It make sense, but looking at his picture when he waas first born... Ithink he might have turned out this way anyway too. > > > > > > Hi there, I have made a folder for Hayden and uploaded some > photos. > > > As you can see from the 12th casts, his left foot is still quite > > > sloped at the heel, much more than the right, even though the > rotation > > > appears to be 70 degrees. But when you see his feet after just a > few > > > weeks out of the casts, and supposedly in the shoes, you can see > the > > > left one already wanting to turn back in. Arrgh! > > > > > > I'm going to collect my thoughts and see if I can compose > something > > > coherent to Dr. Ponseti. I am not sure if the photos I have > taken are > > > good enough for him to see what's happening, though. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 16, 2005 Report Share Posted October 16, 2005 There really has been tons more atypical kids popping up onthe boards lately. I posted Gabe's photos onteh Clubfoot site. After looking at his feet again, I thik if you took the picture of his feet and abducted and everted them, he'd still have wound up with cavus issues. They were definitely chubby enough from the get-go. His big toes were already stuck out/up. It is true that in 3 months of Gabe's casting we probably went through over 25 sets of cast due to slipage... Until his tenotomies, he was often casted 2x a week. I dont know... It make sense, but looking at his picture when he waas first born... Ithink he might have turned out this way anyway too. > > > > > > Hi there, I have made a folder for Hayden and uploaded some > photos. > > > As you can see from the 12th casts, his left foot is still quite > > > sloped at the heel, much more than the right, even though the > rotation > > > appears to be 70 degrees. But when you see his feet after just a > few > > > weeks out of the casts, and supposedly in the shoes, you can see > the > > > left one already wanting to turn back in. Arrgh! > > > > > > I'm going to collect my thoughts and see if I can compose > something > > > coherent to Dr. Ponseti. I am not sure if the photos I have > taken are > > > good enough for him to see what's happening, though. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Angel, So...if these cases of atypical " appeared " after the tenotomy cast, I'm wondering if there is something that happens, and I'm just thinking out loud here, when that super tight achilles is cut, if it somehow has a reverse effect on the plantaris tendon, like if you have two rubberbands stretched tight pulling on the same object, i.e. the calcaneous, from opposite directions - then the one rubberband (the achilles) is cut. This would allow the opposing rubberband (the plantar) to contract, thus shortening the foot, then you are casted for 3 weeks, allowing that tendon to get nice and tight in that shorter position and presto you come out of the cast " atypical " . I just find it so interesting that Dr. P and said that they had never " created " one, that is, that no foot they had ever treated from birth turned out to be 'atypical'. I think the whole atypical thing is really going to be the next great thing that U of I figures out, they seem to really be on the right track. > > > > > > Hi there, I have made a folder for Hayden and uploaded some > photos. > > > As you can see from the 12th casts, his left foot is still quite > > > sloped at the heel, much more than the right, even though the > rotation > > > appears to be 70 degrees. But when you see his feet after just a > few > > > weeks out of the casts, and supposedly in the shoes, you can see > the > > > left one already wanting to turn back in. Arrgh! > > > > > > I'm going to collect my thoughts and see if I can compose > something > > > coherent to Dr. Ponseti. I am not sure if the photos I have > taken are > > > good enough for him to see what's happening, though. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2005 Report Share Posted October 17, 2005 Angel, So...if these cases of atypical " appeared " after the tenotomy cast, I'm wondering if there is something that happens, and I'm just thinking out loud here, when that super tight achilles is cut, if it somehow has a reverse effect on the plantaris tendon, like if you have two rubberbands stretched tight pulling on the same object, i.e. the calcaneous, from opposite directions - then the one rubberband (the achilles) is cut. This would allow the opposing rubberband (the plantar) to contract, thus shortening the foot, then you are casted for 3 weeks, allowing that tendon to get nice and tight in that shorter position and presto you come out of the cast " atypical " . I just find it so interesting that Dr. P and said that they had never " created " one, that is, that no foot they had ever treated from birth turned out to be 'atypical'. I think the whole atypical thing is really going to be the next great thing that U of I figures out, they seem to really be on the right track. > > > > > > Hi there, I have made a folder for Hayden and uploaded some > photos. > > > As you can see from the 12th casts, his left foot is still quite > > > sloped at the heel, much more than the right, even though the > rotation > > > appears to be 70 degrees. But when you see his feet after just a > few > > > weeks out of the casts, and supposedly in the shoes, you can see > the > > > left one already wanting to turn back in. Arrgh! > > > > > > I'm going to collect my thoughts and see if I can compose > something > > > coherent to Dr. Ponseti. I am not sure if the photos I have > taken are > > > good enough for him to see what's happening, though. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 You know, your theory is very similar to Dr Colburn's. I understand from the paper the doctors at UoI presented earlier this year at the POSNA meeting that the IS a physical difference in atypical vs normal clubfoot, so I find it hard to believe that all cases are being " created " . I mean, even if they were, something had to have been present in the first place to allow it to happen. I know it is far more common among inexperienced doctors, which DOES lean towards at least some cases being created; but other cases are happening in the hands of very experienced doctors. Dr Mosca told me that in his time since beginning the P method, he had seen 4 cases - 2 a couple years before Kai came along, and then Kai and Sadie, who were diagnosed virtually together as having atypical. Another of the early recognized cases was being treated by Dr Lehman, who is also considered a very experienced doctor. Dr Colburn, at that same time (2 yrs ago) told me he had seen 2-3 cases in his time and also told me how he was succeeding in treating them (as well as giving me his theory on what happened). Now, I have a very hard time believing that doctors who successfully treat hundreds of clubfeet a year just get stupid 2 or 3 times in their practice. Dr Mosca treats children from all over the State of Washington - Children's Hospital is the main referral unless you are close to Spokane - as well as doing finishing proceedures with most patients from Alaska. That is a pretty large volume of feet! I do agree that some of the cases may be created by slipping casts. But some of these children have other things going on that may be contributing. Sadie had global atonia. Kai has global connective tissue problems. There is a bigger picture that it seems is being missed. Not to mention that I have personally seen well corrected atypical foot bend - at will - in places that no foot should be capable of bending! They dont slip out of the shoes, they wiggle out of them! lol > > > > > > > > Hi there, I have made a folder for Hayden and uploaded some > > photos. > > > > As you can see from the 12th casts, his left foot is still quite > > > > sloped at the heel, much more than the right, even though the > > rotation > > > > appears to be 70 degrees. But when you see his feet after just a > > few > > > > weeks out of the casts, and supposedly in the shoes, you can see > > the > > > > left one already wanting to turn back in. Arrgh! > > > > > > > > I'm going to collect my thoughts and see if I can compose > > something > > > > coherent to Dr. Ponseti. I am not sure if the photos I have > > taken are > > > > good enough for him to see what's happening, though. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 You know, your theory is very similar to Dr Colburn's. I understand from the paper the doctors at UoI presented earlier this year at the POSNA meeting that the IS a physical difference in atypical vs normal clubfoot, so I find it hard to believe that all cases are being " created " . I mean, even if they were, something had to have been present in the first place to allow it to happen. I know it is far more common among inexperienced doctors, which DOES lean towards at least some cases being created; but other cases are happening in the hands of very experienced doctors. Dr Mosca told me that in his time since beginning the P method, he had seen 4 cases - 2 a couple years before Kai came along, and then Kai and Sadie, who were diagnosed virtually together as having atypical. Another of the early recognized cases was being treated by Dr Lehman, who is also considered a very experienced doctor. Dr Colburn, at that same time (2 yrs ago) told me he had seen 2-3 cases in his time and also told me how he was succeeding in treating them (as well as giving me his theory on what happened). Now, I have a very hard time believing that doctors who successfully treat hundreds of clubfeet a year just get stupid 2 or 3 times in their practice. Dr Mosca treats children from all over the State of Washington - Children's Hospital is the main referral unless you are close to Spokane - as well as doing finishing proceedures with most patients from Alaska. That is a pretty large volume of feet! I do agree that some of the cases may be created by slipping casts. But some of these children have other things going on that may be contributing. Sadie had global atonia. Kai has global connective tissue problems. There is a bigger picture that it seems is being missed. Not to mention that I have personally seen well corrected atypical foot bend - at will - in places that no foot should be capable of bending! They dont slip out of the shoes, they wiggle out of them! lol > > > > > > > > Hi there, I have made a folder for Hayden and uploaded some > > photos. > > > > As you can see from the 12th casts, his left foot is still quite > > > > sloped at the heel, much more than the right, even though the > > rotation > > > > appears to be 70 degrees. But when you see his feet after just a > > few > > > > weeks out of the casts, and supposedly in the shoes, you can see > > the > > > > left one already wanting to turn back in. Arrgh! > > > > > > > > I'm going to collect my thoughts and see if I can compose > > something > > > > coherent to Dr. Ponseti. I am not sure if the photos I have > > taken are > > > > good enough for him to see what's happening, though. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 Angel, Do you have the reference for that paper they presented (or is it published yet)? I would love to read it, I'm really interested in this now and would like to read more about the actual physical differences. Do you have pictures of Kai's foot pre-casting, or even pre-tenotomy that show what it looked like then? I'm remembering from your website that you talk about a " virgin " clubfoot that would show the signs of being atypical, specifically the short, fat, chubby characteristics. Did Kai's foot look like that to begin with? Kai would be a good example since he is unilateral - did you see a big difference in the appearance or length of the foot when he was born? I'm also curious what you see on an X-ray of Kai's foot. I'm wondering about the flexibility that you describe and if it has to do with the alignment of the bones (as compared to a normal foot, or a 'normal' clubfoot that has been corrected) or is it just the flexibility of the ligaments, etc. Are the metatarsals still at a steeper angle? When you say his foot bends in " abnormal " ways, can you describe more? Sorry for all the questions, I'm just very interested in all of this and the education won't hurt me either. Thanks, > > > > > > > > > > Hi there, I have made a folder for Hayden and uploaded some > > > photos. > > > > > As you can see from the 12th casts, his left foot is still > quite > > > > > sloped at the heel, much more than the right, even though the > > > rotation > > > > > appears to be 70 degrees. But when you see his feet after > just a > > > few > > > > > weeks out of the casts, and supposedly in the shoes, you can > see > > > the > > > > > left one already wanting to turn back in. Arrgh! > > > > > > > > > > I'm going to collect my thoughts and see if I can compose > > > something > > > > > coherent to Dr. Ponseti. I am not sure if the photos I have > > > taken are > > > > > good enough for him to see what's happening, though. > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2005 Report Share Posted October 18, 2005 Angel, Do you have the reference for that paper they presented (or is it published yet)? I would love to read it, I'm really interested in this now and would like to read more about the actual physical differences. Do you have pictures of Kai's foot pre-casting, or even pre-tenotomy that show what it looked like then? I'm remembering from your website that you talk about a " virgin " clubfoot that would show the signs of being atypical, specifically the short, fat, chubby characteristics. Did Kai's foot look like that to begin with? Kai would be a good example since he is unilateral - did you see a big difference in the appearance or length of the foot when he was born? I'm also curious what you see on an X-ray of Kai's foot. I'm wondering about the flexibility that you describe and if it has to do with the alignment of the bones (as compared to a normal foot, or a 'normal' clubfoot that has been corrected) or is it just the flexibility of the ligaments, etc. Are the metatarsals still at a steeper angle? When you say his foot bends in " abnormal " ways, can you describe more? Sorry for all the questions, I'm just very interested in all of this and the education won't hurt me either. Thanks, > > > > > > > > > > Hi there, I have made a folder for Hayden and uploaded some > > > photos. > > > > > As you can see from the 12th casts, his left foot is still > quite > > > > > sloped at the heel, much more than the right, even though the > > > rotation > > > > > appears to be 70 degrees. But when you see his feet after > just a > > > few > > > > > weeks out of the casts, and supposedly in the shoes, you can > see > > > the > > > > > left one already wanting to turn back in. Arrgh! > > > > > > > > > > I'm going to collect my thoughts and see if I can compose > > > something > > > > > coherent to Dr. Ponseti. I am not sure if the photos I have > > > taken are > > > > > good enough for him to see what's happening, though. > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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