What I learned at the symposium

[Guest guest]

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,