Re: Re: We're approaching 3yo...

[Guest guest]

ahhh... good idea. Thank you!!

At 09:04 AM 1/6/2006, you wrote:

>Kori,

>I think from what you have described it is certainly do-able for you

>guys to continue to age 4 without a problem. You could even maybe

>reduce hours to the 10-12 range, I dunno. I wonder if you have

>trouble getting the doc to agree, if the Shriner's is part of the

>issue if you could get a consult w/ Dobbs since he is w/ Shriner's too

>if that would help?

>

>Just thinking outloud,

>

>

>

> > >Kori,

> > >

> > >Dr. Morcuende told me about the time of the 2004 symposium that after

> > >seeing a number of relapses in older kids (ages 4 to 6), they were

> > >urging parents to have kids wear the brace to age 4, if tolerated,

> > >and sometimes even longer.

> > >

> > >Of course the risk goes down with each year that goes by, and each

> > >case is different; some feet are milder, some are too loose and need

> > >be released earlier.. but I think the idea is that if the child is

> > >doing OK wearing the brace, then it is extra insurance to continue.

> > >

> > >I'm sure you've seen the following from Dr. Morcuende,

> > >

> > > " The rate of relapse decreases with age until about 5-6 years of age.

> > >Overall, the odds of relapse if no bracing is used whatsoever is

> > >something like: <12 months = 80-90 %; <2 years: 60-70%; 3-4 years:

> > >20%, 4-6 years; 1%. However, it is not possible to know in which

> > >group a particular patient is in, so you have to treat everyone

> > >cautiously. "

> > >

> > >He also did a paper on how hyperabduction in the last cast combined

> > >with brace wear were the keys to preventing relapse.

> > >

> > >Here is what Dr. Ponseti wrote to me in August '05:

> > >

> > > " in the past two years or so we have had a few late relapses. We

> > >cannot predict beforehand who is going to relapse. Owing to our

> > >interest in avoiding relapses, we are encouraging parents to continue

> > >the bracing longer, especially if the child tolerates it well. Feet

> > >that were very severe at birth and difficult to correct seem to be

> > >the most vulnerable to relapse. Unfortunately we do not know the

> > >pathology that causes this nor do we know why relapses occur in some

> > >children after 5 years of age. "

> > >

> > >So, I can understand your skittishness about stopping.. I felt the

> > >same way, at the age 3 and 3 1/2 checkpoints. If Darbi is doing well

> > >with the brace, and you are too, I would keep on a while. It might

> > >not be necessary, but that's the way of insurance ..

> > >

> > >Also, I never figured we were 'safe' just because Claire's foot

> > >looked great and functioned so well. I figured it was the brace that

> > >was keeping it that way..

> > >

> > >Hope this helps,

> > >

> > > and Claire

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >