Re: More ATTT Questions

December 3, 2005

Hi

I'm sure there are different answers to some of this but I'll send the answers

from our experience with it.

The casts were non-weight bearing for the first couple weeks especially. During

that period it was crucial he didn't bear weight for the risk he would flex

muscles and tear out the stitches (whatever) inside the foot - that tendon they

reanchor needs time to heal and grow in to place so it won't tear out later.

He wore casts for 6 weeks post op - the first few weeks were the most important

to keep him off his feet but in reality past that it's a losing battle keeping a

kid off his feet.

The scars were minimal, very tidy clean white lines. He had one on the bottom

of his foot for a while but it is completely gone now, it was just a little spot

of a scar, maybe the size around of a pencil or less. On top there are to fine

white lines hardly noticible anymore. There were no stitches on the foot except

the bottom button.

Follow up we went back at 6 weeks to remove the casts. This is where the button

on bottom of the foot gets removed and it's ugly, I won't kid you, yet morbidly

facinating too! LOL! I have 35 mm photos around here some where if I can locate

them AND learn to use my new scanner I just got yesterday I'll send them through

but don't hold your breath on that.

After that I think it was maybe two months later, then six months later then

annually.

The hospital stay was all the day of the surgery, over night and in to the next

afternoon. reacted poorly to the morphine and until I could convince the

nurses to switch pain killers he was sick as a dog screaming and puking.

was 25 months when he had it done. Don't know if that qualifies as

" older " child or not - I think now days it would be considered young but anyway

after the ATTT healed, his pain was eliminated. Prior to it his feet had hurt

all the time and he could hardly walk. Ten days after the casts came off he was

running, literally running and hasn't hurt since.

The lack of pain and the ability to walk/run are what we gained from it, and

those are biggies! But then again there is still the issue of his feet being

shaped funny that the doctors can't quite figure out; his ankles are really

stiff (heels?). I don't know if that is ATTT related, or due to the 2 years of

non ponseti care he had prior to Dr. Ponseti and the ATTT. ON the WHOLE though,

I'd have to say " Satisfied " because he doesn't hurt anymore.

No muscles are cut that i am aware of. It's a very " minor " procedure all in

all...I was able to watch a video of an actual surgery prior to doing it on

. Through the top of teh foot they cut a tendon loose and then slip it

under the skin to a new anchor point. Using a drill they make a hole and put

the tendon completely through the foot in to the bottom - thus the bottom scar -

where it's anchored with a button. It looked like a button off the doctor's

smock. The button holds it so it doesn't slip loose and come back up through

the foot as it heals. The video was graphic and it took me about three times to

watch the whole thing with my eyes open but I was glad to have it - I WANTED to

know what they were doing to him.

But no bones are cut or broken, and that's a biggie for future success, lack of

scar tissue, normal foot growth, etc.

Are you having this done in Iowa? Ask for a the video if you are strong of

stomach. I think there are photos of it also on that World Health booklet.

Good luck honey,

s.

More ATTT Questions

Okay - I know I've gotten the basic info but I've got a few more

questions.

*Are all of the casts non weightbearing or do they put walking casts on

them at some point?

*What are the scars like after awhile? How many are there? I've seen

that there are some on the top and some on the bottom of the foot, right? Any

pics would be good for dh to see if you have them.

*What is the follow up like? Do you still wear the shoes? Do you follow

up annually? Biannually?

*How long was your hospital stay?

*If you have an older child who had this were you happy with the results?

Have they had any pain from the scars, etc?

* I've tried to look up info but can't find what I'm looking for so can

you tell me do they cut muscle and such or just what is done on the inside of

the foot?

I think that will do us for now. Thanks for taking the time to help us if

you can.

Chris

A waist is a terrible thing to mind.

December 3, 2005

Hey

Collin had 3 casts before the ATTT surgery to help stretch it with

Dr. Ponseti, then Dr. Morcuende did his surgery on Sept. 30th, there

are some photo's of the day he had the cast taken off and like a week

after that on our website under collin's story " iowa update " at

http://www.geocities.com/chele323232

He came out of surgery in a plaster cast then before we left the

hospital (we left the same day, didn't have to stay over night, which

shocked me but they said since we were right down the road at the

Mc House it wasn't necessary) they put fiberglass over

it (a lot of it) because they knew we had a hard time keeping him

down. At first he crawled or scooted and if we went out we used a

stroller (at the ronald mcdonald house and in iowa he used a wheel

chair but we couldn't afford to rent a pedatric one once home). In

the 6 weeks that he wore it he deffianlty walked, ran, etc in it

before we left the hospital they gave him a velcro shoe to help

protect it. I can't remember in the 6 weeks when he started walking

in it, etc but after a while it was too hard to tell him to crawl and

have him listen.

His scars as you can see from the website a week later already

looked great I'll take more photos tommorow and send them to cfpics

it has been about 3 weeks now I think that he has been cast free and

the scars are really not that bad at all, way better then what the

nut doctor did too him at 8 weeks old. He has 2 on the top of his

foot and a tiny one on the bottom of his foot, he doesn't have the

indent from the button on the bottom of his foot, just wear the

stiches were that needs to heal. He started running again yesterday

and like I said he's only been out of casts 3 weeks now, he had it

removed Nov. 11th, we go back in 6 months from his surgery date for a

checkup then after that hopefully just once a year. He doesn't have

to wear any type of special shoes or braces anymore. We ended up

being in Iowa 18 days alltogether from the time they started

stretching the foot with casts, the surgery and sticking around a few

days after to make sure everything was ok. If you look in the Global

Health booklet (I forget the link) but ee sent it to me I think

before they have a step by step guide with photos (graphic) of what

the procedure is like.

Overall his foot looks beautiful too me right now and I can't help

but stare at how straight the inside part of his foot is, I think

that is from the plantar fascia release but I'm not real sure. He

always sort of looked like he in toed and the top part of his foot

curved it and now it's so straight to me. I hope this helps a

little. Feel free to e-mail me at chele323232@...

From what Dr. Ponseti explained to me that Collin's tendon in the

middle of the foot that helps you pull it up towards you never

developed it was like he was born with out it(often by wearing the

FAB/DBB it strengthens overtime I think and devlops but with Collin

it didn't), so they moved then tendon next to it over to replace the

middle one and eventually it will strengten and that is what the ATTT

does. I hope that makes some kind of sense it is easier when you can

show someone as your talking.

Michele

December 4, 2005

Hi Chris!

Jake has a left clubfoot and relapsed around the age of 2...he has had ATTT

surgery twice now and is still recovering from his second surgery (it was on

October 18, at the University of Iowa with Dr Dietz). Here's out take on it!

Sorry in advance as I tend to give kind of long posts...

*Are all of the casts non weightbearing or do they put walking casts on them at

some point?

The first time Jake had the surgery, he just had one cast that went from toes

to mid-thigh, with the knee bent, for 6 wks. It was to be nonweightbearing, but

Jake would frequently try and stand on it (he was just over 3 yrs old at the

time and didn't really want to listen to us about it lol). Dr Dietz said that

one 6 week, nonweightbearing cast is what he usually does following ATTT

surgery.

The second time Jake had the surgery, he had a nonweightbearing cast (same as

the first one) for 6 wks. He was MUCH more aware of the risks of

standing/walking on the cast...he does NOT want to have surgery again so he was

very very good about crawling instead of trying to stand or walk. Because the

tendon pulled out a little last time around (more on that later!), Dr Dietz

opted to put Jake in a second walking cast for 3 wks, to help keep his foot in

correct alignment and hopefully make sure it is healed well before he goes

cast-less. Jake will go back to have his walking cast removed on Dec 16.

*What are the scars like after awhile? How many are there? I've seen that

there are some on the top and some on the bottom of the foot, right? Any pics

would be good for dh to see if you have them.

Jake had 3 scars after his first surgery. Two of them were about an inch long

apiece on the top of his foot, one towards the inner (where the tendon was to

begin with) and the other towards the outer (where the tendon was moved to). He

also had a larger incision (maybe 2 inches long or so) on the back of his lower

leg because he had another achilles tenotomy. There was also a teeny spot on

the bottom of his foot where the suture and button came out, but after a few

weeks we couldn't see that one. Second time around, Jake also has a small

incision (I didn't get a good look at it during the cast change so I don't know

how big it is) on the bottom of his foot because they did a tendon release on

his arch (it has become very high over time (they don't know why) and was

actually making his clubfoot about a size and a half shorter than his other

foot).

As far as the long-term appearance of the scars...Jake's faded to just white

lines as they healed (they were dark pink to start with), but this really

depends on how your child heals. Everyone is different. I will check around on

my computer; I'm not sure if I have any pictures of his foot or not. If I can

find any I'll send em to you.

*What is the follow up like? Do you still wear the shoes? Do you follow up

annually? Biannually?

After having this surgery done, the shoes are not necessary according to Dr

Dietz, because this surgery usually corrects the clubfoot without the

possibility of relapse.

I'm not sure about long-term follow up. Jake was seen twice in the year

following his first ATTT, but his was a special case as the tendon pulled out a

little and Dr Dietz was anticipating having to re-do the surgery.

*How long was your hospital stay?

Overnight. Both times we left the hospital around noon the day after surgery.

*If you have an older child who had this were you happy with the results? Have

they had any pain from the scars, etc?

This is kind of a loaded question for us! Keep in mind that our surgical

experience is *not* the norm. For most children, ATTT surgery fixes their

clubfoot and they have no long-term issues. For Jake, though, apparently his

tendon pulled out slightly from the bone (we're not sure exactly how that

happened, if it was Jake attempting to stand on his cast or what) so that it

could not lift his foot as it should. He could walk & run just fine but over

time was walking on tip toes more and more. In the months before his second

surgery he actually could not walk flat-footed. This didn't slow him down in

the least, though, and he did not appear to have any pain of any kind.

So, for our second surgery, instead of just having a suture to hold the tendon

in place, Dr Dietz also put a screw in (it is very tiny, and *dissolves!* I'd

never heard of such a thing). He said it's kind of like wearing both a belt &

suspenders to hold your pants up...extra insurance. At our cast change

appointment, Dr Dietz said he was satisified with the results. Jake was very

hesitant to flex his foot up & down (I'm sure his muscles were very sore after

being in a cast for 6 wks) but he did move it a little. Dr Dietz also noted

that he couldn't feel any lumps on the top of Jake's foot, which he had before

the surgery, apparently from the tendon being bunched up from pulling out.

We'll have to wait & see until after the walking cast comes off & Jake is back

to running & walking as far as whether or not the surgery was successful.

* I've tried to look up info but can't find what I'm looking for so can you tell

me do they cut muscle and such or just what is done on the inside of the foot?

Basically, with this procedure the anterior tibialis tendon is detached from

the bone on the inner side of the foot, and is reattached to a bone on the outer

side of the foot. Usually an xray is done before surgery to make sure the bone

is large enough to do the surgery (if it isn't, they have to wait awhile to do

the surgery). A hole is drilled through the bone and the tendon is inserted

into the bone. Basically this is how tendons attach to bones, they actually are

a part of the bone. Anyhow a suture is used to hold the tendon in place and the

stitch actually comes out the bottom of the foot and is tied through a button to

hold it in place. The suture is removed after the cast is taken off. The

general idea is that the tendon, in its original position, is too tight and

pulls the foot inwards. It is moved to the outer side of the foot so that it

keeps the foot in correct alignment.

* What is a plantar facsia release? Is this what causes the 'button scar' on

the bottom of the foot?

No, the plantar fascia release is a different procedure...I think it's similar

to the achilles tenotomy but on the bottom of the foot instead.

Hope this helps and again I'm sorry I rambled on so. One of my loves as a nurse

is patient teaching...can you tell? Best of luck to you and your family.

Kassia

3/22/01 (Lt clubfoot, 2nd ATTT Oct 2005)

and 11/22/02

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