Guest guest Posted February 13, 2006 Report Share Posted February 13, 2006 Hi Haley, I haven't been following your posts, so I'm not sure of your background. But after reading your e-mail trail, I would go with Dr. Ponseti on this one. My guess is she will need more casting to correct the over-abduction of her forefoot. I haven't seen your pictures, but the reply Ponseti gave you sounds similar to our situation. We came to find out that our doctor was treating Sierra's forefoot with excessive abduction as well. We went to Iowa and saw Ponseti, who turned her feet back to a neutral position and she is now in the shoes at 30 degrees. I would definitely go with the brace, they were made for atypical clubfoot and the difference between the Markell and brace for us were night and day. Jescie and Sierra 6/13/05 BCF 's 18-20 hours/day > > Hello, > > This is the e-mail that I received back from Dr. Ponseti regarding the > pictures of Keira's foot that I e-mailed him. I sent the same pictures to > Dr. Morcuende who said that her foot looked nicely corrected so now I am > somewhat confused! I will e-mail Dr. Ponseti back with this question but > does it sound like she needs more casting, or casting with a different > doctor (I would be willing to take her to Vancouver to see Dr. Pirani), or > just a different brace? > Maybe some of you veterans could help me figure this out. Meanwhile, I will > e-mail Dr. Ponseti to ask the same thing. > > Thanks so much! > > Halley > Btw, I tried to send pictures to the CFPics group but they are too large. > How do you shrink them again? > > > > _____ > > From: Roller, Joyce > Sent: February 13, 2006 8:25 AM > To: Halley Prestage > Subject: From Dr. Ponseti > > February 13, 2006 > > The pictures show the forefoot is hyperabducted and the big toe is short. > The transverse crease that seems to extend over 2/3 of the sole of the foot > I suspect was present even at birth. This type of foot often has a deep > crease on the back of the foot above the heel, but I don't see that Keira > has one. I wonder if the equinus is fully corrected. In the picture where > you are pushing up with your hand, the foot only goes to a right angle with > the leg. The other pictures show the heel is in slight valgus. It looks > like this was a complex atypical clubfoot which your doctor treated with > excessive abduction of the forefoot, which is a common error in the > correction of this type of clubfoot. > > This type of clubfoot does poorly with the Markell open toe lace up shoes. > Keira will be more comfortable and her feet will be held securely in the > three strap sandal type shoes made by Mr. . See his web site > mdorthopaedics.com E-mail mdortho@... > > The shoes should be in 20-30 degrees of outward rotation on the bar so the > forefoot can develop in proper alignment with the hindfoot. The > shoes > also appear helpful in stretching the heelcord. The shoes do not need to go > into 70 degrees of abduction since the hindfoot varus is corrected. > > I.V. Ponseti, M.D. > would you mind looking at Keira's foot? > > Good Afternoon Dr. Ponseti, > > I had e-mailed you a few months ago after we found out via ultrasound about > our daughter's clubfoot. We had considered coming to see you in Iowa but > because we have two other children under three years old, it would have been > quite difficult to arrange. > My daughter, Keira, was born on December 4 2005 with a right club foot. She > was casted at 10 days old with Dr. at the Children's Hospital > in Calgary, Canada. I did ask him all of the qualifying questions before we > began casting to ensure that he was adhering to the Ponseti Method of > treatment. We chose him because out of all of the doctors here in Calgary, > he was described as the " Ponseti-purist " by the head of orthopedics. > She received 6 casts including her tentomy cast. She started as a 6/6 on the > Pirani scale and Dr. scored her every week. She went into her shoes > and bar (Markells) on Wednesday and when Dr. evaluated her, she was > 0/6 on the Pirani scale so he said that her feet are fully corrected. > > Would you please take a look at the attached photos and give me your opinion > of her foot? I was concerned about a crease on the bottom of her foot on the > outside. It was present on Wednesday and Dr. didn't seem to think it > was a problem. My husband thinks it's just because they overcorrect the foot > to 70 degrees. > > I would be so thankful if you would take a look at the attached photos to > give me your opinion/evaluation of her foot and if it seems to be fully > corrected. > By the way, like so many others, I really appreciate all that you do for > these little babies and how you've pioneered this technique to help them > without surgery. You are a blessing to all. > > Thanks so much, > > Halley Prestage > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2006 Report Share Posted February 14, 2006 Halley, I would also be interested to see the photos, I'd like to see if I could pick up on what Dr. P was talking about. Are you subscribed to CFPics? You can send photos there as attachments since the photo space here is limited. Thanks, Tha > > Hailey, > > I would be interested in seeing the photos ... even if you just send > them directly to me. If Dr P is seeing what it sounds like he is, > then it is possible that she does have atypical ... but also, like you > said, Dr Morcuende said it looked good, makes me currious to see what > each of them is seeing. > > Angel > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2006 Report Share Posted February 14, 2006 Angel, I just wanted to add to what you are saying here. I think it is common even in non-atypical clubfoot for the over-abduction of the forefoot to occur. It is easy to do if the doctor is not 100% experienced in the handling of the bones. One of the reasons the Kite method never works quite right is because the doc is pushing the forefoot outward, yet the calcaneous remains jammed under the talus, thus resulting in a breach in the midfoot. > > > > Halley, > > I would do just what you mentioned, just ask Dr. P about the > > difference between what he and Morcuende are saying. I'm sure they > > will confer and get back to you. I'm just not sure from what Dr. P > > said if he is suggesting more casting or not. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2006 Report Share Posted February 14, 2006 Halley, It sounds to me like Dr. did the rotation of the calcaneous under the head of the talus correctly, if he hadn't her foot would not be well corrected at all. I agree, from what Dr. P is saying here, that no new casting should be needed right now. Talking to your doctor about consulting with someone else is usually something people really fret about but in most cases, especially since you are not in argument w/ Dr. about Keira's treatment, it turns out just fine. From what you've described about how detailed you've been with him, and how he has really explained things to you along the way, I don't imagine he would be offended at all, in fact, he will probably expect you to do so, lol! --- Halley Prestage wrote: > Hello, > > Here is the second e-mail I received from Dr. > Ponseti regarding Keira's > foot. I am going to send him some pics of her foot > at birth tonight plus > some additional shots of her foot and see what he > says. > > From his e-mail it sounds as if the brace > on a different angle > setting might be all that is needed. > I am quite hopeful that Dr. corrected her > foot properly, particularly > as it relates to the relationship between the talus > and the calcaneous. I > asked him to show me that the bones were in the > proper position and we went > through the tenotomy check list (I think pg 13 of > Global Help Booklet) > before he did the tenotomy. I asked him specifically > about the calcaneous > and the talus and he showed he the calcaneous must > come out from underneath > the head of the talus (or whatever it says in the > Global health book and > also in Dr. Dobbs article in Biomechanics- I can't > find my Global Health > book to reference but I did take it to the > appointment). > > Anyway, I think that Dr. will be open to > consulting with Dr. Ponseti. > We see him next week so I'll discuss this with him > then. Hopefully he > doesn't feel threatened or defensive that I sent > Ponseti the pictures. Any > ideas of how to approach it in a non-threatening > way? > Meanwhile, the impression kit is on it's way! Yeah! > > Thanks all of you for your help and feedback! > > Halley > > _____ > > From: Roller, Joyce > Sent: February 13, 2006 4:13 PM > To: Halley Prestage > Subject: RE: From Dr. Ponseti > > February 13, 006 > > Yes, I would like to see photos of Keira's foot at > birth. In the atypical > clubfoot at birth there is involvement mostly in the > calf muscle and the > deep plantar intrinsic muscles of the foot. Only > about 3-4% of all clubfeet > are atypical. Possibly your doctor has never > treated one before. The > turning in of the foot and ankle tends to correct > fairly easily but then the > forefoot goes into excessive abduction because the > metatarsals are bent > downwards and the ligaments and joints in the middle > of the foot are loose. > The tendo Achilles is tight and this was probably > corrected with the > tenotomy performed by your doctor. If there is > persistent tightness of this > tendon, it usually improves with time and the foot > hyperabduction also > improves in time with the use of the brace. > > > We have written a paper outlining the proper > treatment for the atypical > clubfoot which we hope will be published in Clinical > Orthopaedics and > Related Research. > Last year when I talked to Dr. Pirani about this, he > had not yet been called > upon to treat one. I think you should see Dr. > . When you get the > shoes, the right shoe should be turned out > 20-30 degrees but no > more. The foot will be nearly straight on the bar > so the metatarsus > adductus will improve. The left shoe should be in > about 30 degrees of > abduction as well. It would be best not to apply > another cast until you see > how the foot responds to the brace. > > Please encourage Dr. to contact me by phone > (319 356-3469) or > e-mail if he would like to discuss Keira's > treatment. > > I.V. Ponseti, M.D. > would you mind looking at Keira's foot? > > Good Afternoon Dr. Ponseti, > > I had e-mailed you a few months ago after we found > out via ultrasound about > our daughter's clubfoot. We had considered coming to > see you in Iowa but > because we have two other children under three years > old, it would have been > quite difficult to arrange. > My daughter, Keira, was born on December 4 2005 with > a right club foot. She > was casted at 10 days old with Dr. at > the Children's Hospital > in Calgary, Canada. I did ask him all of the > qualifying questions before we > began casting to ensure that he was adhering to the > Ponseti Method of > treatment. We chose him because out of all of the > doctors here in Calgary, > he was described as the " Ponseti-purist " by the head > of orthopedics. > She received 6 casts including her tentomy cast. She > started as a 6/6 on the > Pirani scale and Dr. scored her every week. > She went into her shoes > and bar (Markells) on Wednesday and when Dr. > evaluated her, she was > 0/6 on the Pirani scale so he said that her feet are > fully corrected. > > Would you please take a look at the attached photos > and give me your opinion > of her foot? I was concerned about a crease on the > bottom of her foot on the > outside. It was present on Wednesday and Dr. > didn't seem to think it > was a problem. My husband thinks it's just because > they overcorrect the foot > to 70 degrees. > > I would be so thankful if you would take a look at > the attached photos to > give me your opinion/evaluation of her foot and if > it seems to be fully > corrected. > By the way, like so many others, I really appreciate > all that you do for > these little babies and how you've pioneered this > technique to help them > without surgery. You are a blessing to all. > > Thanks so much, > > Halley Prestage > > > [Non-text portions of this message have been > removed] > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.