Re: FW: From Dr. Ponseti

February 13, 2006

Hi Halley,

After getting a reply like that from Dr. Ponseti, I personally would

want her foot seen by a very experienced Ponseti doc and Pirani is

definately that. I know that you had planned to come to see him if

there was ANY question about her feet, at least you have thought

about it already, probably makes the thought of the trip a bit easier.

You may want to call your orthotist and get the ball rolling on

getting her the shoes ordered before you come to Vancouver

so that they will be ready after Dr. Pirani casts her. I would think

that it would only be one or two casts at the Most to get her fully

corrected. He is back at the end of the month, just give a call

to find out when and to get Keira in asap.

So sorry that you guy's are gonna have to make the long trip but it

will be well worth it to get her foot perfect! Know that you already

know this though =)

Make sure you let me know when you are coming out so we (and

& Hayden) can get together =). I know that I am kinda just assuming

that you'll be coming but I am pretty sure that it's a given.

Hugs,

& Grace

>

> 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

>

February 13, 2006

Dr. Morcuende is great and all, but he isn't Ponseti yet:)! If Ponseti thinks

there is still some issues that need tending to, chances are, he's right. I

don't know about shrinking the pics... I have the same problem. I'd email Dr

Ponseti again. Tell him wha tDr Morcuende said... Maybe they can confer

together.

Halley Prestage wrote: 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

February 13, 2006

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.

For re-sizing photos you can use the Microsoft Photo editor - should

be on your system if you have Office installed. Look for it in the

Microsoft office tools in the list of programs. In this program look

for " Image " on the menu, then choose " resize " . Usually if you make it

about 50% of the original size it will be small enough to go through.

The other program that should be on EVERY PC is Paint. Look in the

programs list for " accessories " , it should be there. Open the photo

in this program and go to " image " then " stretch/skew " . You just have

to be sure you are reducing the with by the same amount as the height

otherwise your photo will indeed be stretched.

The program Kori recommends is at www.irfanview.com - It is a free

download and can be used for working with your photos for other things

besides resizing. It's pretty slick for a free program.

allison

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

>

February 13, 2006

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

February 13, 2006

That is another thing I meant to mention ... if the heel is actually

corrected, then more casting may or may not be called for, depending

on the state of the midfoot. If she does have atypical, but the arch

is down, then the only thing that can be done is reduce the exterior

rotation to allow the forefoot to come back into line by itself. If

the arch is still in the wrong position, then it has to be manipulated

into the right position before the forefoot can be brought back

around. I wish like heck I knew exactly what Dr P did when he casted

Kai's foot, because he made it perfect, then those darn shoes screwed

it up again, and Dr Mosca was never quite able to get it back just

right again until recently

Like he said, bringing the forefoot around too much is a common

mistake in dealing with a natural atypical foot. This is how Dr Mosca

messed Kai's foot up so much at first. Know how it happens? By

following the protocol correctly! So, if this ends up being the case

for you guys, you will at least know that the doctor was doing

things " right " ... just wrong for you

Angel

>

> 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.

February 15, 2006

I agree with Faith that a conference would be helpful. Pictures are pictures

and they are not always looked at the same way. Dr. Ponseti saw pictures of our

son's foot back in Sept. and he thought they looked atypical and not fully

corrected. We saw our doctor who said everything was fine. Then, on Feb. 3, we

went to see Dr. Ponseti. He said 's feet were perfect. Guess we aren't

good photographers.

If you could get them to look at the pictures together, they would be able to

work together on it.

1/19/04

faith slattery wrote: