new to the markells and brace

[Guest guest]

Hi

My son, Ethan, has been in the markells and brace for a week and is

still finding it pretty stressful. The occurrence of a blister on his

heel within the first 24 hours did little to help the introduction. The

blister has been treated with duoderm tape, a larger hole cut in the

back of the boot to relieve the pressure, and ensuring that the heel is

down in the boot.

Despite treating the blister, he still seems frustrated by the

restriction presented by the boots. He tenses up as I put the boots on

him, is prone to having the occasional rigid fit. I think things are

improving as he adjusts, but it is pretty horrible to see him unhappy.

Thought you guys might have some tips as to how to help him relax

whilst fitting and wearing the boots?

Cheers

Colette

Melbourne, Oz

[Guest guest]

Collette,

Who is Ethan's doctor? We've had some issues in the past with the

doctors in Australia not following the proper bracing protocol...in

the end the parents have had to get educated and demand what they

want for their child.

Have you seen the tips and tricks document? Do you know how to

check for the proper width of the shoes and ensuring that the

outward rotation of the shoes (abduction) is correct?

Do you have access to a digital camera or a way to share pictures of

Ethan's feet and brace with us on the yahoo group CFPics?

This is the fastest way for us to help you troubleshoot the issues!

Hold the brace up to his back and see how far apart the shoes are.

The inside edges of the heels of the shoes should be at the same

distance as the width of his shoulders. This is minimum width. Max

width would be that the center bolts where the shoes attach are at

shoulder width. Most kids are happy (comfortable) at some spacing

between these two points. Shoe on the clubfoot should be at a 70

degree angle for abduction if this is how the last cast was rotated

as well.

There are pictures articles and links under the bracing section

here: http://members.tripod.com/ponseti_links-ivil

& (3-16-00, left clubfoot)

>

> Hi

> My son, Ethan, has been in the markells and brace for a week and

is

> still finding it pretty stressful. The occurrence of a blister on

his

> heel within the first 24 hours did little to help the

introduction. The

> blister has been treated with duoderm tape, a larger hole cut in

the

> back of the boot to relieve the pressure, and ensuring that the

heel is

> down in the boot.

>

> Despite treating the blister, he still seems frustrated by the

> restriction presented by the boots. He tenses up as I put the

boots on

> him, is prone to having the occasional rigid fit. I think things

are

> improving as he adjusts, but it is pretty horrible to see him

unhappy.

> Thought you guys might have some tips as to how to help him relax

> whilst fitting and wearing the boots?

>

> Cheers

> Colette

> Melbourne, Oz

>

[Guest guest]

Collette,

The feet do look too close together to me. The easiest way to measure

this is by holding the shoes up to his back, there's a picture of this

in the tips document, you can download it from 's site here:

http://members.tripod.com/ponseti_links-ivil/sitebuildercontent/sitebuilderfiles\

/fab_tips_10_05_05.pdf

The other problem is the degree of abduction. If Ethan's last cast

was set at 45 degrees then that's where his shoes should be set at, so

that part should not be causing him discomfort. I would most

definitely ask Dr. Patel about that, I have heard that he is not fully

abducting and I find it odd, considering all his training. What I

learned when I went to the symposium in Iowa last year was that this

degree of abduction is not only found to be the most successful for

avoiding relapses (per Dr. Ponseti's studies), but it is also very

important for creating a normal range of motion in the foot. If the

foot is not fully abducted to 70 degrees then as it gradually drifts

back over the next few years the child will lose flexibility and not

be able to turn the foot as far out as a normal foot; i.e. The full

range of motion of a normal foot is about 45-50 degrees so if you only

abduct to 45 degrees to begin with, then as time passes the foot will

lose some of that abduction, and may only be able to move out a few

degrees if at all.

The other thing I see in the photos is that either Ethan's left shoe

is way too big or his heel is rising up. The right foot looks like

his toes are right where they need to be, but on the left you can't

even see his toes. Poorly fitting shoes will cause him to be

uncomfortable, plus if he is slipping around in the shoe then he will

get blisters, slip out of the shoes entirely and possibly lose

correction. If his feet are two different sizes you need to make the

orthotist split sizes and give you the correct size for both feet!

I hope this helps, hang in there and we'll keep at it until we get

Ethan comfortable. : )

Mom to Jenna (4/7/01) & Sammy (9/25/04, RCF, Dobbs' brace, 14hrs/day)

>

> Hi

>

> Thanks for your response. I have taken 2 photos and placed them on

the site

> in the folder Ethan B. I think the inside heel is in line with the

> shoulders. Initially the orthotist had it too wide, but I think it is ok

> now. What do you think?

>

> Ethan's doctor is Dr Patel. The left foot is the club foot, however both

> feet are at 45 degrees (as opposed to 70 degrees for the club foot).

I need

> to ask Dr Patel why it is not set at 70, but given that the casting only

> went to 45 degrees I can't reset the brace. I think you're correct in

> thinking that the problem is something to do with the brace, but I

assume

> that the 45 degrees would not create discomfort?

>

> Advice/comments appreciated

> Colette

>