RE: Re: Dorsiflextion

February 14, 2006

Hi Faith,

I was just curious why the s are so superior when dealing with an

atypical club foot? Is it just how securely they hold the feet?

I really didn't even consider that Keira might have an atypical clubfoot

until Dr. Ponseti suggested it in an e-mail. They didn't seem very fatty or

stubby or anything like that. What else makes is atypical?

Thanks,

Halley

Re: Dorsiflextion

Hi ! I agree with both Kori and Naomi. His foot doesn't look

quite corrected yet. Needs more dorsiflexion...and it looks like

that Anterior tendon is really pulling that foot up and in right now

too. More casting is always the safest way to go. Your are SOOO

doing the right thing there! A couple more questions (I have to

ask). Your son's foot looks a bit thick to me. Can you tell if your

son has a crease that runs horizontal across the sole of his foot...

or perhaps residual creases on the inside-middle of his foot? Does

his big toe tend to point up like that all the time?

We too experienced this with our son. However, he has atypical cf.

Because his foot was so fat... and his arch so high the actual

degree of dorsflexion was deceptive. He never had to have second

tenotomies, but he will be in the 's for the duration of his

bracing. Markell's will never... well, with very few

exceptions...work with atypical feet. Anyway... will shut up now

and wait for your next postings.

Faith

> Hi guys.. i finally was able to post picsof Jakes foot. Just a

> reminder.. this was my initial post..

>

> My son was born with clubfoot of the right foot. He went thru the

> Ponseti casting, and then issued the Denis Browne Bar and shoes. We

> could not get that boy to keep those shoes on for more than a few

> hours no matter how or what we tried. For over a month, we tried so

> many different things. His foot started turning back in, so the

> orthopedist started the casting again. After 2 additional weeks,

the

> casting was relieved and a foam mold was taken of his feet for a

> special pair of new sandals Dr Ponseti just came out with. They get

> fitted next Friday.. My only concern is, the reason we couldnt (and

> unfortunately still cant) get his shoes to stay on him, is that his

> foot wont go flat enough against the bottom of the shoes. His heel

> stays close to the top of the shoe, making it very easy for him to

> pull his foot out. I cant bend his foot up enough to make it

> completely flat. I dont know if i should request the casting be

> restarted (yet again...) or perhaps opt for surgery. (which i want

> to stay away from.. i've heard too many horror stories about kids

> and adults getting this procedure only to have pain for numerous

> years.) I feel like I am at fault for not being dillegent enough,

> though i have tried and tried.. everytime the shoes do get put on

> him, he cries so much he passes out, only to wake up an hour later,

> in pain and i assume with cramps in his feet, and starts screaming

> again.. a mother can only handle so much..i feel like a bad parent

> for intentionally causing her baby so much undeserved pain..

>

> Somebody please off some advice, as i am at my wits end.

> Rowe

>

February 15, 2006

Well, several reasons.... Several atypical feet are VERY fatty... little sausage

feet. Gabe has very big feet for clubfeet, but many of these feet are REALLY

short. Also, the heels tend to be hidden under a lot of fat. Many of these feet

have limited dorsilexion at first. Often the big toes tend to stick up inthe

air... or appear separate from the rest of the foot. Then there are the plantar

or cavus issues.... The feet tend to have ridiculously high, misalligned arches.

This causes the horizontal crease and transverse crease in the middle of teh

sole of the foot and teh middle outside of the foot. They also, which your

daughter apparently doesn't have, tend to have extra creases in the lower 1/3 of

the calf.

The 's help to reallign the arch. The middle strap must be worn very

tightly. This literally pulls down the arch. Gabe's cavus issues couldn't be

well corrected with casting for instance. Today Gabe's arches are very well

corrected. Often the excess fatty/connected tissue prevelent with these feet

don't allow a good fit inteh Markell's. The feet easily slip out and/or form

blisters. Then there is the issue of dorsiflexion. The 's are made so

that a foot with 0 degress dorsiflexion can be worn comfortably because the foot

is able to sit flat in the shoe and the heel counter doesn't rub against the

back of the leg or the heel... Eventually, (ideally) the tendon stretches and

the foot is able to move back into the heel counter. This could not happen with

the Markell's. And, of course, the 's are custom made to the width and

shape of your childs foot. Feet don't slip out of these shoes. ... no matter how

fatty.. no matter how high teh arch is... no matter where

your childs foot is in dorsiflexion (provided it is at at least 0 degrees).

Many typical cf parents are beginning to orderthem simply because they are more

comfortable...and user friendly. They are easy to put on... take off. I've never

heard of any significant adjustment period from any child using these for the

first time...certainly nothing like with the Markell's. The Markell's are

fine...and certainly less expensive... for typical, well, corrected cf, but they

simply don't work well AT ALL with feet that are even slightly atypical. I,

personally, have only know one child who could wear them. This child's feet were

not fatty and the child had sufficient dorsiflexion so that the heel rested were

it should in the Markell's. It's just a good idea not the waste time or money...

or possibly lose correctio nshould your daughter NEED 's.

Well, it's so late... and my poor brain is shutting down. I hope this helps

some. It would be helpful to see pics of Keira's foot so that I might see what

Dr P thinks would keep you out of MArkell's. You can send them directly to me if

you like.