Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 , There isn't any set protocol for reducing hours for the children who get a later start with the FAB. My son was about 8 months old after his tenotomies and we did a modified reduction schedule so that he spent a little less time in each " bracket " . Our doctor (with Dr Ponseti concurring) felt that some extra time on his feet every day would do him more good than extra time in the FAB. We worked slowly from 23/7 to 16-18/7 over a period of about 5 months. We kept him in the FAB at least 16 hours a day (and closer to 18 most days) until he had been walking for a few months--which didn't happen until he was nearly 15 months old, even though he had been cruising for months... At that point, we went down to 14/7. Now, at 2.5, he's in the FAB a good 13 hours every day. He can walk in his FAB (Markells with red bar), climbs onto and off of things, even tried to climb a ladder recently (heart attack city!). While I understand the impulse to want to decrease the hours in the FAB as much as possible when your little guy is learning to stand and walk, I'd caution you against doing that too quickly. For one thing, even children who started with the Ponseti method as newborns shouldn't be doing the night-time (12-14 hours a day) wear until they are walking. With Jonah, we made sure that his time out of the FAB during the day would be when he was most active. We never had a hard time doing the longer hours--and Jonah never seemed to mind. Hope this helps some. Naomi The Family Naomi Hannah(2/21/1) Jonah(6/20/3, corrected bilateral clubfoot, FAB 12-14/7) artlovr wrote: will be done with the 3 months of 23/7 in a month. At that time he will be nearly 10 months old and his doctor says he will probably be able to go down to 12-14 hours/day. There was an email the other day addressing this and I have a couple of questions. I understand the theory that too much freedom all at once may make it difficult to get the shoes on at night and to sleep through the night but does some of that just depend on your child and their temperment? The schedule to follow in reducing hours that was posted is for a baby who starts the Ponseti method at birth. What about a baby who starts later and is bearing weight a lot by the time they are finished with the first three months in the FAB? I would be interested in hearing anyone's experience with an older baby in reducing the hours. Thanks, and (6-19-05 FAB 23/) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 , I agree with what you are saying here in principle, and it does vary greatly depending on the child and his temperment. The theory behind the dropping hours slowly generally gets one to about the age the child will be walking around the time they are down to 12-14 hours/day, thus coinciding with the baby spending more time weight bearing and walking and doing what nature intended for feet, rather than needing to be in the brace to do it. Since will be 10 months I would think that you would be safe to do an accelerated reduction, one month at a time, gradually reducing his hours until you arrive at 12-14 around the time he is 1 and/or starts walking. I just so hate to hear that people are going immediately from 23/7 to 12-14 because it does cause so many problems. Not that every baby has this problem, but I think mostly, it pays to be safe, doing the longer hours while they are still mostly crawling and not getting the weight bearing time in. My son was still doing 16-18 up until 15 months because he had not started walking yet and Dr. Dobbs and I felt it was better to keep doing the longer hours until he was really getting around on his feet instead of his knees. Hope this helps, > > will be done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Naomi, Thanks. I am sure won't have a problem being in the FAB longer than 12-14 hours when he is 10 months. It seems wise to decrease gradually, though maybe not as gradual as with a younger baby and as said, depending on the baby and their flexibility. will be done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Kelsey was 15 months old when she got out of her FAB 23/7. We went straight to 12-14 hours (nights only) and have had no problems. Kelsey had been cruising etc for several months before she went into the FAB 23/7 and that was difficult but the freedom was great for Kelsey. She was ready to walk, which she did about 4-6 weeks later. I think some of it may depend on the temperament of your child. Jenni artlovr wrote: will be done with the 3 months of 23/7 in a month. At that time he will be nearly 10 months old and his doctor says he will probably be able to go down to 12-14 hours/day. There was an email the other day addressing this and I have a couple of questions. I understand the theory that too much freedom all at once may make it difficult to get the shoes on at night and to sleep through the night but does some of that just depend on your child and their temperment? The schedule to follow in reducing hours that was posted is for a baby who starts the Ponseti method at birth. What about a baby who starts later and is bearing weight a lot by the time they are finished with the first three months in the FAB? I would be interested in hearing anyone's experience with an older baby in reducing the hours. Thanks, and (6-19-05 FAB 23/) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Hi - hurray for the reduction in hours! I think it will be awhile for Hayden - I'll find out tomorrow as we are seeing Dr. Pirani then. He didn't give us any instruction when we transferred to the shoes (probably because the circumstances were weird and he forgot), so I am going to ask him about it. Let me know how it goes for when he is out of them for the day - I long for the day I can get Hayden into a shopping cart! artlovr wrote: will be done with the 3 months of 23/7 in a month. At that time he will be nearly 10 months old and his doctor says he will probably be able to go down to 12-14 hours/day. There was an email the other day addressing this and I have a couple of questions. I understand the theory that too much freedom all at once may make it difficult to get the shoes on at night and to sleep through the night but does some of that just depend on your child and their temperment? The schedule to follow in reducing hours that was posted is for a baby who starts the Ponseti method at birth. What about a baby who starts later and is bearing weight a lot by the time they are finished with the first three months in the FAB? I would be interested in hearing anyone's experience with an older baby in reducing the hours. Thanks, and (6-19-05 FAB 23/) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 I wanted to add that those baby's parents who have reported here that they had difficult adjustment by dropping to nights only were much younger than Kelsey. The infants seem to have a particularly difficult time with sleeping, I'm sure much due to the fact that they're infants lol. I wonder if that was part of your success as well though? Some kids are obviously going to be more easy going than others and tolerate this fine. Personally I don't like the trend, and I think it's detrimental to other docs getting the success the Ponseti Method deserves when and if... they have relapses or intolerance as a result. Then of course, it's all about how the Ponseti Method didn't work. When it wasn't the Ponseti Method at all. In an older child's situation, of course even Dr. Ponseti will trim the reduction schedule and he's even been tweaking with it for certain feet in ways we haven't yet seen. But can in no way see that he would he drop a child to nights only after 23/7, especially in an infant. I think what is important to remember is that we're playing a lottery with these feet. Some will relapse. Some will not. They cannot tell which feet will do this, as Dr. Morcuende told me recently. I think this data will be published in the bracing term and relapse paper that is being presented next month. Here is a quote from a recent email where he explains bracing and relapse a bit. " With respect to bracing in general, the paper by Dr. Ponseti in Journal Joint Boen Surgery, 1963 discussed the need for bracing beyond 2 years since he saw about 60% relapses if not used. In our paper in Pediatrics in 2004, we did recommend to use the brace until about 4 years of age, and we observed a decrease in relapses to about 10%. We are presenting a paper at the Am Acad Orthop Surgery next month in chicago about the natural history of relapses in clubfoot. " what he didn't say here that I think is important is the actual numbers he will be publishing. Previously he'd written this to me: " With regards to the brace, I just finished a study evaluating all patients in the last 50 years (we are actually writing the paper now). Relapses can be seen up to the age of 10 years of age, although they are very rare this late. the numbers you should remember are: 95% chance of relapse chance in 1st year of life (if no brace); 70-80% in 2nd year; 30-40% in 3rd year, 10-15% at 4th year, and 5% afterwards until 10 or so. Unfortunately, there are no signs that will help us to know who is going to relapse or not. So, we recommend to use the brace 10-12 h/day as long as possible, even getting to the 5th year (if the kid tolerates it). " And as we roll on into another topic with this... sorry. I really meant to say that no one knows which feet will relapse. For me... The brace is our insurance premium. We could pay premiums for 50 years and never have to use insurance. We could get really lucky... (or unlucky as the case would then be, having spent hundreds of thousands of dollars for NOTHING! lol...) and be the one who didn't need it, like the kids who are able to do the modifications and come through with flying colors. But if we hadn't paid the premiums and per chance... (since we don't know who is going to get T-boned by a drunk driver) something bad happens we're darn happy we paid the premium that month. This is kinda how I think of it and if that means a bit of caution for a few years... ok. I'm doing it. I'm going to pay the premiums because they're really, really cheap :~} Not right or wrong, and am not in any way saying reducing like that wasn't the right thing to do for you and Kelsey. You know I love you! There's very definitely something to be said about using these great feet as much as they can. I really think it's done wonders for Darbi... this walking, bending, playing... using it and being able to do anything she wants never knowing her foot was a mess at birth... yeah, that's cool! Kori At 03:53 PM 2/27/2006, you wrote: >Kelsey was 15 months old when she got out of her FAB 23/7. We went >straight to 12-14 hours (nights only) and have had >no problems. Kelsey had been cruising etc for several months >before she went into the FAB 23/7 and that was difficult but the >freedom was great for Kelsey. She was ready to walk, which she did >about 4-6 weeks later. I think some of it may depend on the >temperament of your child. > > Jenni > > >artlovr wrote: will be >done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 ahhh... just make dh do the shopping :~} Kids and grocery stores... talk about pulling my hair out! lol Do they have those carts at your stores where the kids can sit in a plastic *car* or something and the basket is out front? Big bulky things, but they love them. He might be to little still though... One good thing about the gold bars... they really do make all that much easier. I hope we get some quick release stuff on the new shoes soon. I feel for poor , we want it and we want it all NOW! lol... he's only been making these for a couple of years, there's going to be some changes coming and someday they'll be looking at our old PM's and wonder how we managed with them hehe... I love that you ended up with a good experience with the Markells. They are not *bad* shoes for most babies once you figure them out. Not all problems are going to be corrected with switching to PM's if correction is at the heart of the issue. I would hate for them to get any negativity from people or physicians expecting miracles for improper Ponseti correction. Your experience clearly shows that it's the foot, not the evil bad Markells :~} Kori At 09:14 PM 2/27/2006, you wrote: >Hi - hurray for the reduction in hours! I think it will >be awhile for Hayden - I'll find out tomorrow as we are seeing Dr. >Pirani then. He didn't give us any instruction when we transferred >to the shoes (probably because the circumstances were weird and >he forgot), so I am going to ask him about it. Let me know how >it goes for when he is out of them for the day - I long for >the day I can get Hayden into a shopping cart! > >artlovr wrote: will be >done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Kori, I do agree that part of our success with dropping earlier was that Kelsey was older. It probably would have been more difficult to make such an abrupt change when she was an infant and I never would have reduced so quickly had she been older. Kelsey, at 15 months old, was so ready to walk and it was the best decision for her especially since before her Ponseti treatment, she would not weight bear at all on her clubfoot. She would drag it behind her like dead weight. Once she started walking though, there is no stopping her. I also believe that her brace is like an insurance policy. Since we got it, it has been a non-negotiable point in our house. She wears it every night and with only a few exceptions, she wears it 12-14 hours. No offense about anything taken Kori. I should have clarified better in my original response. Jenni frogabog wrote: I wanted to add that those baby's parents who have reported here that they had difficult adjustment by dropping to nights only were much younger than Kelsey. The infants seem to have a particularly difficult time with sleeping, I'm sure much due to the fact that they're infants lol. I wonder if that was part of your success as well though? Some kids are obviously going to be more easy going than others and tolerate this fine. Personally I don't like the trend, and I think it's detrimental to other docs getting the success the Ponseti Method deserves when and if... they have relapses or intolerance as a result. Then of course, it's all about how the Ponseti Method didn't work. When it wasn't the Ponseti Method at all. In an older child's situation, of course even Dr. Ponseti will trim the reduction schedule and he's even been tweaking with it for certain feet in ways we haven't yet seen. But can in no way see that he would he drop a child to nights only after 23/7, especially in an infant. I think what is important to remember is that we're playing a lottery with these feet. Some will relapse. Some will not. They cannot tell which feet will do this, as Dr. Morcuende told me recently. I think this data will be published in the bracing term and relapse paper that is being presented next month. Here is a quote from a recent email where he explains bracing and relapse a bit. " With respect to bracing in general, the paper by Dr. Ponseti in Journal Joint Boen Surgery, 1963 discussed the need for bracing beyond 2 years since he saw about 60% relapses if not used. In our paper in Pediatrics in 2004, we did recommend to use the brace until about 4 years of age, and we observed a decrease in relapses to about 10%. We are presenting a paper at the Am Acad Orthop Surgery next month in chicago about the natural history of relapses in clubfoot. " what he didn't say here that I think is important is the actual numbers he will be publishing. Previously he'd written this to me: " With regards to the brace, I just finished a study evaluating all patients in the last 50 years (we are actually writing the paper now). Relapses can be seen up to the age of 10 years of age, although they are very rare this late. the numbers you should remember are: 95% chance of relapse chance in 1st year of life (if no brace); 70-80% in 2nd year; 30-40% in 3rd year, 10-15% at 4th year, and 5% afterwards until 10 or so. Unfortunately, there are no signs that will help us to know who is going to relapse or not. So, we recommend to use the brace 10-12 h/day as long as possible, even getting to the 5th year (if the kid tolerates it). " And as we roll on into another topic with this... sorry. I really meant to say that no one knows which feet will relapse. For me... The brace is our insurance premium. We could pay premiums for 50 years and never have to use insurance. We could get really lucky... (or unlucky as the case would then be, having spent hundreds of thousands of dollars for NOTHING! lol...) and be the one who didn't need it, like the kids who are able to do the modifications and come through with flying colors. But if we hadn't paid the premiums and per chance... (since we don't know who is going to get T-boned by a drunk driver) something bad happens we're darn happy we paid the premium that month. This is kinda how I think of it and if that means a bit of caution for a few years... ok. I'm doing it. I'm going to pay the premiums because they're really, really cheap :~} Not right or wrong, and am not in any way saying reducing like that wasn't the right thing to do for you and Kelsey. You know I love you! There's very definitely something to be said about using these great feet as much as they can. I really think it's done wonders for Darbi... this walking, bending, playing... using it and being able to do anything she wants never knowing her foot was a mess at birth... yeah, that's cool! Kori At 03:53 PM 2/27/2006, you wrote: >Kelsey was 15 months old when she got out of her FAB 23/7. We went >straight to 12-14 hours (nights only) and have had >no problems. Kelsey had been cruising etc for several months >before she went into the FAB 23/7 and that was difficult but the >freedom was great for Kelsey. She was ready to walk, which she did >about 4-6 weeks later. I think some of it may depend on the >temperament of your child. > > Jenni > > >artlovr wrote: will be >done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Still a month ago until the reduction but I am looking forward to the next step. is in the gold bar so it has been relatively easy to undo onside, put him in the shopping cart and reattach the bar but this week when I have been a hurry, I have plunked him in the big part of the basket and he seems to have enjoyed himself there, too, playing with the cans and squishing the bread. I think that will work until he stands up in the cart. When I went in to get him up this morning, he was standing up in his crib. will be done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Hi , I'm the one who posted that information, and yes, it is detailed for a child from birth as that's about how it works out. Generally... But it is true that some older children will blow through that schedule a lot quicker. Still, I'm pretty darn sure that going from 23/7 to 12-14 is a no-no. They do need the time in the brace to both maintain correction properly and to keep them used to it long term. They really don't *need* a full day out of the brace to be able to learn to stand and walk, climb, etc. They can do this in the brace just fine. Personally I've seen a lot of extra abilities coming to Darbi from wearing her brace. She's got excellent balance and is very agile. She gets around really well and does amazing things in her brace, walking on her own and even hopping. I'm thinking I may have an Olympic Snowboarder here if I put the $ into taking her to the mountain ($$$$, still not decided IF I will even try lol). The reason I kept Darbi at the longer hours past the time she was walking because it was SOOOO early. Everyone else on the lists was waiting till walking at a much older age and I felt that it was the best for Darbi if she continued her longer hours for a while longer even though she was walking. It was only 16hr/d anyway, not like I was doing *that much* more by adding the extra hours for a few months, at least not that much more for her. The extra 2hr often just happened anyway as she'd fall asleep for morning nap and at that point... what is the need to take it off just because the time is up? KWIM? I think if I were in your position, that dropping to 16hr (call it 16-18 or 14-16 with emphasis on hard 16 any day you *can get it in* - you pick) now would be just fine and I'd do it. Find the times that work for you to get the hours in and do what works for you. The main reason I stress long hours is that it is just so much easier to do them when baby is young... the alternative could be relapse and back to long hours at the age of 3 which isn't so easy. Insurance premiums paid now (analogy of course) probably will pay off in the long run and they're cheaper at this age than when babe is older. We've had too many parents come here after relapse at older ages and talk about how they wished they'd not discarded or reduced way back when... HTH Korio At 06:37 AM 2/27/2006, you wrote: > will be done with the 3 months of 23/7 in a month. At that time >he will be nearly 10 months old and his doctor says he will probably be >able to go down to 12-14 hours/day. There was an email the other day >addressing this and I have a couple of questions. I understand the >theory that too much freedom all at once may make it difficult to get >the shoes on at night and to sleep through the night but does some of >that just depend on your child and their temperment? The schedule to >follow in reducing hours that was posted is for a baby who starts the >Ponseti method at birth. What about a baby who starts later and is >bearing weight a lot by the time they are finished with the first three >months in the FAB? > >I would be interested in hearing anyone's experience with an older baby >in reducing the hours. > >Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 Kori, Thanks. I think aiming for 16 hours in the beginning is a reasonable compromise. He is developing so fast since he has been in the shoes, it is neat to see what he can do with them on. One of my husband's aunts was so worried that he would be totally incapaciated with them on and would only be able to sit and lie around. I can't wait for her to see him and what he can do! Today he even took a few steps in them and he is only 8 and a half months. (He had pulled up on the sofa and his feet were too far away so he " walked " them closer.) And I know what you mean about the snowboarding. I am thinking that the next time someone askes in the store what kind of shoes he has, I will tell them we are training him for snowboarding in the 2022 Olympics. 6-19-05 FAB 23/7 > > will be done with the 3 months of 23/7 in a month. At that time > >he will be nearly 10 months old and his doctor says he will probably be > >able to go down to 12-14 hours/day. There was an email the other day > >addressing this and I have a couple of questions. I understand the > >theory that too much freedom all at once may make it difficult to get > >the shoes on at night and to sleep through the night but does some of > >that just depend on your child and their temperment? The schedule to > >follow in reducing hours that was posted is for a baby who starts the > >Ponseti method at birth. What about a baby who starts later and is > >bearing weight a lot by the time they are finished with the first three > >months in the FAB? > > > >I would be interested in hearing anyone's experience with an older baby > >in reducing the hours. > > > >Thanks, > > and (6-19-05 FAB 23/) > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 We were a little older than normal - Meir was about 8 months old when we found Dr. Tuck and got the right casting, tenotomy, etc. I don't have everything in my Palm Pilot, but based on the appointment dates I think it was about 6 weeks at 23/7 (which unfortunately was rarely 23 but as close as we could get it) and then straight to 12/7 (at not quite a year old). On the 12/7 it got to be easier for me (my wife has yet to successfully put the shoes on - she long ago stopped trying) to put them on during the day so he would sleep better, and he got quite good at crawling around and having fun wearing them until two things happened. First, he started working his feet out - which ultimately we were able to stop with the FAQ document and the right size bar. Second, Dr. Tuck was very upset at us - he wanted the " out of shoes " time to be the awake time so he could learn to walk. So we (with the help of the FAQ) did switch it to nighttime - and that's where he's been at for several months now. He started walking at about 17 months - or was it 19 months? In any case, he cruised for a long time before he walked, and even climbed up the playset and went down the slide long before he walked. As far as late walking, we're not in the least concerned about that - Dr. Tuck said we don't need PT or anything - just keep the shoes/bar on at night for hopefully the next year. (He'll need speech since he's not talking yet, but that has nothing to do with his club foot!) - Seth (meir, lcf, 1/29/04, fab 12/7) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 A gradual reduction doesn't mean it has to last for months, kwim? So if you you wanted to err on the side of caution to avoid potential sleep issues, you could gently reduce the hours over a period of say, a couple weeks? will be done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2006 Report Share Posted February 28, 2006 HI Our son Ethan finished with is boots and bars full time wear at 9 and 1/2 months and we see Naomi in Manchester UK she's a Ponseti listed doctor and really knows her stuff. Anyhow we went from 23/24 down to 20/24 for approx 8 weeks and then down to 18/24 at the moment. When I last spoke to her she said we could gradually reduce our hours down to 14 over the next 5 -6 weeks. However when I sais that on this site I'd heard via the emails posted from Dr Ponseti 14 hours wasn't recommended until the child is walking she straight away said to go with Dr Ponseti after all he says 'is the law' in these matters! I find that with Ethan at 18 hours we have from about 10-12 out then he has a nap and then he has them off again 2.30-6.30pm by which time he's had his bath and is getting ready for bed. I really don't find Ethan seems held back by his bars. He crawls, stands and moves in them as much on as off and if it keeps his little feet perfect I'm just happy to do it! Hope this helps Kathy --- frogabog wrote: --------------------------------- I wanted to add that those baby's parents who have reported here that they had difficult adjustment by dropping to nights only were much younger than Kelsey. The infants seem to have a particularly difficult time with sleeping, I'm sure much due to the fact that they're infants lol. I wonder if that was part of your success as well though? Some kids are obviously going to be more easy going than others and tolerate this fine. Personally I don't like the trend, and I think it's detrimental to other docs getting the success the Ponseti Method deserves when and if... they have relapses or intolerance as a result. Then of course, it's all about how the Ponseti Method didn't work. When it wasn't the Ponseti Method at all. In an older child's situation, of course even Dr. Ponseti will trim the reduction schedule and he's even been tweaking with it for certain feet in ways we haven't yet seen. But can in no way see that he would he drop a child to nights only after 23/7, especially in an infant. I think what is important to remember is that we're playing a lottery with these feet. Some will relapse. Some will not. They cannot tell which feet will do this, as Dr. Morcuende told me recently. I think this data will be published in the bracing term and relapse paper that is being presented next month. Here is a quote from a recent email where he explains bracing and relapse a bit. " With respect to bracing in general, the paper by Dr. Ponseti in Journal Joint Boen Surgery, 1963 discussed the need for bracing beyond 2 years since he saw about 60% relapses if not used. In our paper in Pediatrics in 2004, we did recommend to use the brace until about 4 years of age, and we observed a decrease in relapses to about 10%. We are presenting a paper at the Am Acad Orthop Surgery next month in chicago about the natural history of relapses in clubfoot. " what he didn't say here that I think is important is the actual numbers he will be publishing. Previously he'd written this to me: " With regards to the brace, I just finished a study evaluating all patients in the last 50 years (we are actually writing the paper now). Relapses can be seen up to the age of 10 years of age, although they are very rare this late. the numbers you should remember are: 95% chance of relapse chance in 1st year of life (if no brace); 70-80% in 2nd year; 30-40% in 3rd year, 10-15% at 4th year, and 5% afterwards until 10 or so. Unfortunately, there are no signs that will help us to know who is going to relapse or not. So, we recommend to use the brace 10-12 h/day as long as possible, even getting to the 5th year (if the kid tolerates it). " And as we roll on into another topic with this... sorry. I really meant to say that no one knows which feet will relapse. For me... The brace is our insurance premium. We could pay premiums for 50 years and never have to use insurance. We could get really lucky... (or unlucky as the case would then be, having spent hundreds of thousands of dollars for NOTHING! lol...) and be the one who didn't need it, like the kids who are able to do the modifications and come through with flying colors. But if we hadn't paid the premiums and per chance... (since we don't know who is going to get T-boned by a drunk driver) something bad happens we're darn happy we paid the premium that month. This is kinda how I think of it and if that means a bit of caution for a few years... ok. I'm doing it. I'm going to pay the premiums because they're really, really cheap :~} Not right or wrong, and am not in any way saying reducing like that wasn't the right thing to do for you and Kelsey. You know I love you! There's very definitely something to be said about using these great feet as much as they can. I really think it's done wonders for Darbi... this walking, bending, playing... using it and being able to do anything she wants never knowing her foot was a mess at birth... yeah, that's cool! Kori At 03:53 PM 2/27/2006, you wrote: >Kelsey was 15 months old when she got out of her FAB 23/7. We went >straight to 12-14 hours (nights only) and have had >no problems. Kelsey had been cruising etc for several months >before she went into the FAB 23/7 and that was difficult but the >freedom was great for Kelsey. She was ready to walk, which she did >about 4-6 weeks later. I think some of it may depend on the >temperament of your child. > > Jenni > > >artlovr wrote: will be >done with the 3 months of 23/7 in a month. At that time > he will be nearly 10 months old and his doctor says he will probably be > able to go down to 12-14 hours/day. There was an email the other day > addressing this and I have a couple of questions. I understand the > theory that too much freedom all at once may make it difficult to get > the shoes on at night and to sleep through the night but does some of > that just depend on your child and their temperment? The schedule to > follow in reducing hours that was posted is for a baby who starts the > Ponseti method at birth. What about a baby who starts later and is > bearing weight a lot by the time they are finished with the first three > months in the FAB? > > I would be interested in hearing anyone's experience with an older baby > in reducing the hours. > > Thanks, > and (6-19-05 FAB 23/) > > > > > > > Quote Link to comment Share on other sites More sharing options...
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