Guest guest Posted July 21, 2006 Report Share Posted July 21, 2006 , I'm going to butt in. I think Kori meant that severity doesn't play a role in the success of the Ponseti method. The method works no matter how severe the foot is. Yes, you'd probably want an experienced doctor- but if the doctor knew what they were doing, they would be able to achieve the correction regardless of the severity of the foot (for regular idiopathic congenital clubfoot) and not have to use a PMR to complete correction. These would be the cases that Dr. P refers to as the feet that may need " up to 9 casts " to achieve correction, where the average is 5-7. Does that make sense? > > >Hi. I ran into an 11 month old today in s today at the > > >library! That's the first time we have ever seen another clubfoot > > >child in treatment, casts or braces (except for 1 time in Dr. P's > > >office). So fun for Lily to see someone who looked like her! Is > there > > >ever a clubfoot gathering in Iowa City? The way Lily laughed and > > >pointed at the little one's s made me happy. > > > > > >However, after speaking with this mother, I know she is seeing the > > >local ortho who is not following Dr. P to a " T " . Her daughter's > case > > >is unilateral and mild and she was fine with the local ortho. I > didn't > > >say anything other than that we loved Dr. Ponseti and if she was > ever > > >concerned, he and his team have worked miracles on Lily, but in > > >retrospect, I think I should have said something, but what? > > > > > > > > > > > >Send instant messages to your online friends > > ><http://uk.messenger.yahoo.com>http://uk.messenger.yahoo.com > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 21, 2006 Report Share Posted July 21, 2006 First of all, , welcome to the chaos that is us trying to muddle our way through this stuff. I'm not Kori (she's the one with the tattoos, I'm the one who's never so much as dyed her hair), but I've got a relevant paper open on my laptop right now, so I'll give this a shot. This paper is over in the Files section, if you want to take a stab at reading it. It's the newly-published paper on complex idiopathic clubfoot (I believe it's under complex.pdf). The paper starts out talking about " a small percentage of clubfeet [that] are very severe and difficult to treat " . While many physicians wind up doing surgery on these feet, the doctors in Iowa (and the other places that are part of this study, I presume) have found that they can correct them following their standard technique. It takes a little longer (8-10 casts versus 5-6), but the technique does not need to be modified as it does for the complex feet. They mention these feet again near the end of the paper: " Orthopaedists familiar with the treatment of congenital clubfoot know a small percentage of clubfeet are stiff and resistant to manipulation.However, the tissues usually soften after three to four casts, and the feet eventually are corrected with five or six more casts. " How many casts did Lily have? I think the idea is that severity *does* matter to a certain extent, but that when a doctor is experienced enough and knows what she/he is doing, it's not a big deal. The thing we run into in the groups is that physicians who are having trouble with a particular foot/pair of feet will just throw up their hands and say: " Oh, these feet are way severe--the Ponseti method won't work. When do you want to schedule the surgery? " . Severity gives an " out " to the physician--and to the parent!--but it doesn't have much to do with how whether or not the Ponseti method works. Hope that helps, Naomi wrote: Hi Kori. I have a question for you about severity. When we finally saw Dr. P, we brought newborn pictures and Dr. Ponseti said he could see she her clubfeet at birth were " very severe " and " severely deformed " . When he examined her feet, hed added some other terms which boiled down to they weren't corrected either(he never used the words atypical or complex which I see here sometimes but he did say her feet were " resistant " ). Dr. Ponseti said that our original ortho (with whom he was familiar) could probably " treat more moderate clubfoot " but not feet of Lily's " severity " . This left me with the distinct idea that severity does matter. I would like to be as educated on clubfoot as possible so would you please tell me why you believe our information is in conflict? Thanks, Kori. I know you are one of the resident experts! > >Hi. I ran into an 11 month old today in s today at the > >library! That's the first time we have ever seen another clubfoot > >child in treatment, casts or braces (except for 1 time in Dr. P's > >office). So fun for Lily to see someone who looked like her! Is there > >ever a clubfoot gathering in Iowa City? The way Lily laughed and > >pointed at the little one's s made me happy. > > > >However, after speaking with this mother, I know she is seeing the > >local ortho who is not following Dr. P to a " T " . Her daughter's case > >is unilateral and mild and she was fine with the local ortho. I didn't > >say anything other than that we loved Dr. Ponseti and if she was ever > >concerned, he and his team have worked miracles on Lily, but in > >retrospect, I think I should have said something, but what? > > > > > > > >Send instant messages to your online friends > ><http://uk.messenger.yahoo.com>http://uk.messenger.yahoo.com > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 21, 2006 Report Share Posted July 21, 2006 Hi , Thanks for your confidence in me! Much appreciated :~} The statement that regardless of severity, all feet can be treated non-surgically means nothing more than in EXPERT hands, every foot can be corrected. Of course not every foot will stay corrected, a small percentage will relapse despite strict bracing and a very few of those relapsed feet may need the ATTT surgery if after all efforts are exhausted (re-casting usually) the foot continues to pull in. They transfer the one Anterior Tibialis Tendon over just a bit to the outside (to the 3rd metatarsal I believe) in a relatively minor surgery and this takes care of the problem. And this also does not include clubfoot that is secondary to other disorders (neurogenic cf, spina bifida, arthogryopis, etc.) where the underlying condition may make correction more difficult. OK, so basically what is being said here is that not all doctors are able to treat every foot. Some are simply not experienced or skilled enough for the more severe or resistant feet. Resistant means basically they resist correction with the standard protocols. Some feet go right into place and little finesse is required. Some feet need more experienced/skilled hands. Severity is often blamed for a doctors' recommendation for surgery. When these feet are seen by a doc who has experience enough to handle these feet, severity flies out the window with good casting and the feet come back fixed. It may take special attention or knowledge about how to treat more severe feet and many will fall into the category of atypical/complex but even these feet can be fixed. You just gotta find the doctor who knows how to do it and won't give up calling the feet *too severe*. does that help? Kori At 02:11 PM 7/21/2006, you wrote: >Hi Kori. > >I have a question for you about severity. When we finally saw Dr. P, >we brought newborn pictures and Dr. Ponseti said he could see she her >clubfeet at birth were " very severe " and " severely deformed " . When >he examined her feet, hed added some other terms which boiled down to >they weren't corrected either(he never used the words atypical or >complex which I see here sometimes but he did say her feet >were " resistant " ). Dr. Ponseti said that our original ortho (with >whom he was familiar) could probably " treat more moderate clubfoot " >but not feet of Lily's " severity " . > >This left me with the distinct idea that severity does matter. I >would like to be as educated on clubfoot as possible so would you >please tell me why you believe our information is in conflict? >Thanks, Kori. I know you are one of the resident experts! > > > > > > >Hi. I ran into an 11 month old today in s today at the > > >library! That's the first time we have ever seen another clubfoot > > >child in treatment, casts or braces (except for 1 time in Dr. P's > > >office). So fun for Lily to see someone who looked like her! Is >there > > >ever a clubfoot gathering in Iowa City? The way Lily laughed and > > >pointed at the little one's s made me happy. > > > > > >However, after speaking with this mother, I know she is seeing the > > >local ortho who is not following Dr. P to a " T " . Her daughter's >case > > >is unilateral and mild and she was fine with the local ortho. I >didn't > > >say anything other than that we loved Dr. Ponseti and if she was >ever > > >concerned, he and his team have worked miracles on Lily, but in > > >retrospect, I think I should have said something, but what? > > > > > > > > > > > >Send instant messages to your online friends > > ><<http://uk.messenger.yahoo.com>http://uk.messenger.yahoo.com>htt > p://uk.messenger.yahoo.com > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 21, 2006 Report Share Posted July 21, 2006 Thank you Kori, and Naomi. WOW! Your posts were incredibly informative! I think I get it...and I think I will print out these 3 posts for my binder--they were awesome. P.S. Lily had 12 casts, but only the last 3 with Dr. P. > > > >Hi. I ran into an 11 month old today in s today at the > > > >library! That's the first time we have ever seen another clubfoot > > > >child in treatment, casts or braces (except for 1 time in Dr. P's > > > >office). So fun for Lily to see someone who looked like her! Is > >there > > > >ever a clubfoot gathering in Iowa City? The way Lily laughed and > > > >pointed at the little one's s made me happy. > > > > > > > >However, after speaking with this mother, I know she is seeing the > > > >local ortho who is not following Dr. P to a " T " . Her daughter's > >case > > > >is unilateral and mild and she was fine with the local ortho. I > >didn't > > > >say anything other than that we loved Dr. Ponseti and if she was > >ever > > > >concerned, he and his team have worked miracles on Lily, but in > > > >retrospect, I think I should have said something, but what? > > > > > > > > > > > > > > > >Send instant messages to your online friends > > > ><<http://uk.messenger.yahoo.com>http://uk.messenger.yahoo.com>htt > > p://uk.messenger.yahoo.com > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 21, 2006 Report Share Posted July 21, 2006 hi guys...id appreciate it if you could give me cynthia's number asap. i want to have asecond opinion..thanks > > > > >Hi. I ran into an 11 month old today in s today at the > > > > >library! That's the first time we have ever seen another > clubfoot > > > > >child in treatment, casts or braces (except for 1 time in Dr. > P's > > > > >office). So fun for Lily to see someone who looked like her! Is > > >there > > > > >ever a clubfoot gathering in Iowa City? The way Lily laughed > and > > > > >pointed at the little one's s made me happy. > > > > > > > > > >However, after speaking with this mother, I know she is seeing > the > > > > >local ortho who is not following Dr. P to a " T " . Her daughter's > > >case > > > > >is unilateral and mild and she was fine with the local ortho. I > > >didn't > > > > >say anything other than that we loved Dr. Ponseti and if she > was > > >ever > > > > >concerned, he and his team have worked miracles on Lily, but in > > > > >retrospect, I think I should have said something, but what? > > > > > > > > > > > > > > > > > > > >Send instant messages to your online friends > > > > > ><<http://uk.messenger.yahoo.com>http://uk.messenger.yahoo.com>htt > > > p://uk.messenger.yahoo.com > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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