Friday, July 12, 2013

And you shake it all about....

So yesterday we had a regularly scheduled visit with our home physical therapy teacher. Lena has had regular appointments with speech and physical therapists for a few years through the Early Childhood Intervention program. Big brother Emerson had the same thing. We were tapering off Lena's appointments and getting ready to be done this fall when she turns 3. Now this new surgery lingering in our future is going to increase the amount of time out PT will be available.

She came yesterday and gave us a few ideas of how to begin the PT to hopefully avoid surgery on the right foot and maybe improve the left as well. I could tell after just 45 minutes with the PT mixing stretching and playing that Lena was already exhausted. We'll start off with just once a day (and maybe doing one leg in the morning and the other later on in the day). The goal is to keep her happy and avoid her being upset while doing PT... because if she becomes a crabby pants about it the whole thing becomes 10X more difficult.

For the right leg we're supposed to realign her foot to a neutral position, slide her butt forward so the knee is in line with the foot, and then give her toys to stretch and reach for while we hold her leg in place. This will allow HER to be the one stretching and we can avoid injuring her by pushing too hard. Secondary stretch (shown in photo) is to support her foot and just pulling back gently to stretch her Achilles.

For the left leg we need to find a little square bone at the top of her foot near where the crease is going up to the leg. Slide it over to the middle to be centered with the leg and then stretch it similar to how we did the right leg. This is a difficult stretch to achieve, but we will do our best! There is also a massage to do all down the outside of the calf to help loosen up that tendon which will eventually be lengthened.

 Our home PT will be coming back the next two weeks and then we finally have our official appointment with the PT specialists at Gillette at the end of July. This will give us a good start and hopefully their information just builds on what we'll already be doing.

Friday, July 5, 2013

Once a triangle always a triangle....

Our daughter has been brace free since November and we had no scheduled appointments until fall 2013 for just a regular maintenance check-up appointment for both kids legs.

Mid-winter we started to have some concerns about the position of her feet. When a child is on recovery from clubbed feet the Ponseti bar OVER corrects their feet and then when the braces are removed there is a period of time when the tendons tighten back up a bit and move the feet into neutral position. Lena's feet were not coming forward at the same pace. We have a physical therapist who comes to the house twice a month who was also a little bit concerned. Long rambling paragraph short... we ended up doing nothing at that period in time because it started to get better on it's own and we were a little bit distracted with additional appointments for our son who was having some reflux issues.

About a month ago we became concerned again. Her feet were just not looking right. We brought her into the ortho surgeon and learned we have two different problems going on.  Consider your calves to have tendons on both sides that work like horse reigns. On the left side of both of her feet the reign is too tight and short. 

Her right leg is a "rubber crowbar" where the inner J tendon that runs from mid-calf to the arch of the foot is tightening which means when she goes to take a step it is slow to get to flat position when she goes to put weight on it again. I think this could be considered a mild relapse of the club feet. This could be fixed with physical therapy and stretches. 

Left foot however has a bigger problem. The foot is basically a tripod for where it makes contact to the ground. Two spots on the front and then one on the heel. Hers is leaning because the tendons on the outside of the foot are too tight and pulling her foot out from under herself. That one most likely cannot be correct with PT. He said it is a difficult stretch to gain and even a professional might not hit it just right. Basically you have to move her foot into neutral and THEN stretch it... otherwise if you don't get it exactly in neutral you'll just be stretching the wrong area. 

We asked what would happen if this was all left untreated. The doctor explained that once she hit puberty and started to grow fast and when she was getting more into sports her feet would be come incredibly painful. So, obviously we have to do something about that! We have an appointment with the specialist PT at Gillette at the end of July and we'll also receive help from our home PT. Hopefully through that we can avoid surgery on the right leg. We'll hold off on surgery until the fall to give that a chance to work, and because no one wants to be in a cast during the summer time! She will need to be put under general anesthesia, so IF we are unable to fix the right leg with PT this summer we'd want to take care of both feet at the same time rather than doing the left right now and then ending up needing to do the right leg in a year. 

Both surgeries are fairly simple and quick. Just cutting the tendon to lengthen it slightly through an incision about 1/2 inch long.   I believe he said she'd be in a cast for about 3 weeks and that she'd even be able to walk on the cast. 

80% of children with clubbed feet need a surgery or two to correct the birth defect. We have been super fortune to have not needed anything other than the casting and braces up until this point. Surgery can be scary, and I don't consider us unlucky now. Just more like an "Oh darn, so close to avoiding all that stuff!!"