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!!" 

One Week into Recovery

My baby girl has been in casts for a full week. Her ankles are already straight! What a big improvement. I've had many questions about what the casts do, and the basic answer is that they help align the calves and ankles to be straight. It holds her legs in position and helps stretch out the tendon that has her legs curling. There is a science behind what angle her legs are held in. When she moves into the Ponseti bar braces they will be angling her feet into the correct position. Actually, they OVER correct because once she is out of the brace there will always be a period where the feet start to turn back inward. Yearly follow up appointments will make sure her feet are on track. So, casts take care of the legs and the braces take care of the feet. That is my understanding of it anyway!

Many of the support forums I am on for clubbed feet have parents who mentioned taking casts off at home the night before an appointment. I made the mistake of mentioning this to my husband, and before I knew it he was unwrapping the casts. It was terrifying to hold down my son while they took a buzz saw to his leg two years ago, so I didn't do a whole lot to stop my husband from manually removing our daughters casts. Here is a video of a little boy getting his spica cast removed... this is the sad baby we didn't have to experience this morning; http://www.youtube.com/watch?v=PLvkUHnXq0A

At our appointment today we were scolded a little bit for removing the casts 16 hours before her appointment. They said that her legs were more stiff than they would have been and that they didn't bend as far as they probably would have had we let them remove it. My husband wasn't in the room, but I explained their concerns to him and I think his plan is to remove her casts manually the morning of her next appointment. I'm making him call in and get permission! I don't like not following doctors orders, and as much as this whole process can be painful/annoying I do know that the closer we follow their outlined planned the faster she'll be done with the whole thing. I'd hate for us to have an extra week of casting just because she isn't stretching as fast as they'd like her to be.

Next week she could graduate to the AFO shoes, or have one more week of casting. How well she stretching this week will determine our fate! I am hoping we'll be done! Casts might be the fastest part of recovery, but it is my least favorite stage for sure!