Re: Lindsey, Cast Lady or .....

[Guest guest]

Hi Clarrissa,

Suzzane gave perfect info... also it is good to note that the foot is

prepped in a sterile fashion and also the procedure is done in sterile

fashion. You can do a sniff test daily (or more) at the toes of the

cast if you are nervous. The baby would also exibit more fussiness,

fever or general malaise.

The risk of infection is present for any invasive procedure but for

this it is very small. Things should go very well for you and Judd in

Iowa.

The Cast Lady

[Guest guest]

Clarrissa,

Suzzane and the cast lady have given you some good information. I

would agree that anytime that there is a cut, whether outside in the

backyard or at a hospital, there is a risk of infection. I do feel

that because of the preparation, the small degree of the " incision "

and the limited amount of time in the cast (3 weeks) that exists

after a tenotomy, that the risk of infection (especially a serious

one) would be very low. I also think that the risk is much less than

the risk for an infection to occurr with the " real " clubfoot surgery

(posterior release type procedures).

My guess is that risk of infection would be greater for the " real "

clubfoot surgery because the incisions and degree to which the foot

is opened up is much, much greater. Also, with the " real " clubfoot

surgery, the casts remain on for from 8 to 12 weeks although they may

be changed once or twice during that period. The only place where I

have seen the statistical risks of infections detailed is in two

surgically oriented clubfoot treatment books that I read (references

to which are given at the end of this message). These potential

risks along with others are listed in the " Parent research paper "

that I have posted in the files section of the nosurgery4clubfoot

site.

In those 2 books the statistical risks that they had experienced for

infection after the major clubfoot surgery were defined in summary as

follows:

2. Wound Infection (Goldner 2 out of 400)(Lehman 1 in 250 from 1980-

89)

3. Pin-Tract Infection (Goldner 6 out of 400)

We have had 2-3 parents at the parentsplace site whose children had

the major clubfoot surgery and had this occur who posted from June

–

Dec 99. I would prefer not to post the links here, but if you want to

locate them please e-mail me privately and I will send them to you.

With regards to the tenotomy, I do not have any statistics or

references to the potential risk of infection, and I can't find a

reference to it in Dr. Ponseti's book in the tenotomy section but I

assume that it has been less than what was reported in the referenced

studies for the reasons I gave above. It seems like I remember a

nurse or someone in Iowa (although I can't remember who) that I asked

say that they had never had a problem caused by the tenotomy.

In his 1999 Video " A 43 Year Case Study " , Dr. Ponseti said;

" When

compared to other techniques for correction of the deformity, our

manipulation, casting and splinting procedure has never resulted in

any disability for the patients. "

To some degree, it is not that the Ponseti method has no risks, but

just that it appears to have fewer and less severe potential risks

and complications than any other documented method of treatment.

and (3-17-99)

The books where the risks information that I found is located are:

" The Child's Foot and Ankle " , edited by Drennan,

University of

New Mexico, Raven Press, New York 1992

Chapter 5 - Congenital Talipes Eqinovarus (Clubfeet), by

, Case Western Reserve Hospital, Cleveland, Ohio; W.

Simons III, Medical College of Wisconsin, Milwaukee, Wisc. (this

chapter says that the major clubfoot surgery needs to be done about

90% of the time)

Chapter 6 – Complications in the Management of Talipes

Equinovarus,

by Wallace B Lehman and Dan Atar, Hospital for Joint Diseases, New

York and Soroka Hospital, Ben Gurion University, Beer-Sheva, Israel

(Discusses the risks and complications of casting and surgery and how

to try to minimize them. Dr. Lehman is an emeritus professor and the

senior ped. ortho. of pediatric orthopedics at NYU's Wallace Lehman

Center for Children. He visited the U of Iowa in the Fall of 1999

and switched over to the Ponseti method with other doctors at NYU by

February of 2000. He was one of the speakers at the U of Iowa's

Ponseti method training clinc in Sept 2000.) In this chapter from

1992, they felt that the major surgery only needed to be done 35-50%

of the time, other than the Ponseti method and recently the French

method, these were the lowest rates of surgery that I had read about.)

" Disorders of the Foot and Ankle " , edited by Melvin Jahss,

Hospital

for Joint Diseases, Mount Sinai School of Medicine, New York;

Published by WBSaunders Co, Philadelphia, 1991 2nd ed.

Chapter 33 – Idiopathic Congenital Talipes Equinovarus

(Clubfoot), by

J. Leonard Goldner, MD and Fitch MD, Duke University (This

chapter said that the major surgery needed to be done 90% of the

time. A young doctor from Duke attended Dr. Ponseti's Sept 2000

training clinic in Iowa although I would not just assume that they

have begun using the Ponseti method.)

Chapter 34 – Revision Clubfoot Surgery, by Dan Atar (Ben Gurion

University, Beer-Sheva, Israel), Wallace Lehman (Hospital for Joint

Diseases, NYU, New York), Alfred Grant, Allan Strongwater (Discusses

the possible complications of 1st surgeries, how to try to avoid them

and how to do subsequent surgeries if they are needed)

> Hi Clarrissa,

> Suzzane gave perfect info... also it is good to note that the foot

is

> prepped in a sterile fashion and also the procedure is done in

sterile

> fashion. You can do a sniff test daily (or more) at the toes of the

> cast if you are nervous. The baby would also exibit more fussiness,

> fever or general malaise.

> The risk of infection is present for any invasive procedure but

for

> this it is very small. Things should go very well for you and Judd

in

> Iowa.

>

> The Cast Lady

[Guest guest]

Hello Clarissa and family,

My feeling is that the risk of infection is present, but

low. " Normal " operative infection rates are usually quoted at 1% and

I would suspect that this would be about the same. The best sign

that there is a problem is baby being " fussier " than usual or a

fever. The procedure is done in my clinic as I learned it on my

visit to Iowa, using " sterile technique " . The skin is prepped with

iodine or a similar " bug killing " solution, the surgeon wears sterile

gloves and uses sterile instruments. The wound is covered with a

sterile dressing prior to the cast.

So.... although it is natural to wonder and worry, I wouldn't lose

too much sleep over this concern.

Hope that this helps.

son

[Guest guest]

Thank you all for your information and input. It has

helped a lot. And even though I conveyed these

statements to my mother in law, she still doesn't

believe a darn word that comes out of my mouth.

She thinks that because Judd will be wearing the cast

for 3-4 weeks that he will pee all over it, and then

get an 'ulcer' on his leg. I gently informed her that

he's been wearing a cast for 21 weeks now and hasn't

peed on it yet.

Then she said, well, he'll get it wet. I said, how

the heck is he going to get it wet? Jump in the

bathtub with his sister? Sheesh, the kid just learned

how to roll over! I told her the only people that

could get it wet are people who can get to water on

their own, and I was only bathing him with a

washcloth, so that leaves me out. And since Adam

doesn't wash anything but his face, that leaves him

out, and his sister isn't allowed to even bring her

milk near him, so that leaves her out. Then I asked

her if she was planning on tossing him in some water.

To which she huffed out 'NO!'.

Sometimes I feel she thinks I am a moron, and I don't

have a clue when it comes to anything. UGH! She

makes me want to pull out my hair!!

Sorry for rambling but if I try to tell this to Adam

he just gets mad at me.

Oh, I have pictures of Judd's feet up, there is quite

a difference and I was very impresed at how much

considering he had only 2 casts on with Dr. P.

http://www.angelfire.com/wi/doodlebug/judd

=====

Clarissa, Hailey 10-5-98, Judd (rt cf) 9-22-00;

http://www.angelfire.com/wi/doodlebug

__________________________________________________

[Guest guest]

Shoot, put the wrong link in the last one! LOL, I'm

losing it!

http://www.angelfire.com/wi/doodlebug/judd.html

=====

Clarissa, Hailey 10-5-98, Judd (rt cf) 9-22-00;

http://www.angelfire.com/wi/doodlebug

__________________________________________________

[Guest guest]

Clarissa,

What cuties your kids are!! Thanks for sharing the pics and Judd's foot

looks great.

Joy

http://community.webtv.net/joybelle15/ROSESCLUBFOOTPAGE

[Guest guest]

What a doll! I love the name Judd. Thanks for sharing with us.

Jody

Re: Re: Lindsey, Cast Lady or .....

> Shoot, put the wrong link in the last one! LOL, I'm

> losing it!

>

> http://www.angelfire.com/wi/doodlebug/judd.html

>

> =====

> Clarissa, Hailey 10-5-98, Judd (rt cf) 9-22-00;

http://www.angelfire.com/wi/doodlebug

>

> __________________________________________________

>

[Guest guest]

Clarissa,

I just checked out your web page, your children are adorable and I love how

you put your pages together, especially the " characters " on Hailey's pages!

Thanks for sharing.

Holly and

Re: Re: Lindsey, Cast Lady or .....

>Shoot, put the wrong link in the last one! LOL, I'm

>losing it!

>

>http://www.angelfire.com/wi/doodlebug/judd.html

>

>=====

>Clarissa, Hailey 10-5-98, Judd (rt cf) 9-22-00;

http://www.angelfire.com/wi/doodlebug

>

>__________________________________________________

>

[Guest guest]

Holly,

Thanks a bunch. It took me quite awhile, but I

think I got them the way I want them. We'll see

though, I'll probably change my mind in a month or so.

LOL!

Clarissa

--- Dave and Holly Trudeau wrote:

> Clarissa,

> I just checked out your web page, your children are

> adorable and I love how

> you put your pages together, especially the

> " characters " on Hailey's pages!

> Thanks for sharing.

> Holly and

> Re: Re: Lindsey, Cast

> Lady or .....

>

>

> >Shoot, put the wrong link in the last one! LOL,

> I'm

> >losing it!

> >

> >http://www.angelfire.com/wi/doodlebug/judd.html

> >

> >=====

> >Clarissa, Hailey 10-5-98, Judd (rt cf) 9-22-00;

> http://www.angelfire.com/wi/doodlebug

> >

> >__________________________________________________

> >

[Guest guest]

Clarissa,

Great job on the Judd's web site. I love the pictures of him with his

sister! It is so endureing watching siblings love on one another.

Thanks for shareing this

Sara and Ivy 8/17/99

www.clubfoot.net

Re: Re: Lindsey, Cast Lady or .....

> Shoot, put the wrong link in the last one! LOL, I'm

> losing it!

>

> http://www.angelfire.com/wi/doodlebug/judd.html

>

> =====

> Clarissa, Hailey 10-5-98, Judd (rt cf) 9-22-00;

http://www.angelfire.com/wi/doodlebug

>

> __________________________________________________

>