Re: Annika's Update

[Guest guest]

Lori,

Hope Annika is doing Okay. I know what an ajustment it must be to be

back in casts after all this time! We will be praying for her and

that this will do the trick!

and Caleb 3-31-01

- In nosurgery4clubfoot@y..., gillam@r... wrote:

> Well, we got a call from Dr. Colburn yesterday and he and Dr.

Ponseti

> had talked at length about Annika's case. I also called Dr.

Ponseti

> afterwards and talked with him too.

>

> Dr. P had presented Annika's xrays and video to the 3 other doctors

> there. Not suprisingly, there were 3 different opinions from the 4

> doctors. 2 of them recommended doing nothing at this point. Take

> xrays again in 6 mo.-1yr to see if the alignment has gotten worse.

2

> of the doctors recommended intervention; one said casting, the

other

> a gastrocnemous lengthening. Dr. Colburn was recommending casting

> first to see what that may accomplish, then maybe the lengthening.

> So, (VERY long story shortened) we opted to do the casting.

>

> We headed up to Dr. Colburns today and he first did a ?floroscope?

> test on her. Looks like a small version of an xray which takes

> pictures of the bones as well. First, with her knee straight, he

> dorsiflexed her foot and took a picture. Then, with her knee bent,

> he dorsiflexed her foot and took another picture. He then measured

> the increase in dorsiflexion in the shot where her knee was bent.

> There was a 6 percent increase (minimal increase). According to

Dr.

> C, what this means is that both her gastrocnemous and soleus

muscles

> are shortened which means that a gastrocnemous lengthening would

not

> be used should surgery be considered. Instead, I believe, a Z-

> lengthening of the tendo achilles would be the option of choice for

a

> surgical intervention. We'll cross that bridge when we come to it.

>

> Anyhow, after that, it was time for casting. Annika wasn't keen on

> the idea, but cooperated anyway. I hadn't realized that Dr.

Colburn

> planned on using a fiberglass cast. It's not the type of

fiberglass

> that peels off though. It seems pretty darn hard and will have to

be

> cut off. The reason that he said he didn't need to use plaster, is

> because he is not 'moulding' the cast to the foot. All we are

trying

> to accomplish is increasing the dorsiflexion. Also, it is a below

> the knee-walking cast. Dr. Colburn assures me that Annika will not

> lose the outward rotation of her feet while she is out of the FAB.

> (I'm praying he's right) Anyhow, Annika was very compliant while

> they were putting her pretty purple casts on. They gave her little

> velcro walking shoes to put on over the bottom of the casts. Oh,

> they cast both legs. She will have this set on for 2 weeks and

then

> she'll get a second set put on for another 2 weeks, and probably a

> 3rd set. At that point, I assume Dr. Colburn will do another

> floroscope test or xray to see if there is a measured improvement.

> Again, all of this is in the hopes of lengthening her

> achilles/gastroc/soleus so that her heel will come down more which

> will change the direction of force on the bones so her foot doesn't

> rocker. Make sense?

>

> Anyhow, that's about the size of it. I didn't feel like typing ALL

> of the details right now, so if anyone has ANY questions, feel free

> to ask away.

>

> Lori and Annika

[Guest guest]

Lori,

I really hope this works and straightens the bones in question in Annika's

foot. I'm trying to imagine your 2 1/2 year old in casts again and it's

hard. It's very good that she is able to walk in them though, thank god for

that I'll bet your saying. Casts that would have basically immobilized her

(especially for that length of time) would have been a night mare. I was

thinking when I read your first post about possible casting again, that I

realized it would mean casting not just the one, but both feet since you

can't leave the one foot alone for too long with out shoes or a cast. I

remember when Dr. P was talking to us about a possible second tenotomy on

's right foot that it would mean both feet back in casts and then an

additional 3 full months 24/7 in the brace AGAIN. (Right after we just

finished the first round of treatments.) That was overwhelming for me to

think about again, I remember. I guess this is really the area where being a

bilateral baby really stinks!

Will Dr. Colburn do xrays after he takes this first round of casts off to

see if there is any improvement? If they casts do the trick, do you know

what will be needed to keep her foot/bones from doing this again, will the

shoe brace be enough this time? Or have'nt you yet gotten to that

discussion.

Well, take it easy and one day at a time. I've got my fingers crossed for

Annika!

Holly and

P.S. How's that baby sister doing these days? Bet she's getting big!

Annika's Update

>Well, we got a call from Dr. Colburn yesterday and he and Dr. Ponseti

>had talked at length about Annika's case. I also called Dr. Ponseti

>afterwards and talked with him too.

>

>Dr. P had presented Annika's xrays and video to the 3 other doctors

>there. Not suprisingly, there were 3 different opinions from the 4

>doctors. 2 of them recommended doing nothing at this point. Take

>xrays again in 6 mo.-1yr to see if the alignment has gotten worse. 2

>of the doctors recommended intervention; one said casting, the other

>a gastrocnemous lengthening. Dr. Colburn was recommending casting

>first to see what that may accomplish, then maybe the lengthening.

>So, (VERY long story shortened) we opted to do the casting.

>

>We headed up to Dr. Colburns today and he first did a ?floroscope?

>test on her. Looks like a small version of an xray which takes

>pictures of the bones as well. First, with her knee straight, he

>dorsiflexed her foot and took a picture. Then, with her knee bent,

>he dorsiflexed her foot and took another picture. He then measured

>the increase in dorsiflexion in the shot where her knee was bent.

>There was a 6 percent increase (minimal increase). According to Dr.

>C, what this means is that both her gastrocnemous and soleus muscles

>are shortened which means that a gastrocnemous lengthening would not

>be used should surgery be considered. Instead, I believe, a Z-

>lengthening of the tendo achilles would be the option of choice for a

>surgical intervention. We'll cross that bridge when we come to it.

>

>Anyhow, after that, it was time for casting. Annika wasn't keen on

>the idea, but cooperated anyway. I hadn't realized that Dr. Colburn

>planned on using a fiberglass cast. It's not the type of fiberglass

>that peels off though. It seems pretty darn hard and will have to be

>cut off. The reason that he said he didn't need to use plaster, is

>because he is not 'moulding' the cast to the foot. All we are trying

>to accomplish is increasing the dorsiflexion. Also, it is a below

>the knee-walking cast. Dr. Colburn assures me that Annika will not

>lose the outward rotation of her feet while she is out of the FAB.

>(I'm praying he's right) Anyhow, Annika was very compliant while

>they were putting her pretty purple casts on. They gave her little

>velcro walking shoes to put on over the bottom of the casts. Oh,

>they cast both legs. She will have this set on for 2 weeks and then

>she'll get a second set put on for another 2 weeks, and probably a

>3rd set. At that point, I assume Dr. Colburn will do another

>floroscope test or xray to see if there is a measured improvement.

>Again, all of this is in the hopes of lengthening her

>achilles/gastroc/soleus so that her heel will come down more which

>will change the direction of force on the bones so her foot doesn't

>rocker. Make sense?

>

>Anyhow, that's about the size of it. I didn't feel like typing ALL

>of the details right now, so if anyone has ANY questions, feel free

>to ask away.

>

>Lori and Annika

>

>

>

[Guest guest]

Lori,

I am sure he did, but I hope that Dr. C. supported her midfoot and put a good

" arch " in the cast in this area. One of the problems with using casting to pull

the heel down is the risk of rockering the foot. If Annika is already

rockering, he must be very careful how much dorsiflexion he puts into the cast.

Look at her little casts and make sure there is a good arch in the midfoot area.

I am saying this from experience. We used the fiberglass short casts on Quinn.

It is really easy to rocker a foot by applying too much dorsiflexion and by not

supporting the midfoot as the cast dries, and boy, does the fiberglass dry fast.

Also, dig deep about RB on the internet. I am under the assumption that once

the foot rockers, achilles lengthening will not help....as Dr. Ponseti pointed

out. Are they saying that she has not rockered yet? I am in the middle of

organizing house renovations, and my mind is jello, so forgive me if I am way

off base here.

<end mother hen mode>

Annika sounds like a little trooper. To be still for that must have been hard

for her. Purple casts! Now, that I would have liked to have had for Quinn

during his correction. I would imagine they will stay a bit cleaner, and cuter,

than the off-white ones!

Keep us up on how she does. You guys are in our prayers.

Jody

Annika's Update

Well, we got a call from Dr. Colburn yesterday and he and Dr. Ponseti

had talked at length about Annika's case. I also called Dr. Ponseti

afterwards and talked with him too.

Dr. P had presented Annika's xrays and video to the 3 other doctors

there. Not suprisingly, there were 3 different opinions from the 4

doctors. 2 of them recommended doing nothing at this point. Take

xrays again in 6 mo.-1yr to see if the alignment has gotten worse. 2

of the doctors recommended intervention; one said casting, the other

a gastrocnemous lengthening. Dr. Colburn was recommending casting

first to see what that may accomplish, then maybe the lengthening.

So, (VERY long story shortened) we opted to do the casting.

We headed up to Dr. Colburns today and he first did a ?floroscope?

test on her. Looks like a small version of an xray which takes

pictures of the bones as well. First, with her knee straight, he

dorsiflexed her foot and took a picture. Then, with her knee bent,

he dorsiflexed her foot and took another picture. He then measured

the increase in dorsiflexion in the shot where her knee was bent.

There was a 6 percent increase (minimal increase). According to Dr.

C, what this means is that both her gastrocnemous and soleus muscles

are shortened which means that a gastrocnemous lengthening would not

be used should surgery be considered. Instead, I believe, a Z-

lengthening of the tendo achilles would be the option of choice for a

surgical intervention. We'll cross that bridge when we come to it.

Anyhow, after that, it was time for casting. Annika wasn't keen on

the idea, but cooperated anyway. I hadn't realized that Dr. Colburn

planned on using a fiberglass cast. It's not the type of fiberglass

that peels off though. It seems pretty darn hard and will have to be

cut off. The reason that he said he didn't need to use plaster, is

because he is not 'moulding' the cast to the foot. All we are trying

to accomplish is increasing the dorsiflexion. Also, it is a below

the knee-walking cast. Dr. Colburn assures me that Annika will not

lose the outward rotation of her feet while she is out of the FAB.

(I'm praying he's right) Anyhow, Annika was very compliant while

they were putting her pretty purple casts on. They gave her little

velcro walking shoes to put on over the bottom of the casts. Oh,

they cast both legs. She will have this set on for 2 weeks and then

she'll get a second set put on for another 2 weeks, and probably a

3rd set. At that point, I assume Dr. Colburn will do another

floroscope test or xray to see if there is a measured improvement.

Again, all of this is in the hopes of lengthening her

achilles/gastroc/soleus so that her heel will come down more which

will change the direction of force on the bones so her foot doesn't

rocker. Make sense?

Anyhow, that's about the size of it. I didn't feel like typing ALL

of the details right now, so if anyone has ANY questions, feel free

to ask away.

Lori and Annika