Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 wonderful! Thank you. That's what I thought. Kori At 04:26 PM 5/3/2004, you wrote: > " ...I wonder about one thing though - and I think I know the answer >but someone will surely correct me if I'm wrong... the 5% that are >difficult to correct are babies that have worn the DBB and still not >stayed corrected right? These babies get correction from casting at >first but relapse right? Or do they not respond to the casting like >the other 95% do? If someone could clarify I'd be thrilled to clear >that up for myself.... " > >Kori, >When I was in Iowa in March, Dr. P and Dr. Morcuende stated that they >have not conducted a PMR at the hospital in years. They stated that >they now know how to treat the " resistant clubfoot " without surgery. >Yes, you're on the right track- our Kai, Chelsea, Asa etc. would be >that old 5% statistic. Now they are certain that 99-100% of clubfeet >can be corrected without reconstructive surgery, though it would >probably take another medical study (which I'm sure is underway) to >be published to change that statistic officially. There are also >complicated feet with conditions such as arthrogryposis to take into >account, though I know that they've had exceptional results with >these cases as well. > >I hope this helps- > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Kori, When we were at the U of Iowa in 1999 or 2000, we once had heard Dr. Dietz mention that for children who had begun the initial treatment from near birth at the U of Iowa, that they had not needed to do a posterior release type of surgery since the early 1980's. My impression is that the few that may have had the surgery were where treatment had been started somewhere else or if the FAB/DBB had been discontinued by the parents and they were not able to get the feet recorrected enough to avoid having to do a posterior release type of surgery. In the recent U of Iowa study reported in the Journal of Pediatrics, they indicated that they had treated 157 children from 1991 to 2001 and had to do 3 posterior release types of surgery. Although I am not certain, my guess is that those 3 children had gone to Iowa after treatment elsewhere or were where there was non-compliance in the use of the FAB/DBB http://pediatrics.aappublications.org/cgi/content/abstract/113/2/376 As Dr. Ponseti allows for in his statement as his web site, " Less than 5% of infants born with clubfeet may have very severe, short, plump feet with stiff ligaments, unyielding to stretching with a deep transverse skin fold across the sole of the foot and another crease above the heel. These babies require special treatment and may need surgical correction. " http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/parents.htm l But as mentioned, for children with clubfoot associated with arthrogryposis or genetic syndromes, that although the Ponseti method helps that many of those children do need to have the posterior release types of surgery. The U of Iowa and others combined their treatment results to present a paper on Arthrogryposis at the recent 2004 AAOS Convention. http://www.aaos.org/wordhtml/anmt2004/sciprog/268.htm and (3-17-99) > " ...I wonder about one thing though - and I think I know the answer > but someone will surely correct me if I'm wrong... the 5% that are > difficult to correct are babies that have worn the DBB and still not > stayed corrected right? These babies get correction from casting at > first but relapse right? Or do they not respond to the casting like > the other 95% do? If someone could clarify I'd be thrilled to clear > that up for myself.... " > > Kori, > When I was in Iowa in March, Dr. P and Dr. Morcuende stated that they > have not conducted a PMR at the hospital in years. They stated that > they now know how to treat the " resistant clubfoot " without surgery. > Yes, you're on the right track- our Kai, Chelsea, Asa etc. would be > that old 5% statistic. Now they are certain that 99-100% of clubfeet > can be corrected without reconstructive surgery, though it would > probably take another medical study (which I'm sure is underway) to > be published to change that statistic officially. There are also > complicated feet with conditions such as arthrogryposis to take into > account, though I know that they've had exceptional results with > these cases as well. > > I hope this helps- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2004 Report Share Posted May 4, 2004 > As Dr. Ponseti allows for in his statement as his web site, " Less > than 5% of infants born with clubfeet may have very severe, short, > plump feet with stiff ligaments, unyielding to stretching with a > deep transverse skin fold across the sole of the foot and another > crease above the heel. These babies require special treatment and > may need surgical correction. " > http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/parents.htm I'll be danged! I am sure I read this back when we started treatment for Kai; and later when corresponding to Dr Ponseti he mentioned " short, fat feet with deep medial (transverse) crease " , which is what got the ball rolling that landed us in IC, but I connected the two. This almost completely describes Kai's foot! The only difference is that only a portion of his ligaments are stiff (the rest are very loose?!) and his foot was NOT unyielding to stretching. As for the rest, his foot was definitely severe (I think like a 5 on the Pirani scale) short, fat with deep creases on the sole and above the heel. I can definitely say that while in the beginning Dr Ponseti would not completely rule out the need for surgical correction, he has since relayed to me that he not only doesnt think surgery is needed, but that it could potentially be more dammaging in the long run for Kai. Dr Mosca concurred, saying that too much was involved in a foot like Kai's to consider surgery. I am guessing that another medical study would indeed show that that 5% statistic has dropped significantly. Angel Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2004 Report Share Posted May 4, 2004 > As Dr. Ponseti allows for in his statement as his web site, " Less > than 5% of infants born with clubfeet may have very severe, short, > plump feet with stiff ligaments, unyielding to stretching with a > deep transverse skin fold across the sole of the foot and another > crease above the heel. These babies require special treatment and > may need surgical correction. " > http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/parents.htm I'll be danged! I am sure I read this back when we started treatment for Kai; and later when corresponding to Dr Ponseti he mentioned " short, fat feet with deep medial (transverse) crease " , which is what got the ball rolling that landed us in IC, but I connected the two. This almost completely describes Kai's foot! The only difference is that only a portion of his ligaments are stiff (the rest are very loose?!) and his foot was NOT unyielding to stretching. As for the rest, his foot was definitely severe (I think like a 5 on the Pirani scale) short, fat with deep creases on the sole and above the heel. I can definitely say that while in the beginning Dr Ponseti would not completely rule out the need for surgical correction, he has since relayed to me that he not only doesnt think surgery is needed, but that it could potentially be more dammaging in the long run for Kai. Dr Mosca concurred, saying that too much was involved in a foot like Kai's to consider surgery. I am guessing that another medical study would indeed show that that 5% statistic has dropped significantly. Angel Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2004 Report Share Posted May 4, 2004 I would just like to interject here. This study that is being referenced is regarding posterior release surgery only, correct? If there were only three patients who needed this surgery, perhaps the feet were uncorrectable or so stiff that they could not be adequately captured with an FAB. To assume that these children needed to have posterior surgery because their parents were noncompliant seems a little presumptious. Of these 157 children, you didn't mention the number of children who needed anterior releases who had been corrected with the Ponseti method. Does it reference that anywhere in this report? This is the number I would be really curious to see. It sure seems that lots of people are talking about having to have ATTT surgery at three or 4 years old. Although I am sure that parental noncompliance is definitely a factor in relapses, I think that sometimes feet just relapse. After all, the shoes are just leather that gets softer over time. When Rose's foot started to curve, Dr. Mosca even said that sometimes this happens, even if the parent does everything they are supposed to do. I could see in her shoe where her foot pushed the leather out of the way. I would venture to guess that no parent is perfect and we have all left the FAB off once or twice, whether by accident or on purpose. Since no parent is going to be perfect in there application of the FAB, parents make a pretty good scape goat for relapses. I just think we should keep this in mind and not beat parents up so much. The fact that we do not hurl the FAB somewhere into the middle of next week is testament that we understand how important it is. Sorry for the rant. Robin & Rose 3/12/03 Right Club Foot Egbert martinegbert@...> wrote: Kori, When we were at the U of Iowa in 1999 or 2000, we once had heard Dr. Dietz mention that for children who had begun the initial treatment from near birth at the U of Iowa, that they had not needed to do a posterior release type of surgery since the early 1980's. My impression is that the few that may have had the surgery were where treatment had been started somewhere else or if the FAB/DBB had been discontinued by the parents and they were not able to get the feet recorrected enough to avoid having to do a posterior release type of surgery. In the recent U of Iowa study reported in the Journal of Pediatrics, they indicated that they had treated 157 children from 1991 to 2001 and had to do 3 posterior release types of surgery. Although I am not certain, my guess is that those 3 children had gone to Iowa after treatment elsewhere or were where there was non-compliance in the use of the FAB/DBB http://pediatrics.aappublications.org/cgi/content/abstract/113/2/376 As Dr. Ponseti allows for in his statement as his web site, " Less than 5% of infants born with clubfeet may have very severe, short, plump feet with stiff ligaments, unyielding to stretching with a deep transverse skin fold across the sole of the foot and another crease above the heel. These babies require special treatment and may need surgical correction. " http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/parents.htm l But as mentioned, for children with clubfoot associated with arthrogryposis or genetic syndromes, that although the Ponseti method helps that many of those children do need to have the posterior release types of surgery. The U of Iowa and others combined their treatment results to present a paper on Arthrogryposis at the recent 2004 AAOS Convention. http://www.aaos.org/wordhtml/anmt2004/sciprog/268.htm and (3-17-99) > " ...I wonder about one thing though - and I think I know the answer > but someone will surely correct me if I'm wrong... the 5% that are > difficult to correct are babies that have worn the DBB and still not > stayed corrected right? These babies get correction from casting at > first but relapse right? Or do they not respond to the casting like > the other 95% do? If someone could clarify I'd be thrilled to clear > that up for myself.... " > > Kori, > When I was in Iowa in March, Dr. P and Dr. Morcuende stated that they > have not conducted a PMR at the hospital in years. They stated that > they now know how to treat the " resistant clubfoot " without surgery. > Yes, you're on the right track- our Kai, Chelsea, Asa etc. would be > that old 5% statistic. Now they are certain that 99-100% of clubfeet > can be corrected without reconstructive surgery, though it would > probably take another medical study (which I'm sure is underway) to > be published to change that statistic officially. There are also > complicated feet with conditions such as arthrogryposis to take into > account, though I know that they've had exceptional results with > these cases as well. > > I hope this helps- > Quote Link to comment Share on other sites More sharing options...
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