Guest guest Posted August 18, 2004 Report Share Posted August 18, 2004 Tiffani, Here is some information on ultrasounds and when clubfoot developes. I do not think that it is possible to tell too much about the severity of a clubfoot from an ultrasound, only that it most likely is a clubfoot. That may explain why for any individual parent, a doctor may not feel a medical need to see the ultrasounds prior to birth. Here is some more information relating to Ultrasounds from prior messages. A number of parents on different internet groups have had their childs clubfoot identified on a prenatal ultrasound. In Dr. Ponseti's 1996 book on page 50, he says, " Present day sonography applied to the study of fetal development in utero has opened a new dimension in this field. Under sonography, we and others ... have observed that an apparently normal foot of an 11-week- old fetus turns into a clubfoot at 14 weeks within a uterine cavity filled with abundant amniotic fluid. The congenital clubfoot, therefore, seems to be a developmental anomaly originating after the third month of intrauterine life and not an embryonic malformation. " Other information from Dr. Ponseti on when clubfoot begins to develop can be seen in his 2001 article on treating relapses. " The clubfoot in otherwise normal children is a developmental anomaly originating after the third month of intrauterine life. It is induced by an unknown dysfunction in the posterior and medial aspects of the lower leg, ankle and foot ... " " The period of dysfunction causing the deformity starting in the middle third of pregnancy lasts to the third or fourth year of life. In mild cases, it may start in late fetal life, and remain active for only a few months after birth. In all cases, the resulting fibrosis is most pronounced from a few weeks preceding birth, to a few months after birth. This is the period when collagen accretion is greatest in tendons and ligaments of normal mammals and presumably also of man. The speed of growth of the foot decreases after the first year of life, diminishing greatly after five years. " http://groups.yahoo.com/group/nosurgery4clubfoot/message/13223 At the 3rd International Congress on Clubfoot in San Diego last August, Dr. Henri Bensahel of Paris, France presented a study they had done on 5,000 ultrasounds since 1998. Their studies results said that clubfoot by ultrasound " is easier (to identify) when the investigation is made around the 20th week of pregnancy. By that time, the talipes equinovarus can be well screened. The calf is less developed than usual and the comparison is easier if the clubfoot is unilateral. The diagnosis is also suspected by looking at the shape of the foot and it's ability to move. However, the confirmation of (it being a) true clubfoot is made (at) the time of the physical exam at birth ... In our study, the prenatal diagnosis of clubfoot could be made from the 12th week to the 34th week of pregnancy. " " Thanks to the ultrasound investigation during pregnancy, we can evaluate the type of deformity of the foot although we are not able to (determine) the degree of severity. The severity is not related to the time of the prenatal diagnosis. " A poll on that ultrasound question at the Ponseti site had 22 responses with these results. Diagnosed during 2nd trimester - 8 or 36% Diagnosed during 3rd trimester - 0 Diagnosed after birth - 14 - 63% http://groups.yahoo.com/group/nosurgery4clubfoot/surveys?id=59565 At our own ultrasound, it was not brought up, but later the U of Iowa doctors looked at our ultrasound snapshot picture and were able to identify that the clubfoot was there and had been missed. Clubfoot can be seen in ultrasounds, but it can't really be determined for sure if it is a real clubfoot until after the baby is born and is examined. Some children have what is called postional clubfoot which may look like clubfoot on an ultrasound, but is passively correctable and needs little or no treatment to be resolved. " Real " clubfoot will need treatment to correct. One study in London on 14 children published in the Journal of Bone and Joint surgery in August 2000, indicated that 32% of their sample really didn't have " true " clubfoot. They said " A total of 32% of feet required no treatment and so could be considered functional false-positive results on the scan. " From Medline is this abstract of the Londond study, " Clinical outcome of congenital talipes equinovarus diagnosed antenatally by ultrasound. " Tillett RL, Fisk NM, K, Hunt DM. Department of Orthopaedics, St 's Hospital, London, England. " Congenital talipes equinovarus is a common anomaly which can now be diagnosed prenatally on a routine ultrasound scan at 20 weeks of gestation. Prenatal counselling is increasingly offered to parents with affected fetuses, but it is difficult to counsel parents if there is a chance that the fetus may not have talipes. Our study correlates the prenatal ultrasound findings of 14 infants diagnosed as having unilateral or bilateral talipes during their routine 20- week ultrasound scan with their clinical findings at birth and the treatment received. No feet diagnosed as talipes on the ultrasound scan were completely normal at birth and therefore there were no true false-positive results. One foot graded as normal at 20 weeks was found to have a mild grade-1 talipes at birth, but did not require treatment other than simple stretches. A total of 32% of feet required no treatment and so could be considered functional false- positive results on the scan. Serial casting was required by 13% of feet and surgical treatment by 55%. The severity of the talipes is difficult to establish before birth. A number of patients are likely to need surgical treatment, but a proportion will have talipes so mildly that no treatment will be required. In counselling parents at 20 weeks, orthopaedic surgeons need to know whether or not there is a small chance that the ultrasound diagnosis could be wrong and also that the talipes may be so mild that the foot will not require treatment. " PMID: 10990315 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10990315 In the above study from London, for 81% of feet (55% of 68%) they determined as being " real " clubfeet at birth, they used the surgery for treatment. That rate of surgery is in the same range as a number of studies reported in the U.S. other than in the Ponseti method. The following study indicated that for 103 children born with clubfoot at an Australian hospital only 25% were picked up on ultrasounds. The abstract does not say whether or not all of the 103 mothers had had ultrasounds or not. J Pediatr Orthop 1999 Jan-Feb;19(1):11-3 Prenatal ultrasound diagnosis of clubfoot. Burgan HE, Furness ME, BK. Women's and Children's Hospital, Adelaide, South Australia. Prenatal ultrasound diagnosis of clubfoot is increasing. Of 103 patients with clubfoot diagnosed at birth, 26 (25.2%) positive prenatal scans were identified with the earliest diagnosis being made at 15 weeks. A questionnaire assessment indicated that 17 (65.4%) deemed that the explanation of the baby's condition was clear. With an increasing incidence of antenatal detection, it is suggested that parents require adequate antenatal counseling by a specialist in the area of clubfoot to improve the understanding of the natural history and treatment of this condition. PMID: 9890279 [PubMed - indexed for MEDLINE] and (3-17-99) http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/egbert.html > Thank you all for the advice... I realize I'm in for a long haul and > I'm willing to " convince " my fiance all over again if HE relapses! > I'm going to home with the baby all day while he's at work so the > bar shouldnt be a problem in my eyes. He'll be with her in the > evenings but with me there also. I'll be certain to tell him (if > the doctor doesnt) that the DBB is the most important part of the > treatment, and most crucial. I'm sticking to my guns, guys! > > As for Dr. Noonan... he emailed me back and didn't mention the > ultraound pictures. He did seem like he really thinks it's useless > for us to come in before her birth but if we want to we certainly > can. My fiance said last night that he would like to meet him > before as would I for obvious reasons, I think. We want to know > who's going to be treating our newborn baby... it really is a big > deal to us. > > My fiance isn't a bad guy. I have to defend him here because I > don't want you guys to think he's horrid. He really does have the > baby in mind and he is only saying what he thinks would be the > fastest and best thing for her. He hasn't however done his homework > and this upsets me. I think he needs to read up on his arguments > before he can bring them to the table and argue with me about it. > He has claimed he will but nothing yet... I try not to get on him > because I do tell him a lot of what I find and he does seem to think > it's best now. I really can't complain! > > Anyways, I'm hoping I won't have to use any of your responses for > why she has a cast on since it will be winter and she'll be tucked > away in her warm clothes. It's cold here in Wisconsin so there > won't be any weird looks for a bundled up baby! > > Thanks again for the advice and laughs. > > Tiffani Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2004 Report Share Posted August 18, 2004 tiffani where in WI are you? I grew up in Duluth, mn. Just across the bridge was Wisconsin. so we were there often. --- Tiffani tahuwgb@...> wrote: > Thank you all for the advice... I realize I'm in for > a long haul and > I'm willing to " convince " my fiance all over again > if HE relapses! > I'm going to home with the baby all day while he's > at work so the > bar shouldnt be a problem in my eyes. He'll be with > her in the > evenings but with me there also. I'll be certain to > tell him (if > the doctor doesnt) that the DBB is the most > important part of the > treatment, and most crucial. I'm sticking to my > guns, guys! > > As for Dr. Noonan... he emailed me back and didn't > mention the > ultraound pictures. He did seem like he really > thinks it's useless > for us to come in before her birth but if we want to > we certainly > can. My fiance said last night that he would like > to meet him > before as would I for obvious reasons, I think. We > want to know > who's going to be treating our newborn baby... it > really is a big > deal to us. > > My fiance isn't a bad guy. I have to defend him > here because I > don't want you guys to think he's horrid. He really > does have the > baby in mind and he is only saying what he thinks > would be the > fastest and best thing for her. He hasn't however > done his homework > and this upsets me. I think he needs to read up on > his arguments > before he can bring them to the table and argue with > me about it. > He has claimed he will but nothing yet... I try not > to get on him > because I do tell him a lot of what I find and he > does seem to think > it's best now. I really can't complain! > > Anyways, I'm hoping I won't have to use any of your > responses for > why she has a cast on since it will be winter and > she'll be tucked > away in her warm clothes. It's cold here in > Wisconsin so there > won't be any weird looks for a bundled up baby! > > Thanks again for the advice and laughs. > > Tiffani > > ===== Tam It is better to remain silent and be thought a fool, than to open your mouth and remove all doubt. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2004 Report Share Posted August 19, 2004 I live by Madison but grew up in the northern part of Wisconsin by Rhinelander. Visit any of those towns? > > > Thank you all for the advice... I realize I'm in for > > a long haul and > > I'm willing to " convince " my fiance all over again > > if HE relapses! > > I'm going to home with the baby all day while he's > > at work so the > > bar shouldnt be a problem in my eyes. He'll be with > > her in the > > evenings but with me there also. I'll be certain to > > tell him (if > > the doctor doesnt) that the DBB is the most > > important part of the > > treatment, and most crucial. I'm sticking to my > > guns, guys! > > > > As for Dr. Noonan... he emailed me back and didn't > > mention the > > ultraound pictures. He did seem like he really > > thinks it's useless > > for us to come in before her birth but if we want to > > we certainly > > can. My fiance said last night that he would like > > to meet him > > before as would I for obvious reasons, I think. We > > want to know > > who's going to be treating our newborn baby... it > > really is a big > > deal to us. > > > > My fiance isn't a bad guy. I have to defend him > > here because I > > don't want you guys to think he's horrid. He really > > does have the > > baby in mind and he is only saying what he thinks > > would be the > > fastest and best thing for her. He hasn't however > > done his homework > > and this upsets me. I think he needs to read up on > > his arguments > > before he can bring them to the table and argue with > > me about it. > > He has claimed he will but nothing yet... I try not > > to get on him > > because I do tell him a lot of what I find and he > > does seem to think > > it's best now. I really can't complain! > > > > Anyways, I'm hoping I won't have to use any of your > > responses for > > why she has a cast on since it will be winter and > > she'll be tucked > > away in her warm clothes. It's cold here in > > Wisconsin so there > > won't be any weird looks for a bundled up baby! > > > > Thanks again for the advice and laughs. > > > > Tiffani > > > > > > > ===== > Tam > > It is better to remain silent and be thought a fool, > than to open your mouth and remove all doubt. > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2004 Report Share Posted August 19, 2004 I live by Madison but grew up in the northern part of Wisconsin by Rhinelander. Visit any of those towns? > > > Thank you all for the advice... I realize I'm in for > > a long haul and > > I'm willing to " convince " my fiance all over again > > if HE relapses! > > I'm going to home with the baby all day while he's > > at work so the > > bar shouldnt be a problem in my eyes. He'll be with > > her in the > > evenings but with me there also. I'll be certain to > > tell him (if > > the doctor doesnt) that the DBB is the most > > important part of the > > treatment, and most crucial. I'm sticking to my > > guns, guys! > > > > As for Dr. Noonan... he emailed me back and didn't > > mention the > > ultraound pictures. He did seem like he really > > thinks it's useless > > for us to come in before her birth but if we want to > > we certainly > > can. My fiance said last night that he would like > > to meet him > > before as would I for obvious reasons, I think. We > > want to know > > who's going to be treating our newborn baby... it > > really is a big > > deal to us. > > > > My fiance isn't a bad guy. I have to defend him > > here because I > > don't want you guys to think he's horrid. He really > > does have the > > baby in mind and he is only saying what he thinks > > would be the > > fastest and best thing for her. He hasn't however > > done his homework > > and this upsets me. I think he needs to read up on > > his arguments > > before he can bring them to the table and argue with > > me about it. > > He has claimed he will but nothing yet... I try not > > to get on him > > because I do tell him a lot of what I find and he > > does seem to think > > it's best now. I really can't complain! > > > > Anyways, I'm hoping I won't have to use any of your > > responses for > > why she has a cast on since it will be winter and > > she'll be tucked > > away in her warm clothes. It's cold here in > > Wisconsin so there > > won't be any weird looks for a bundled up baby! > > > > Thanks again for the advice and laughs. > > > > Tiffani > > > > > > > ===== > Tam > > It is better to remain silent and be thought a fool, > than to open your mouth and remove all doubt. > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2004 Report Share Posted August 19, 2004 I live by Madison but grew up in the northern part of Wisconsin by Rhinelander. Visit any of those towns? > > > Thank you all for the advice... I realize I'm in for > > a long haul and > > I'm willing to " convince " my fiance all over again > > if HE relapses! > > I'm going to home with the baby all day while he's > > at work so the > > bar shouldnt be a problem in my eyes. He'll be with > > her in the > > evenings but with me there also. I'll be certain to > > tell him (if > > the doctor doesnt) that the DBB is the most > > important part of the > > treatment, and most crucial. I'm sticking to my > > guns, guys! > > > > As for Dr. Noonan... he emailed me back and didn't > > mention the > > ultraound pictures. He did seem like he really > > thinks it's useless > > for us to come in before her birth but if we want to > > we certainly > > can. My fiance said last night that he would like > > to meet him > > before as would I for obvious reasons, I think. We > > want to know > > who's going to be treating our newborn baby... it > > really is a big > > deal to us. > > > > My fiance isn't a bad guy. I have to defend him > > here because I > > don't want you guys to think he's horrid. He really > > does have the > > baby in mind and he is only saying what he thinks > > would be the > > fastest and best thing for her. He hasn't however > > done his homework > > and this upsets me. I think he needs to read up on > > his arguments > > before he can bring them to the table and argue with > > me about it. > > He has claimed he will but nothing yet... I try not > > to get on him > > because I do tell him a lot of what I find and he > > does seem to think > > it's best now. I really can't complain! > > > > Anyways, I'm hoping I won't have to use any of your > > responses for > > why she has a cast on since it will be winter and > > she'll be tucked > > away in her warm clothes. It's cold here in > > Wisconsin so there > > won't be any weird looks for a bundled up baby! > > > > Thanks again for the advice and laughs. > > > > Tiffani > > > > > > > ===== > Tam > > It is better to remain silent and be thought a fool, > than to open your mouth and remove all doubt. > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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