Guest guest Posted May 16, 2004 Report Share Posted May 16, 2004 , What degree has your doctor set the FAB/DBB? I was at Dr. Herzenberg's September 2001 Ponseti method training meeting in Baltimore when Dr. Dietz of the U of Iowa was asked about the possibility of knee problems because the final cast and FAB/DBB were at 70 degrees. His answer was that they have not seen knee related problems in the past 40-50 years of the use of the method at the U of Iowa. Dr. Dietz was one of the doctors who did the 1993 longer term outcome study that looked at patients treated in the 1950's and 1960's. They did all kinds of tests, interviews, questionaires etc and there were not knee problems. A message about that meeting can be seen at http://health.groups.yahoo.com/group/nosurgery4clubfoot/message/8882 My guess is that doctors new to the Ponseti method are a bit nervous to abduct the feet out to the 70 degrees either in the final casts or in the FAB/DBB. My impression is that when they do that, since it is a modification to the Ponseti method, that there may be an increased risk of relapsing. and (3-17-99) > Just a quick question and an update. > > is now one month into wearing his dbb's and at last I dare > to say that he is staying in the boots and doing very well. The two > maintenance casts made a huge difference to the level of correction > he had previously attained ie, the worse of the two feet is now > looking really good. There is no doubt that our previous nightmare > with the dbbs was due to the feet being insufficiently corrected. > > Our consultant has refused to put his feet at 70 degrees as he says > the knees cannot rotate this much. Ok I can see his point but as you > know your children's feet are at this angle. So before we crank up > the rotation of his boots our query is... Has there been a study of > Ponseti treated children to review whether any knee problems are > experienced as a result of the treatment? Any info on this would be > greatly appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2004 Report Share Posted May 16, 2004 There are many ortho's that feel this way. My ortho was one of them. Ponseti has over 40 plus years of research on this and if there were a problem with kids knees he wouldn't do it. Ponseti himself used to not rotate the shoes out as far and found out there is a much higher chance of relapsing when the shoes aren't rotated out to 70 degrees. With that said you can't just rotate out to 70 degrees on your own. The child's last cast (post tenonomy) has to be out at 70 degrees for them to go into the shoe comfortable. My son's last cast was set at 50 degrees and he was put into his shoes at 45 degrees. I consulted with Dr.P and he said since my son was loose ligamented that I could try rotating out the shoes 5 degrees once a week and see how far he tolerated it. We got him to 60 degrees with no fuss. Anything after that was painful for him. We've left him at 60 and he is 2 and has been fine. Looking back on it and all I wished I just had him recasted a couple of times and then into the shoe to get him to 70. You can and should email Dr. P explaining the ortho's opinion on the knee and Ponseti will get back to you and let you know why he dismisses that. This is the only way you will confident enough to go back to your ortho and let him know the degrees need to be switched. My orginal doctor took it quite well when I showed up with them CF foot angled out to 60 degrees and let him know I was in contact with Dr. P. > >Reply-To: nosurgery4clubfoot >To: nosurgery4clubfoot >Subject: 70 degrees >Date: Sun, 16 May 2004 08:18:09 -0000 > >Just a quick question and an update. > > is now one month into wearing his dbb's and at last I dare >to say that he is staying in the boots and doing very well. The two >maintenance casts made a huge difference to the level of correction >he had previously attained ie, the worse of the two feet is now >looking really good. There is no doubt that our previous nightmare >with the dbbs was due to the feet being insufficiently corrected. > >Our consultant has refused to put his feet at 70 degrees as he says >the knees cannot rotate this much. Ok I can see his point but as you >know your children's feet are at this angle. So before we crank up >the rotation of his boots our query is... Has there been a study of >Ponseti treated children to review whether any knee problems are >experienced as a result of the treatment? Any info on this would be >greatly appreciated. > > > _________________________________________________________________ Stop worrying about overloading your inbox - get MSN Hotmail Extra Storage! http://join.msn.click-url.com/go/onm00200362ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2004 Report Share Posted May 16, 2004 , This is a good question and I wasn't aware of this concern of later knee problems. My question would be this. They haven't been rotating out to 70 degrees for the last 40 to 50 years, though, have they? I thought the 70 degrees was a somewhat recent modification of Dr. Ponseti's of say the last 10 years to so. Is this correct or no? Thanks, Chris mom to Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2004 Report Share Posted May 17, 2004 Just to say that 's feet are currently at 60 degrees. He is " very " !! comfortable with them at this angle. In fact he is better at this angle than before when they were about 40 to 50 degrees - this angle seemed to give him what we believe was hip trouble though who actually knows, as of course he can't speak much at the moment. I'd be interested to know how long the 70 degrees has been in place too. Mum to : 5 month, bilateral clubfeet > , > > This is a good question and I wasn't aware of this concern of later > knee problems. > > My question would be this. They haven't been rotating out to 70 > degrees for the last 40 to 50 years, though, have they? I thought > the 70 degrees was a somewhat recent modification of Dr. Ponseti's of > say the last 10 years to so. Is this correct or no? > > Thanks, > > Chris > mom to Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2004 Report Share Posted May 17, 2004 We are also at 60 degrees and I have considered changing it myself, but read somewhere that Dr. P sets it anywhere from 50-70 degrees. Louisa and Zoe 2-22-04 > > , > > > > This is a good question and I wasn't aware of this concern of later > > knee problems. > > > > My question would be this. They haven't been rotating out to 70 > > degrees for the last 40 to 50 years, though, have they? I thought > > the 70 degrees was a somewhat recent modification of Dr. Ponseti's > of > > say the last 10 years to so. Is this correct or no? > > > > Thanks, > > > > Chris > > mom to Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2004 Report Share Posted May 17, 2004 Dr. Ponseti had set 's sandals at 60 degrees. I don't know if it makes a difference between the boots and the sandals. I would assume there would be no difference though. Just thought I'd add my 2 cents. Bridget & bl cf 2/20/04 amandajlear amandajlear@...> wrote: Just a quick question and an update. is now one month into wearing his dbb's and at last I dare to say that he is staying in the boots and doing very well. The two maintenance casts made a huge difference to the level of correction he had previously attained ie, the worse of the two feet is now looking really good. There is no doubt that our previous nightmare with the dbbs was due to the feet being insufficiently corrected. Our consultant has refused to put his feet at 70 degrees as he says the knees cannot rotate this much. Ok I can see his point but as you know your children's feet are at this angle. So before we crank up the rotation of his boots our query is... Has there been a study of Ponseti treated children to review whether any knee problems are experienced as a result of the treatment? Any info on this would be greatly appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 , We have the sandals which are set at 60 degrees, too. I asked Dr. Ponseti about this and he said that 60 degrees in the shoes are equivalent to 70 degrees in the Markell shoes, since they are made differently. Just thought you'd be interested in this. and Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 It is good to know there is a reason for the different angle settings. Thanks for letting me know. Bridget ck_cz persbus@...> wrote: , We have the sandals which are set at 60 degrees, too. I asked Dr. Ponseti about this and he said that 60 degrees in the shoes are equivalent to 70 degrees in the Markell shoes, since they are made differently. Just thought you'd be interested in this. and Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 It is good to know there is a reason for the different angle settings. Thanks for letting me know. Bridget ck_cz persbus@...> wrote: , We have the sandals which are set at 60 degrees, too. I asked Dr. Ponseti about this and he said that 60 degrees in the shoes are equivalent to 70 degrees in the Markell shoes, since they are made differently. Just thought you'd be interested in this. and Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2004 Report Share Posted May 18, 2004 It is good to know there is a reason for the different angle settings. Thanks for letting me know. Bridget ck_cz persbus@...> wrote: , We have the sandals which are set at 60 degrees, too. I asked Dr. Ponseti about this and he said that 60 degrees in the shoes are equivalent to 70 degrees in the Markell shoes, since they are made differently. Just thought you'd be interested in this. and Sophia 12/8/03 bcf Quote Link to comment Share on other sites More sharing options...
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