Re: Another ultrasound

[Guest guest]

Dear linda,

Our due dates are one day apart (am due June 25)! what an amazing coincidence.

Also found out about my son's club feet in our last ultrasound.

My next u/s isn't for several weeks, but my ob-gyn did tell me to did say that i

should ask the attending physician/technician to ask whether or not the club

feet diagnosis was " suggestive " or more or less conclusive. Sometimes the

reports they make aren't exactly clear what degree of certainty they attach to

the diagnosis. And she did say to note how long they observed the feet, and

whether or not the baby moved during that period (to make sure that it's not

just an awkward position).

love,

dedet

linda07033 linda07033@...> wrote:

I am going for another ultrasound this week. I am now 28 weeks

pregnant, and my son was diagnosed with bilateral clubfeet at the

last ultrasound. Are there any questions I should ask when I go?

Also, I have an appointment with a Ponseti Orthopedic surgeon on the

22nd April. What questions should I ask him? I'm so new to this that

I don't even know that I don't know something!! I'm just grateful for

the clubfoot groups where I could learn about the amazing treatments

available.

and (due June 24th)

[Guest guest]

Dear linda,

Our due dates are one day apart (am due June 25)! what an amazing coincidence.

Also found out about my son's club feet in our last ultrasound.

My next u/s isn't for several weeks, but my ob-gyn did tell me to did say that i

should ask the attending physician/technician to ask whether or not the club

feet diagnosis was " suggestive " or more or less conclusive. Sometimes the

reports they make aren't exactly clear what degree of certainty they attach to

the diagnosis. And she did say to note how long they observed the feet, and

whether or not the baby moved during that period (to make sure that it's not

just an awkward position).

love,

dedet

linda07033 linda07033@...> wrote:

I am going for another ultrasound this week. I am now 28 weeks

pregnant, and my son was diagnosed with bilateral clubfeet at the

last ultrasound. Are there any questions I should ask when I go?

Also, I have an appointment with a Ponseti Orthopedic surgeon on the

22nd April. What questions should I ask him? I'm so new to this that

I don't even know that I don't know something!! I'm just grateful for

the clubfoot groups where I could learn about the amazing treatments

available.

and (due June 24th)

[Guest guest]

Dear linda,

Our due dates are one day apart (am due June 25)! what an amazing coincidence.

Also found out about my son's club feet in our last ultrasound.

My next u/s isn't for several weeks, but my ob-gyn did tell me to did say that i

should ask the attending physician/technician to ask whether or not the club

feet diagnosis was " suggestive " or more or less conclusive. Sometimes the

reports they make aren't exactly clear what degree of certainty they attach to

the diagnosis. And she did say to note how long they observed the feet, and

whether or not the baby moved during that period (to make sure that it's not

just an awkward position).

love,

dedet

linda07033 linda07033@...> wrote:

I am going for another ultrasound this week. I am now 28 weeks

pregnant, and my son was diagnosed with bilateral clubfeet at the

last ultrasound. Are there any questions I should ask when I go?

Also, I have an appointment with a Ponseti Orthopedic surgeon on the

22nd April. What questions should I ask him? I'm so new to this that

I don't even know that I don't know something!! I'm just grateful for

the clubfoot groups where I could learn about the amazing treatments

available.

and (due June 24th)

[Guest guest]

Here is some information on ultrasounds and when clubfoot

developes.

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

> I am going for another ultrasound this week. I am now 28 weeks

> pregnant, and my son was diagnosed with bilateral clubfeet at the

> last ultrasound. Are there any questions I should ask when I go?

> Also, I have an appointment with a Ponseti Orthopedic surgeon on

the

> 22nd April. What questions should I ask him? I'm so new to this

that

> I don't even know that I don't know something!! I'm just grateful

for

> the clubfoot groups where I could learn about the amazing

treatments

> available.

>

> and (due June 24th)

[Guest guest]

Here is some information on ultrasounds and when clubfoot

developes.

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

> I am going for another ultrasound this week. I am now 28 weeks

> pregnant, and my son was diagnosed with bilateral clubfeet at the

> last ultrasound. Are there any questions I should ask when I go?

> Also, I have an appointment with a Ponseti Orthopedic surgeon on

the

> 22nd April. What questions should I ask him? I'm so new to this

that

> I don't even know that I don't know something!! I'm just grateful

for

> the clubfoot groups where I could learn about the amazing

treatments

> available.

>

> and (due June 24th)

[Guest guest]

Here is some information on ultrasounds and when clubfoot

developes.

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

> I am going for another ultrasound this week. I am now 28 weeks

> pregnant, and my son was diagnosed with bilateral clubfeet at the

> last ultrasound. Are there any questions I should ask when I go?

> Also, I have an appointment with a Ponseti Orthopedic surgeon on

the

> 22nd April. What questions should I ask him? I'm so new to this

that

> I don't even know that I don't know something!! I'm just grateful

for

> the clubfoot groups where I could learn about the amazing

treatments

> available.

>

> and (due June 24th)

[Guest guest]

, the following link is from 's site and contains the

parent's checklist (questions to ask your Ponseti doctor).

http://pages.ivillage.com/ponseti_links/id13.html

Good luck.

Daiga and Owen, 02/04/03

Unilateral LCF, DBB 14/24

> I am going for another ultrasound this week. I am now 28 weeks

> pregnant, and my son was diagnosed with bilateral clubfeet at the

> last ultrasound. Are there any questions I should ask when I go?

> Also, I have an appointment with a Ponseti Orthopedic surgeon on

the

> 22nd April. What questions should I ask him? I'm so new to this

that

> I don't even know that I don't know something!! I'm just grateful

for

> the clubfoot groups where I could learn about the amazing

treatments

> available.

>

> and (due June 24th)