Guest guest Posted May 24, 2004 Report Share Posted May 24, 2004 I have debated since last week when I got Dr Mosca's reply to the monthly photos weather or not to post anything about it. Today I got Dr Ponseti's response and it was very similar to Dr Mosca's (see both below). My thoughts on this are just all over the place. They both mention the ATTT - although just as a " too early to tell " - and Dr Ponseti basically says we have to risk damaging Kai's midfoot to minimize the chances of the ATTT. I guess it is just hard to even hear mention of any surgery when we have and are still fighting so hard to *prevent* surgery. I know both doctors are just trying to be upfront and know that we are very educated about Kai's foot, but this is just one of those instances where I wish they had just bit their tongues! Dear Mrs. Gray, Kai's foot remains flexible with full correction of all contractures. He does not yet have good muscle control. It's too early to know if he is one of the children with clubfoot and muscle imbalance who will benefit from transfer of the tibialis anterior. We'll know in the next year or so. Try using high-top shoes to give his ankle a little more support and control. S. Mosca, MD May 24, 2004 Dear Mrs. Gray: The photos indicate the muscles on the inner side of the foot and leg (supinators) are stronger than the pronators. This is observed in babies with severe clubfeet when they start to walk. Gradually the pronators develop more strength and are able to better stabilize the foot. The fact that the lateral crease is getting deeper is related to the outward rotation angle of the shoes. On the other hand the position of the shoes stretches the supinators and strengthens the pronations. Therefore I would leave the shoes as they are. It will be interesting to see how the muscles develop over the next few months. It is too early to know if an anterior tibialis tendon transfer will be necessary. This can be decided months from now once we know if the pronator strength improves sufficiently to overcome the supinators. I will tell about the need to use a stronger leather strap to hold the foot in the shoe more firmly. I.V. Ponseti, M.D. Quote Link to comment Share on other sites More sharing options...
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