Description of atypical cf from Dr P

[Guest guest]

I recieved this message last night from Dr Ponseti. It is very technical, and I

have not yet taken the time to break it down so that it is in layman's terms,

but I will be doing that today and will be happy to send the result to anyone

who wants it. I am having a bit of trouble with storage on my hotmail right

now, so you can e-mail me at fntsyangel@...

July 24, 2004

We are preparing a paper on atypical clubfoot which will be submitted to a

leading orthopaedic journal in the near future. We have collected about 40

casts from around the world, 20 of which are from the U.S. We have delayed

sending this in for publication because we are still learning about the

deformity. Usually the foot is short and stubby with a transverse crease or

fold on the sole of the foot and usually another on the back of the foot above

the heel. The main deformity and the components most resistant to correction

are equinus and cavus (or plantaris). The adduction of the hind foot, which is

the main deformity in the usual clubfoot, is not a big problem in the atypical

clubfoot.

In the atypical clubfoot the heel varus can be easily corrected and there is

fairly good motion in the subtalar joint. The talus, however, is in very severe

equinus and almost subluxated forward under the tibia. The equinus is

unyielding. If the doctor persists in correcting the atypical clubfoot by

abducting the forefoot severely, he causes a secondary deformity which is the

abduction of the forefoot with a fold on the outside of the foot and a

subluxation of the metatarsals at the Lisfranc joint. Therefore in most cases

the best treatment is to do an early percutaneous tendo Achilles tenotomy (after

the second or third cast) and not persist in abducting the forefoot. After the

tenotomy it is usually possible to bring the talus back into the ankle but not

without fully correcting the equinus. This usually requires another tenotomy of

the tendo Achilles later on.

A very important point is that these short, stubby feet have to be placed in

's shoes as soon as the last cast is removed. By gradually

tightening the middle strap on the shoes, the plantaris can be improved. We

feel the deformity is caused by thickening and tightness of the posterior

hindfoot and plantar ligaments. This seems to improve with time and by age

12-14 months there is a loosening and most children we have seen are able to

walk well.

I realize this description is technical but I don't know how else to explain it.

It is important to say the doctors' big mistake is to try to treat this

deformity with surgery since the surgery is followed by severe scarring and this

makes correction much more difficult.

[Guest guest]

Hi Angel,

I would love to see the layman's version. Some of the technical terms

still leave me confused. I'm catching on but it still doesn't make

complete sense.

BTW, I like the anatomy link you sent. That does help to picture the

bones I've lost a lot of my anatomy knowledge over the years.

Marilouise

> I recieved this message last night from Dr Ponseti. It is very

technical, and I have not yet taken the time to break it down so that

it is in layman's terms, but I will be doing that today and will be

happy to send the result to anyone who wants it. I am having a bit of

trouble with storage on my hotmail right now, so you can e-mail me at

fntsyangel@c...

>

[Guest guest]

Hi Angel,

I would love to see the layman's version. Some of the technical terms

still leave me confused. I'm catching on but it still doesn't make

complete sense.

BTW, I like the anatomy link you sent. That does help to picture the

bones I've lost a lot of my anatomy knowledge over the years.

Marilouise

> I recieved this message last night from Dr Ponseti. It is very

technical, and I have not yet taken the time to break it down so that

it is in layman's terms, but I will be doing that today and will be

happy to send the result to anyone who wants it. I am having a bit of

trouble with storage on my hotmail right now, so you can e-mail me at

fntsyangel@c...

>

[Guest guest]

Hi Angel,

I would love to see the layman's version. Some of the technical terms

still leave me confused. I'm catching on but it still doesn't make

complete sense.

BTW, I like the anatomy link you sent. That does help to picture the

bones I've lost a lot of my anatomy knowledge over the years.

Marilouise

> I recieved this message last night from Dr Ponseti. It is very

technical, and I have not yet taken the time to break it down so that

it is in layman's terms, but I will be doing that today and will be

happy to send the result to anyone who wants it. I am having a bit of

trouble with storage on my hotmail right now, so you can e-mail me at

fntsyangel@c...

>

[Guest guest]

This was so, so helpful! This describes Devlin's feet exactly! Our family

doctor keeps asking us to get more information on her specific condition

becasue he's been following her case and I told him to call Dr. P. I think he

was reluctant but now with this description I forwarded him he'll have some

foundational knowledge if/when he calls Dr. Ponseti. I also had trouble

explaining to people what duPont had done wrong and now with this

description of the " secondary deformity " (abduction of the forefoot) he

explains, I can make more sense. That's exactly what duPont did to her.

When that article comes out I'm going to have it laminated and sent to Dr. Jay

at duPont---I'll also send it to Dr. Bower. He's the head of duPont orthopedics

and he told us that Ponseti was basically an old man who's methods will die

with him. Don't get me started about that guy!!!

I didn't see a link to an anatomy website. Can you share that with me?

Thanks.

Mommy to Devlin, bilateral atypical cf