Re: Reply from Dr. Ponseti

[Guest guest]

When Dr. Ponseti put Devlin in the shoes, he only had them

rotated (I think) 20 degrees. It was certainly not more than 30

degrees. Obviously, Dr. Ponseti considers the individual case itself,

and there are exceptions to the " set " treatment for the " ordinary "

(I'm not calling ANY of our babies ordinary, mind you) club foot. In

Devlin's case (also atypical cf, bilateral), her feet had mostly just

the equinous part of the deformity so the 70 degree rotation would

have been overcorrection for a condition she didn't have.

Send him an email for clarification---I'm sure he'll explain what he

means and why.

Good luck.

>

> Hi all

> I received a reply from Dr. Ponseti today. The only thing I am

> confused about is the 40-50 degree rotation of the shoes. Does he

> mean just for now and then work our way up to 70 degrees? Has anyone

> had the shoes not at 70 degrees? Any way here is the response:

> November 22, 2004

>

> Certainly Tommy has an atypical, complex clubfoot deformity. The

> ankle dorsiflexion is just to neutral. The feet are short and

> stubby. You have to tighten the middle strap very tightly so the

> heel will come down as far as possible. Your son's feet are

> difficult to treat, but you are in good hands. He may need 2 or 3

> more plaster casts to further dorsiflex the foot. The shoes on the

> bar should be turned out to only 40-50 degrees. Perhaps they are

> turned out too much now. You will see the degrees indicated and can

> adjust the rotation by removing the screw and inserting it in the

> proper hole.

>

> I.V. Ponseti, M.D.

[Guest guest]

I'm pretty sure (someone correct me if I'm wrong please) that the atypical

feet aren't being set at 70 degrees for various reasons due to their nature

and there's also the fact that if baby is in the shoes, those are

not set at 70 either for some reason (design?). Atypical should be in the

's because they often don't stay in the Markell's and then you've

got both situations going for you so the degree setting would be far less

than 70.

Anyone got a better understanding of this??

Kori

At 06:57 PM 11/22/2004, you wrote:

>When Dr. Ponseti put Devlin in the shoes, he only had them

>rotated (I think) 20 degrees. It was certainly not more than 30

>degrees. Obviously, Dr. Ponseti considers the individual case itself,

>and there are exceptions to the " set " treatment for the " ordinary "

>(I'm not calling ANY of our babies ordinary, mind you) club foot. In

>Devlin's case (also atypical cf, bilateral), her feet had mostly just

>the equinous part of the deformity so the 70 degree rotation would

>have been overcorrection for a condition she didn't have.

>

>Send him an email for clarification---I'm sure he'll explain what he

>means and why.

>

>Good luck.

>

>

>

>

>

> >

> > Hi all

> > I received a reply from Dr. Ponseti today. The only thing I am

> > confused about is the 40-50 degree rotation of the shoes. Does he

> > mean just for now and then work our way up to 70 degrees? Has anyone

> > had the shoes not at 70 degrees? Any way here is the response:

> > November 22, 2004

> >

> > Certainly Tommy has an atypical, complex clubfoot deformity. The

> > ankle dorsiflexion is just to neutral. The feet are short and

> > stubby. You have to tighten the middle strap very tightly so the

> > heel will come down as far as possible. Your son's feet are

> > difficult to treat, but you are in good hands. He may need 2 or 3

> > more plaster casts to further dorsiflex the foot. The shoes on the

> > bar should be turned out to only 40-50 degrees. Perhaps they are

> > turned out too much now. You will see the degrees indicated and can

> > adjust the rotation by removing the screw and inserting it in the

> > proper hole.

> >

> > I.V. Ponseti, M.D.

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Hi .

That is great you heard back from him!!!! I think he is saying to start

at 50 degrees, because maybe his feet aren't turned out the full 70

(because they are atypical). Like he said, very difficult to treat, so it

is more challenging to get the feet out to full correction/rotation. Maybe

over time, after more casting, he will reach the full 70 degree rotation.

I am no doctor, so I'm sure I'm making no sense whatsoever. Try the 50

degrees and see if the shoes stay on better. Try to get that middle strap

as tight as possible, even if you have to add another hole. Remember,

your protocol is going to stray slightly because of Tommy's unique

situation.

I would forward Dr.P's email response to Dr. H so he knows what he had to

say.

When is your next appointment with Dr.H? I still agree that you are in

good hands with Dr. H and I think Dr.P can coach him along if needed.

Good luck and keep us posted!!

Shook

Retail Operations Manager/Baking Instructor

Vie de France Yamazaki, Inc.

2070 Chain Bridge Rd. Suite 500

Vienna, VA 22182

x374

x374

fax

[Guest guest]

Hi ,

I did foward the e-mail to Dr. Herzenberg. We are scheduled to go

back on December 16th. It does make me happy to hear Dr. Ponseti say

we are in good hands even though Tommy is a tough case. I will let

you know what happens.

> Hi .

> That is great you heard back from him!!!! I think he is saying to

start

> at 50 degrees, because maybe his feet aren't turned out the full 70

> (because they are atypical). Like he said, very difficult to

treat, so it

> is more challenging to get the feet out to full

correction/rotation. Maybe

> over time, after more casting, he will reach the full 70 degree

rotation.

> I am no doctor, so I'm sure I'm making no sense whatsoever. Try

the 50

> degrees and see if the shoes stay on better. Try to get that

middle strap

> as tight as possible, even if you have to add another hole.

Remember,

> your protocol is going to stray slightly because of Tommy's unique

> situation.

> I would forward Dr.P's email response to Dr. H so he knows what he

had to

> say.

>

> When is your next appointment with Dr.H? I still agree that you

are in

> good hands with Dr. H and I think Dr.P can coach him along if

needed.

>

> Good luck and keep us posted!!

>

>

> Shook

> Retail Operations Manager/Baking Instructor

> Vie de France Yamazaki, Inc.

> 2070 Chain Bridge Rd. Suite 500

> Vienna, VA 22182

> x374

> x374

> fax

>

>

[Guest guest]

Hi ,

I did foward the e-mail to Dr. Herzenberg. We are scheduled to go

back on December 16th. It does make me happy to hear Dr. Ponseti say

we are in good hands even though Tommy is a tough case. I will let

you know what happens.

> Hi .

> That is great you heard back from him!!!! I think he is saying to

start

> at 50 degrees, because maybe his feet aren't turned out the full 70

> (because they are atypical). Like he said, very difficult to

treat, so it

> is more challenging to get the feet out to full

correction/rotation. Maybe

> over time, after more casting, he will reach the full 70 degree

rotation.

> I am no doctor, so I'm sure I'm making no sense whatsoever. Try

the 50

> degrees and see if the shoes stay on better. Try to get that

middle strap

> as tight as possible, even if you have to add another hole.

Remember,

> your protocol is going to stray slightly because of Tommy's unique

> situation.

> I would forward Dr.P's email response to Dr. H so he knows what he

had to

> say.

>

> When is your next appointment with Dr.H? I still agree that you

are in

> good hands with Dr. H and I think Dr.P can coach him along if

needed.

>

> Good luck and keep us posted!!

>

>

> Shook

> Retail Operations Manager/Baking Instructor

> Vie de France Yamazaki, Inc.

> 2070 Chain Bridge Rd. Suite 500

> Vienna, VA 22182

> x374

> x374

> fax

>

>

[Guest guest]

Ava has bilateral atypical cf. She is in the 's and her R

foot is set at 70 and her L at 60 per Dr. Ponseti. I don't know why

the difference but her R foot is more severe. When we take the shoes

off for the hour by the time I go to put them back on her R foot is

usually in the neutral position and laying on the outside of the

foot. That's pretty quick considering she is in them 23/7. Hopefully

we will know more when we go back to Iowa in 1wk. Anticipating

another tenotomy.

KK

>

> Hi all

> I received a reply from Dr. Ponseti today. The only thing I am

> confused about is the 40-50 degree rotation of the shoes. Does he

> mean just for now and then work our way up to 70 degrees? Has

anyone

> had the shoes not at 70 degrees? Any way here is the response:

> November 22, 2004

>

> Certainly Tommy has an atypical, complex clubfoot deformity. The

> ankle dorsiflexion is just to neutral. The feet are short and

> stubby. You have to tighten the middle strap very tightly so the

> heel will come down as far as possible. Your son's feet are

> difficult to treat, but you are in good hands. He may need 2 or 3

> more plaster casts to further dorsiflex the foot. The shoes on the

> bar should be turned out to only 40-50 degrees. Perhaps they are

> turned out too much now. You will see the degrees indicated and

can

> adjust the rotation by removing the screw and inserting it in the

> proper hole.

>

> I.V. Ponseti, M.D.

[Guest guest]

Ava has bilateral atypical cf. She is in the 's and her R

foot is set at 70 and her L at 60 per Dr. Ponseti. I don't know why

the difference but her R foot is more severe. When we take the shoes

off for the hour by the time I go to put them back on her R foot is

usually in the neutral position and laying on the outside of the

foot. That's pretty quick considering she is in them 23/7. Hopefully

we will know more when we go back to Iowa in 1wk. Anticipating

another tenotomy.

KK

>

> Hi all

> I received a reply from Dr. Ponseti today. The only thing I am

> confused about is the 40-50 degree rotation of the shoes. Does he

> mean just for now and then work our way up to 70 degrees? Has

anyone

> had the shoes not at 70 degrees? Any way here is the response:

> November 22, 2004

>

> Certainly Tommy has an atypical, complex clubfoot deformity. The

> ankle dorsiflexion is just to neutral. The feet are short and

> stubby. You have to tighten the middle strap very tightly so the

> heel will come down as far as possible. Your son's feet are

> difficult to treat, but you are in good hands. He may need 2 or 3

> more plaster casts to further dorsiflex the foot. The shoes on the

> bar should be turned out to only 40-50 degrees. Perhaps they are

> turned out too much now. You will see the degrees indicated and

can

> adjust the rotation by removing the screw and inserting it in the

> proper hole.

>

> I.V. Ponseti, M.D.

[Guest guest]

Dr P told us that 60 degrees was all that needed.. I don't know why it's

different from what we all know but honestly I never questioned it because it

came from him. I figured if anyone knew what they were talking about it would

definately be Dr P....

-------------- Original message --------------

Hi all

I received a reply from Dr. Ponseti today. The only thing I am

confused about is the 40-50 degree rotation of the shoes. Does he

mean just for now and then work our way up to 70 degrees? Has anyone

had the shoes not at 70 degrees? Any way here is the response:

November 22, 2004

Certainly Tommy has an atypical, complex clubfoot deformity. The

ankle dorsiflexion is just to neutral. The feet are short and

stubby. You have to tighten the middle strap very tightly so the

heel will come down as far as possible. Your son's feet are

difficult to treat, but you are in good hands. He may need 2 or 3

more plaster casts to further dorsiflex the foot. The shoes on the

bar should be turned out to only 40-50 degrees. Perhaps they are

turned out too much now. You will see the degrees indicated and can

adjust the rotation by removing the screw and inserting it in the

proper hole.

I.V. Ponseti, M.D.

[Guest guest]

Dr P told us that 60 degrees was all that needed.. I don't know why it's

different from what we all know but honestly I never questioned it because it

came from him. I figured if anyone knew what they were talking about it would

definately be Dr P....

-------------- Original message --------------

Hi all

I received a reply from Dr. Ponseti today. The only thing I am

confused about is the 40-50 degree rotation of the shoes. Does he

mean just for now and then work our way up to 70 degrees? Has anyone

had the shoes not at 70 degrees? Any way here is the response:

November 22, 2004

Certainly Tommy has an atypical, complex clubfoot deformity. The

ankle dorsiflexion is just to neutral. The feet are short and

stubby. You have to tighten the middle strap very tightly so the

heel will come down as far as possible. Your son's feet are

difficult to treat, but you are in good hands. He may need 2 or 3

more plaster casts to further dorsiflex the foot. The shoes on the

bar should be turned out to only 40-50 degrees. Perhaps they are

turned out too much now. You will see the degrees indicated and can

adjust the rotation by removing the screw and inserting it in the

proper hole.

I.V. Ponseti, M.D.

[Guest guest]

Hi ,

Glad you heard back! Don't have experience with the different

rotation.

It' always nice to hear how highly Dr P regards Dr H

Marilouise

9/9/03, LCF, DBB 12-16/24

Owen and 3/20/99

>

> Hi all

> I received a reply from Dr. Ponseti today. The only thing I am

> confused about is the 40-50 degree rotation of the shoes. Does he

> mean just for now and then work our way up to 70 degrees? Has

anyone

> had the shoes not at 70 degrees? Any way here is the response:

> November 22, 2004

>

> Certainly Tommy has an atypical, complex clubfoot deformity. The

> ankle dorsiflexion is just to neutral. The feet are short and

> stubby. You have to tighten the middle strap very tightly so the

> heel will come down as far as possible. Your son's feet are

> difficult to treat, but you are in good hands. He may need 2 or 3

> more plaster casts to further dorsiflex the foot. The shoes on

the

> bar should be turned out to only 40-50 degrees. Perhaps they are

> turned out too much now. You will see the degrees indicated and

can

> adjust the rotation by removing the screw and inserting it in the

> proper hole.

>

> I.V. Ponseti, M.D.