Re: OK - where are those posts about bar length? - musings... I'm irritable toni

[Guest guest]

Kori,

Maybe this one will help your case coming from Jay Markell, I like the

part where he says whatever is more comfortable for the baby:

--- " We supply alot of the bars to the hospitals and orthotists. I side

with the global health pamphlet, in that it is the baby's heels that

need to be at about shoulder width. I also agree that there is

probably a comfort range of 2-3 inches, depending on the baby.

One thing that is confusing is inch length of a specified bar and the

effective length of heel seperation when you turn the feet out to 70

degrees. A standard 8 inch bar (gold or red) measures 8 inches from

center of hole or bolt to center of hole/bolt. However, after you turn

the feet out to 70 degrees external (assuming a bilateral case), The

effective heel to heel distance decreases to about 6 inches.

So if a baby measures 8 inches across at the shoulders, and is going

to have both feet turned out to 70 degrees, then a 10 inch bar is

probably indicated.

The whole problem can be avoided if the orthotics dept. or facility

either uses an adjustable bar, or keeps a small inventory of different

length bars. Whatever, is most comfortable for the baby is what should

be used.

I hope this helps and doesn't confuse the matter further.

Jay Markell

Markell Shoe Co. "

Hope this helps,

> Sorry all, I know I had this information before the great *crash

bang boom

> dead laptop deal*, and it's on yahoo's site. But I don't do yahoo's

site

> unless I absolutely have to. I have very little ram in this puter,

and I'm

> not going to search forever for those posts. I know someone has them

> handy... please and thank you! What I want are the articles that

have Dr.

> Ponseti saying both bolt to bolt, and heel to heel. I have the Global

> Health linked somewhere so that's one place, but I remember seeing

quotes

> from seminars or articles where it said both as well. Anyone??

That has

> led all of us to assume that there's an open *range* that babies are

> comfortable with. That information, coupled with the fact that many

babies

> do just fine in a fixed length bar for a period of months, obviously

> phasing through the *range* as they grow... means that there's no

one way

> to measure the bar. You do what baby is most comfortable with

within that

> *range*. This does not seem to me to be something difficult to

> accept. But apparently my altercation with the lady orthotist last

week

> ran through the shop, and my guys indicated to me that they were

> essentially on the side of that woman and her OPINION that the bar

length

> was just FINE for Darbi. Which it wasn't. She hasn't had a wakeful

night

> since they changed it, and not once has said " ow " about her shoes since

> then either. So apparently more education needs to be forced upon some

> people before they GET IT that mom knows best. I have to send this guy

> those quotes. I've got the new one's address and he's the one who

thought

> it was *amazing* that Darbi hadn't had sleep issues since she got the

> longer bar. You know it is... simply AMAZING! Who knew??? ARGH!!!!

>

> I will say however, that *my guy*, Rob is pretty great. He humors

me in a

> weird way, yet I know that he believes that I have inside scoop on

all this

> and he's nice about it. Even if he does think I'm a whack job. I

think

> all of them there could be great too, so I am going forward with

continuing

> to be a PIT-ROYAL-A and not looking back. Of course, when you're there

> arguing with medical people and your kids are running around being

crazy

> it's not always easy to be smart and elegant and educated. I hate

> that... they get you every time... docs... now orthotists...

Rob is

> cool though, he even brought up Dr. Pirani from BC and the Uganda

project

> and we talked about their success rates. I would love to find

some info

> on that for him, just to show him I listened and it's a great thing

they're

> doing there. I so love the idea that they tell cast techs how to

correct

> the feet and how to cast and they do exactly that. Then they tell the

> parents to use the FAB (Steenbeck Brace - which is for those who don't

> know, a FAB that can be made by any cobbler with materials easily

found in

> third world countries.), and those parent follow the instructions

and are

> wonderfully compliant. And isn't their success rate nearly

> 100%? Hummmm..... What's up with that anyway? ugh...

>

> Good news is, her impressions are going to be on their way. And

hopefully

> will be able to make Kai's shoes from her feet size. Or Angel

will

> check her email and go to a florist shop lol.

>

> I gave them a copy of the PDF draft of the tips brochure Naomi and I

have

> been working on. I hope they take a good long look at it this time,

it's

> not a post anymore and easier to read for the average orthotist

> (hehehe...). It's looking good and while not yet finished for

publication,

> it's on it's way to the masses! Thanks Naomi for all your hard work!

>

> OK - I'm just a little pissy tonight after today, I hate arguing with

> medical professionals. Contrary to popular belief lol! I guess

that's why

> I'm here though, because while life would be easy with perfect

> caregivers... if no one else here is going to champion this wonderful

> cause... it may as well be me so I have something to do :~} Oh, and I

> forgot to call Darby today, sorry all. I'll try tomorrow. While

I'm at

> the Zoo in the freaking RAIN with my son's preschool class. And it's

> totally typical Portland rain too, not a lot... just nearly

> constant... should be a fun morning...

>

> Thanks for listening to my rant, if you got this far.

>

> Kori

[Guest guest]

Kori,

Here are more that Naomi posted a while back:

page 79 of Dr Ponseti's book states:

This[maintaining the foot in external rotation]is best accomplished

with the

feet in well-fitted, open-toed, high-top shoes attached in external

rotation to

a bar of about the length between the baby's shoulders.

{This is the most ambiguous}

From the FAB instructions out of Iowa City:

http://members.tripod.com/ponseti_links-ivil//id12.html

Measure the distance between the outside of the shoulders, this will

be equal to

the distance between the center heel screws in the shoe; lengthen the

bar to

match your measurements.

{I take the " center heel screws " to be the screws that are nearest the

heel on

the sole plate, so it's a heel-to-heel measurement.}

From Foot Abduction Orthosis Setup for Idiopathic Clubfoot, by

Hall:

http://members.tripod.com/ponseti_links-ivil//id10.html

Width of bar: outside shoulder width equals width between the center

of the

heels (after shoes are abducted)

{Again, a heel-to-heel measurement.}

From the Global-Help booklet, page 15:

http://www.global-help.org/publications/cf-english.pdf

The bar should be of sufficient length so that the heels of the shoes

are at

shoulder width. A common error is to prescribe too short a bar, which

the child

finds uncomfortable [C]. A narrow brace is a common reason for a lack of

compliance.

> Sorry all, I know I had this information before the great *crash

bang boom

> dead laptop deal*, and it's on yahoo's site. But I don't do yahoo's

site

> unless I absolutely have to. I have very little ram in this puter,

and I'm

> not going to search forever for those posts. I know someone has them

> handy... please and thank you! What I want are the articles that

have Dr.

> Ponseti saying both bolt to bolt, and heel to heel. I have the Global

> Health linked somewhere so that's one place, but I remember seeing

quotes

> from seminars or articles where it said both as well. Anyone??

That has

> led all of us to assume that there's an open *range* that babies are

> comfortable with. That information, coupled with the fact that many

babies

> do just fine in a fixed length bar for a period of months, obviously

> phasing through the *range* as they grow... means that there's no

one way

> to measure the bar. You do what baby is most comfortable with

within that

> *range*. This does not seem to me to be something difficult to

> accept. But apparently my altercation with the lady orthotist last

week

> ran through the shop, and my guys indicated to me that they were

> essentially on the side of that woman and her OPINION that the bar

length

> was just FINE for Darbi. Which it wasn't. She hasn't had a wakeful

night

> since they changed it, and not once has said " ow " about her shoes since

> then either. So apparently more education needs to be forced upon some

> people before they GET IT that mom knows best. I have to send this guy

> those quotes. I've got the new one's address and he's the one who

thought

> it was *amazing* that Darbi hadn't had sleep issues since she got the

> longer bar. You know it is... simply AMAZING! Who knew??? ARGH!!!!

>

> I will say however, that *my guy*, Rob is pretty great. He humors

me in a

> weird way, yet I know that he believes that I have inside scoop on

all this

> and he's nice about it. Even if he does think I'm a whack job. I

think

> all of them there could be great too, so I am going forward with

continuing

> to be a PIT-ROYAL-A and not looking back. Of course, when you're there

> arguing with medical people and your kids are running around being

crazy

> it's not always easy to be smart and elegant and educated. I hate

> that... they get you every time... docs... now orthotists...

Rob is

> cool though, he even brought up Dr. Pirani from BC and the Uganda

project

> and we talked about their success rates. I would love to find

some info

> on that for him, just to show him I listened and it's a great thing

they're

> doing there. I so love the idea that they tell cast techs how to

correct

> the feet and how to cast and they do exactly that. Then they tell the

> parents to use the FAB (Steenbeck Brace - which is for those who don't

> know, a FAB that can be made by any cobbler with materials easily

found in

> third world countries.), and those parent follow the instructions

and are

> wonderfully compliant. And isn't their success rate nearly

> 100%? Hummmm..... What's up with that anyway? ugh...

>

> Good news is, her impressions are going to be on their way. And

hopefully

> will be able to make Kai's shoes from her feet size. Or Angel

will

> check her email and go to a florist shop lol.

>

> I gave them a copy of the PDF draft of the tips brochure Naomi and I

have

> been working on. I hope they take a good long look at it this time,

it's

> not a post anymore and easier to read for the average orthotist

> (hehehe...). It's looking good and while not yet finished for

publication,

> it's on it's way to the masses! Thanks Naomi for all your hard work!

>

> OK - I'm just a little pissy tonight after today, I hate arguing with

> medical professionals. Contrary to popular belief lol! I guess

that's why

> I'm here though, because while life would be easy with perfect

> caregivers... if no one else here is going to champion this wonderful

> cause... it may as well be me so I have something to do :~} Oh, and I

> forgot to call Darby today, sorry all. I'll try tomorrow. While

I'm at

> the Zoo in the freaking RAIN with my son's preschool class. And it's

> totally typical Portland rain too, not a lot... just nearly

> constant... should be a fun morning...

>

> Thanks for listening to my rant, if you got this far.

>

> Kori