2018 Update on N's Journey

January 2018

We've begun taping N's feet to increase the external rotation of her feet and support hyper-pronation in order to keep the arch from forming too early.  With clubfoot the goal is to keep the soft tissue flexible and the arch is formed by tightening tissue.  When clubfoot is at play, that tightening can cause the foot to turn back in.  The DTKAFO works to hyper-pronate the feet in order to combat the arch forming early and recurrence of the clubfoot deformity from happening. 

Initially N's feet were made complex by poorly skilled doctors and when clubfeet are complex or become complex, they can no longer be over corrected without causing a "break" in the outer edge of the foot.  This is why we are working with Jerald (he adjusted N's brace to increase the abduction/external rotation of the brace) to increase the external rotation of her bilateral clubfeet which coupled with walking, will keep the feet corrected through growth spurts. In addition, we are taping with the guidance of Physical Therapist, to further encourage her feet to gain abduction, especially during the day when she's not wearing the DTKAFO. 

Jerald also suggested Reverse Last shoes and N's often wearing them as well but one thing that can happen with PT/Kinesiotaping/Bracing, etc. is that the body counters the force applied by these mechanisms.  Because N started wearing the DTKAFO at a year old rather than immediately after correction/casting, the effects of the DTKAFO and the length of time she'd need to continue bracing were unknown but Jerald was happy to work with us and we've seen huge improvements in her feet right from the very start.  In December 2016 after 3 months full time in the Mitchell Brace I had x-rays taken and then I again had x-rays taken in July 2017 after 3 months wearing the DTKAFO for naps and night time, here are the comparisons between the two. 

Notice the rotation of her feet before and after wearing the DTKAFO.  Look at the difference in her heal bone, it finally dropped after 10 months of bracing (7 in the Mitchell Brace and 3 in the DTKAFO)!

 

End of the Year Update on N's Little Feet!

 October 2, 2017

In October, N had another check up with her orthopedic surgeon.  Again, he said she was doing really well and had great flexibility and well corrected feet.  He didn’t have any concerns!  And in case this is your first visit to the blog, N was born with bilateral clubfeet that were made complex through poor manipulations and casting.  When she was 4 months old and after 13 sets of casts in our home state, we traveled to Iowa and her feet were corrected by a leading Ponseti clubfoot doctor in August 2016.  She’s 20 months now and running and climbing everywhere! 

After we saw the ortho. We walked over to the physical therapy office where the French Functional Method of clubfoot treatment is done by physical therapists.  The therapist was thrilled with N’s feet and couldn’t believe how well corrected they are and the flexibility she has.  She said typically parents are just night bracing at this point and was impressed that we are doing both naps and night time for a total of about 15 hours of bracing every 24 hours.  She couldn’t believe we are also Stretching Through Play for Clubfoot daily. In addition, the PT showed us the stretches used in the French method of correction because I was interested and wanted to know for future reference.  We left feeling at ease with another good report.

October 22, 2017

A couple of weeks later, N and I jetted off to Maine to visit friends and so we decided we’d also sneak in a face to face check up with Jerald Cunningham who designed, fabricated and fitted N with her DTKAFO Cunningham Clubfoot Braces.  During the check up Jerald watched N as she walked and ran up and down the hallway, he stretched her feet noting 20-25 degrees of dorsilflexion or range in her Achilles tendon, and he checked the fit of the braces.  The braces  need to be adjusted for growth (we’d already made two adjustments).  

As she was running Jerald made the observation that her feet, particularly her right foot, were nearly straight the majority of the time, rather than angled away from the mid-line of her body/rotated outward.  He explained to me that other children her age typically walk with their feet angled out for stability and that in order to maintain correction of her feet through the growth spurts of four and five years old, her feet needed to be externally rotated (which is typically achieved through casting but wasn’t in her case) but why?  He explained that when the feet are externally rotated the way the feet make contact with the ground applies a corrective force against the big toes pushing the feet outward with each step.  

Jerald adjusted the brace further rotating the foot pieces outward from about 40 degrees to 50 degrees and he ordered N “Reverse Last” or “Outflare” shoes for daytime use.  The soles of these shoes are wedged to help align the legs and feet with outward rotation by using the child’s weight and movement as they stand and walk.  The toes of the shoes flare away from the mid-line allowing the toes to spread out correctly for balance, rather than toward the mid-line of the body.

Feeling concerned, Jerald showed me photos of N’s feet from our initial appointment with him in April 2017 when N got her DTKAFOs after 7 months in the boot and bar brace.  N’s toes and forefoot were actually rotated inwards about 10 degrees rather than being over corrected and she seems to have slight Metatarsus Adductus which is where the toes turn towards the mid-line.  The MA is very slight and will resolve with the stretching force applied to them while she walks and in one month of wearing the "Reverse Last Shoes" i've already seen them improve and straighten more.  

N's Toes, you can see they're turned towards mid-line as she grips the ground when standing.  This is already resolving with the Reverse Last Shoes!

In December I began looking for a physical therapist to work on helping N gain more external rotation and to address the slight MA you can see in the image.  We met with one PT who suggested 
 getting N to use her tiptoes more and to make a game out of it by using suction cup toys high on the window or a mirror that she could reach for/toys up on a counter she can reach for.  Also, giving a bit of pressure to the ball of her foot with my hand, while she’s sitting so that her reflex would be to push back with the ball of her foot rather than curling her toes.  I continued meeting with PT's and have now found the right for us!  She will work with N to gain more external rotation in her feet through exercises and kinesiotaping, etc.  I look forward to working with her and sharing N's progress in 2018!