It's a "process": When your feet are one in a million

  Pim was born with atypical bi-lateral club feet and a  left hand wrist contracture. Starting at about 3 weeks of age we started casting her feet using the Ponseti method and started splinting her wrist at night and massaging and stretching it several times a day. Right before Thanksgiving, Pim had a tenotomy on each foot and then was put in her last set of casts. On Monday of this past week, she had her casts removed and started wearing braces. 

Right before leaving for Maine to get her braces, I received a care package in the mail. One the items in the box was a batik of giraffes with long straight legs. My friend said the batik reminded her of Pim and our journey to treat her club feet. What is most appropriate about those giraffe is that club feet is not just about a foot deformity. It is a leg/ankle and foot deformity. The inward turning and rotating of the feet is caused by the Achilles tendon being too tight and short. Tendons attach muscle to bone. The Achilles attaches the calf muscle to the heel and provides the tension needed to be able to flex and

extend the foot at the ankle. People with club feet have different soft tissue and musculature than the general population. The tissue tends to be bunched up where the contractures form and is more fibrous. In addition, clubfeet have more slow twitch muscle fibers that are shorter in length. It is not uncommon to see less capillaries and nerve endings connected to the tissue as well. All of this lays a foundation for weaker muscles and resistance to change. Pim has atypical feet, which occurs in about 1 in a 1,000 club foot cases. Her feet are extremely resistant to correction. For every study done about club feet there are always statistics about children who relapse or need multiple surgeries and casts. Pim is one of those children. When we began reading the literature, we discovered that the traditional method of casting and boots and bar bracing didn't have guaranteed outcomes for kids like her.

Based on our understanding of club feet we decided we wanted to pursue a treatment plan that addressed her club feet as part of a series of anatomical dysfunctions and the foot/ankle/leg as a system. In addition to her feet turning inwards and being stuck in severe plantar flexion,
Pim's left tibia is rotated slightly and like other children with club feet, she has underdeveloped calf muscles and small, chunky feet. We are hoping for better outcomes long term, less surgical interventions and greater flexibility and pain free movement.

Over the course of three days, Pim's braces were custom built, modified and fine tuned to best support her continued therapy. We've been in the braces for 6 days. She has adjusted well to them so far, with no disruption to her normal sleeping habits, no distress from discomfort or pain. She had a mild skin reaction to the straps, which is common and had a hot spot develop on her skin from pressure from one of the straps. We adjusted the tightness of the strap and her wearing schedule to help her skin adjust.