Whoops - the last post, didn't!

So I will attempt to re-create that one.  I was re-reading the article "A new approach to the treatment of congenital vertical talus" out of the Journal of Children's Orthopedics published in 2007.  It was the only article I could find published in the last 10 years on the treatment of CVT leading up to E's surgery, and the surgical procedure described was similar to what Dr. H was proposing.  I noticed this time, however, that the authors talked about the post-op bracing being done on CVT kids with an emphasis on keeping the foot in neutral (not in external rotation which was where E was braced into) and on frequent stretching (not recommended by Dr. H).  Now, keeping the foot in external rotation (ER) never made a whole lot of sense to me.  For one, it was the hip that was rotated, not the foot.  It puts no stretch on the outer tissues of his foot as it puts the foot into the same directional rotation that it was when he was born.  Dr. H assured me that was the correct position, however, so we went with it.  I have been stretching E's foot since it came out of the cast.  I'm a physical therapist - it's part of my genetic makeup to stretch.  It's good to stretch if you have NO orthopedic problems.  It cannot hurt to stretch someone who does.  So that, too, made sense to me.  The article does NOT talk about wearing an AFO during the day.  Attached to the article was an email address to Dr. Dobbs, of the Dobbs brace, who happened to be one of the co-authors.  Now, the article was published in 2007, so I figured no way was it still a valid email address.  But, on the chance it was, I sent off an email with a quick synopsis of E's case.  At 10pm on a Friday night.  And I got a reply by 10:05pm.  Seriously.  I've worked in health care for 10 years now, and I don't think I've ever had a doc respond to a question I've asked that quickly - or even close to that quickly.  


He said that yes, that was still his post-op protocol for CVT kids and he braced them differently than club foot kids because the problem was basically the opposite of what goes on with a club foot.  Putting the foot in neutral keeps it in a better position.  He is a strong advocate of stretching the foot, and he does not put them in an AFO during the day unless there is something else going on with the child.  All of which made sense to me.  So, trying to be fair, I called Dr. H's office on Monday to find out what his rational was for putting E in a standard club foot brace and position.  Tuesday afternoon (a much more normal doctor-returning-calls-via-the-nurse time frame) his nurse called back and said he put E in that position because it was the position your foot naturally goes when you lie down, but we could change it if we wanted.  Not really a ringing endorsement, in my book.  


So we're leaning toward switching protocols now.  And Dr. Dobbs has offered to take E as a patient.  However, Dr. Dobbs is located in St. Louis, and the funds are a bit tight right now.  We are looking at the Ponsetti docs down in southern Florida, since we're moving there this summer.  I'm planning to call the 2 closest to us to find out what their protocols look like, since switching over to one of them makes sense.  Of course, we could always still fly to St. Louis - who knows?

5 days and still no AFO

but boy, am I enjoying watching my little boy running around in TWO SHOES!  I know it won't last, and the brace will likely arrive on Monday, so it will be back to business as usual, but MAN, is it nice.  I specifically sent the brace to Cascade on Monday with the hope that it would make it back by today to minimize our time out of it.  I'm going to drop my rep at Cascade an email tonight (she won't read it before Monday, I know, but that way it's done and I don't forget) to find out what day it got shipped out.

In the meantime, learning to walk without the brace was exciting.  There was a lot of falls on Monday, a few on Tuesday, and only 1 significant one on Wednesday where he actually landed and gave himself a nice bruise.  Yesterday and today it has seemed like he's gotten the hang of walking with shoes and no external support on that right ankle.  He's getting more adventuresome though - repeatedly walking across the mulched flower beds off to the side of our driveway almost as if to prove he can - followed by shooting me a triumphant grin like "Hey Mom!  Did you see what I did?"  So cute!

Also, I sent out an email to Dr. Dobbs (of the Dobbs bar fame).  I was reviewing the one current research article on CVT that I've been able to find to see pre and post-op protocols to compare with Dr. H's, and I noticed that there was an email address attached to it.  So I went out on a limb and shot him an email with a brief synopsis of E's progress.  I'm curious about the ways that his post-op protocol differs from Dr H's, and I'm wondering if those differences are significant, or if, because we're stretching E's foot in spite of our surgeon, that should be sufficient.  So, we'll see.  I'll be sure to post back what his response is.

Oops - a busy toddler kept me away!

So we've been walking for almost 2 months now, which means I rarely get to sit, much less write a blog LOL!  E's walking is going great, and in the last few weeks he's finally figured out how to stand up without using his hands.  Today I noticed he walked straight from the driveway onto the pinestraw in the front yard - a feat that previously would require holding mommy or daddy's finger for stability.  He is actually falling more frequently these days because he's less cautious.  He picks up the pace at the drop of the hat, and he's not always very good about toe clearance on the affected/AFO side which results in tripping.  We're getting ready to ship his AFO back to Cascade tomorrow morning for the addition of a "Houdini" strap.  As any healthy almost-18-month-old would, E has figured out how to unstrap his brace.  He hasn't transitioned to removing it completely, but I figure that's not far behind.  Hopefully the brace will only be gone until Friday, and since we're within the first 90 days, Cascade is both paying for shipping and covering the repair/upgrade.  The only other issues we're having with the brace is where it contacts his skin it is causing some increase in his excema and there's a little bit of wear on the padding where the brace hits his calf.  The one issue is going to be a concern as the weather gets warmer, so we may have to invest in special socks to protect his skin and minimize heat.  The other issue I'm hoping Cascade will fix while they have the brace.  If not, no worries - it's not structural.  I'll be calling Dr. H tomorrow morning at hubby's request to find out what his opinion is on E's footwear while the brace is gone.  I'm banking on it only being gone 5 days, and I'll extend how long E wears the DB bar/shoes both after waking up in the morning and after nap and make sure he wears shoes with good, supportive arches at all times in between.  DH wants confirmation from the doc that this is ok.  I think Dr. H doesn't have to live all day with a toddler who will NOT like being in the DB bar back to the 16 hours per day we were in prior to the AFO.  Right now, E doesn't mind the bar/shoes.  If it becomes an issue and we have to fight him to wear it, it may decrease the length of time we use it overall.  At our last appointment, Dr. H said we basically needed to keep him in it until at least 2, but the longer the better.  If the next 6 months is a battle, we'll likely stop then.  If it continues to not be a battle, we can probably keep with it until we hit potty training at night and naps, which from what I've been told is likely quite a while since E is all boy.  So, I have my opinion (shocking, I know!), but I'll give Dr. H an opportunity to weigh in.  We'll see.