Matthew Dobbs i was asked to foward this information to you Here is a little history, as requested. My daughter is 11 months old. She had her first set of casting and a percutaneous tenotomy starting at about 2 months of age under the care of Dr. X at Shriners Spokane. After the tenotomy she was still slightly plantarflexed, so we took some time off and worked on her stretches. In July, at around 8 mos old she started her second set of casting culminating in a fully sedated tenotomy. After her 3 week post-surgery casts came off she was almost neutral in plantarflexion/dorsiflexion, but cant be stretched past neutral in a dorsi direction. In fact, her heels are slightly lifted off the base of her Mitchell boots. But the reason I am writing is about her eversion. When Dr. X first set her Dennis-Browne bar at 20 degrees, I asked him why she lacked more eversion. He said this is quite common in children with myelomeningocele. I knew this was not true as I am on the Baby Center message board with 1500 other parents of Spina Bifida children and I have NEVER seen a childs bar set at such a neutral position. He told me that I must be mistaken. He said that I must be thinking of children with idiopathic club feet. I was so bothered by this, that I wrote to Dr. Y in Portland, ME for a second opinion. We had been in previous contact regarding his innovative clubfoot bracing available through Atlantic Pro Care. He agreed with me that he had not seen this problem in his practice, but that he felt that a neutral eversion would serve my daughter just fine. So I did not pursue it any further. But my husband and I have always been very uncomfortable with the unnatural position of her ankles when she has the bar on. I have included a few pictures. As I write this Im wondering what it is Im asking of you. I initially called to make sure we were using the bar correctly. I wondered if the bar was supposed to be straight in the neutral position and perhaps we somehow changed something. I have attached a picture of the angle of the wings of the bar when it is at rest. This makes her neutral position an unnatural looking position. It would make more sense to me if the bar was straight when it was relaxed. But you seemed to indicate that all the problems are a result of her 20 degree position. Im hoping to take your response to my next appointment on the 17th and ask Dr. X to increase her angle to 45 degrees if her feet will allow it. Once point that I failed to mention is that we have been doing various manual therapies on her feet and she has gained a lot of play in her inversion and eversion as a result. Im sorry if this email is all over the place. I struggle with what I am asking. I just want to make sure we are using the bar correctly, that 1) it is serving its function of preventing relapse and, 2) is not causing harm to her ankles. Thank you so much for your time. Concerned Mom
Posted on: Thu, 06 Nov 2014 16:48:04 +0000
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