Catch up 3

Clubbed Feet 17 months old

Precasting in prep for bilateral posterior tendon release surgery

What standing up on clubbed feet looks like

17 months old- Rachel has been pulling herself up and standing since December 2012. This picture is a good indicator as to why surgery was so necessary. Her feet did not respond to the typical serial casting, heel cord releases and AFO's that are traditionally used to treat clubbed feet. In prep for surgery Rachel had 3 sets of cast placed to help stretch her feet. In children with spina bifida and clubbed feet it is typical to find that they only have one artery in their feet verses 2 arteries like a "normal" foot would have. One of the risks of the surgery is circulation problems due to only one artery supplying the foot with blood. (Makes sense now why our little ones with spina bifida and clubbed feet typically have cold feet)

Another view of clubbed feet being stood on- Rachel loves her big sister Alicia!

Cast set #1 in surgery prep

Cast set # 2 in surgery prep

Cast set # 3 and surgery day January 24th 2013

Wearing casts has not slowed down Rachel- she continues to four point crawl in them and has managed to figure out how to stand in the casts. She somehow plants her toes down and stands ballerina style. Rachel is a very determined little girl. Instead of all of the casting she had received in her lifetime slowing her down- she has used them as strength training tools. Prior to beginning the surgery prep casting she had also been going swimming at the YMCA. Once in the water- she is an equal to her peers and she immediately began to doggy paddle and move in the water with grace. (Yes- as soon as all the casting is done- this girl is starting swimming lessons)

Left foot after posterior tendon release surgery

Right foot after posterior tendon release surgery

Both feet after surgery- notice the positioning of her feet in the casts. Beautiful! We are looking forward to seeing the results. Her orthopedic doctor is predicting 5-6 weeks of follow up casting. After the casting is done she is going to special bracing made- per her ortho he does not want to go with the Ponsetti bar and Dennis Brown shoes due to the severity of her clubbed feet. Our follow up appt is on February 4th- at the follow up appointment- he is predicting that he may need to add a few stitches to her incisions.

Yes- that is Rachel a few hours post op trying to figure out how to escape her hospital bed. What I wanted to show was the bleeding through the casts. This is a very typical expectation with the posterior tendon release sugery- some children may have only a small spot of blood come through their casts while others may have blood all the way up to the tops of their casts. The bleeding is related to a pocket of blood being in the surgerical area that has "wicked" its way out. In other words- it looks worse than it is. Per her orthopedic doctor he had to remove a lot of scar tissue in both feet and manipulated some nerves and the artery and some of the displaced bones. No bones were removed as had originally been a possibility. We frequently check the circulation in her toes and have been trying to prevent Rachel from standing up. She needs to remain nonweight bearing on her feet.  

One of the cutest and busiest patients ever!

Three days post op and Rachel is trying to figure out how to climb up on our exercise bike. To her defense I do sometimes place her on my lap and position her legs on mine and we ride together. I get the bonus of extra resistance and she gets the bonus of gentle ROM exercise to her legs.