This first time I heard this phrase I had no idea what it was. And the first time I heard it was moments after I had Easton. He was born with Club feet. So many questions were rushing through my head. Moments after you had a baby is not the best time to find out there is something wrong. I had no idea what Club Feet was or how you go out fixing it. Or if you could even fix it. So many questions were swirling in my brain.Luckily there has been a lot of advancements with the treatment of club feet and we live super close to one of the best children’s hospital in the country. Dr. Holmes at Primary Children’s Hospital is amazing. We started treatment or casting on Easton’s feet the day he got of the NICU. (He was also born 6 weeks early and spent 10 days in the NICU.) The treatment for club feet isn’t very complicated but it is very overwhelming to a mom who has no idea what it is. So here is a brief summary of what they did to Easton to straighten out his crooked feet. “Today, the globally accepted standard treatment is the Ponseti method, a minimally-invasive approach which was developed by the late Dr. Ignacio Ponseti at the University of Iowa. Because this method relies on casting and a tenotomy instead of major surgery, the treatment is more affordable and can be made more easily accessible.
The treatment phase begins with a series of casts that gradually move the foot into the correct position over the course of 6 to 8 weeks. The foot is gently manipulated, then placed in a cast to hold the new position. Each week, the cast is removed and the foot is again manipulated and placed in a new cast, incrementally moving the foot into the correct position.
For many children, a tenotomy is required to lengthen the Achilles tendon. This outpatient procedure can be performed under local anesthesia and is done before the final cast is applied. The final cast is in place for 3 weeks, ensuring flexion of the foot while the tendon regrows. Following casting, the maintenance phase begins. In this phase, the feet maintain their corrected position by the use of a foot abduction brace (sometimes called “boots and bars”). The brace is worn 23 hours a day for 3 months, then worn at night until the child is 5 years old to ensure the correction.”
That was our life for Eastons first 3 1/2 years of his life. But it was worth it. He is worth it. A couple of months ago Easton started to complain that his feet were hurting and we noticed that he was limping when running. One night I was tickling his feet and I noticed his feet were not as straight as they should be. So I called Dr. Holmes and up to Primary’s we went. We were right his feet were “recurring” or turning back in. So now what? It has been 4 years since we stopped bracing. Time for a tendon transfer.
“In general, the original correction may be recovered in four to six weeks with manipulations and plaster casts, changed every 14 days, holding the foot in marked abduction and as much dorsiflexion as possible at the ankle in the last cast. This treatment is followed by lengthening the tendo Achilles when dorsiflexion of the ankle is less than 15 degrees. A percutaneous tenotomy can be performed until one year of age. The last plaster cast is left on for three to four weeks. When the cast is removed, shoes attached in external rotation to a bar are worn at night and with naps, until the child is about four years old.
To prevent further relapses, the tendon of the tibialis anterior muscle is transferred to the third cuneiform in children over two-and-one-half years of age, if this muscle tends to strongly supinate the foot. Often this supination takes place when the medial navicular displacement is not fully corrected and the AP talocalcaneal angle is under 20 degrees. Transfer of the tibialis anterior tendon averts further relapses, maintains the correction of the heel varus, improves the anteroposterior talocalcaneal angle, and thus greatly reduces the need for medial release operations. The tibialis anterior tendon transfer is an easy operation and much less damaging to the foot than the release of the tarsal joints. Joint releases are needed when the deformity recurs in spite of the tibialis anterior transfer. The tibialis anterior tendon should never be split, so as to not lose its eversion power, nor should it be transferred to the fifth metatarsal or to the cuboid, since this would excessively evert the foot, causing severe foot pronation and heel valgus.”
Basically we are casting again to stretch the tendons out and then surgery. After the surgery he will be in casts again for 4 weeks. It is going to be a long summer. But I think we will make it. Easton is such a strong and amazing kid. He can even walk around in those casts. And his wheelchair is just another mode of running around our circle. I am so lucky for my friends and family who have stepped up to help Easton out. My brother built us a wheelchair ramp. My parents put one in at their house and help with the other kids. Alicia watches my kids every friday when I take Easton up to get new casts on.
I’ll keep you updated on his progress.