Morning all, a patient that I thought would warrant debate (which I believe similar have been before)
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Yesterday I saw a 4 1/2 yo boy with a history of Talipes Equino Varus. He had tenotomies done at 3 months, then underwent the Ponseti method and was using Denis Browne boots (parents told me that at first he was wearing them up to 23hrs a day, and only finished wearing them at night at age 3). Then in Jun 2010 he also had muscle transfers.
He was a full term prenancy, born by normal vaginal delivery, weighing 6lbs 7oz. He bagan walking independently at 14 months, but as he was in the boots only shuffled at first. There is no family history and his old brother (aged 9) has no problems.
With regard to range and quality of motion in his joints, on standing he cannot weight bear on his heels, standing comfortably in an equinus position - if he tries to put his heels down, he falls over backwards. His talocrural joint can only achieve 90* and he can only maximally evert his STJ to neutral (no further). Gait wise he walks with a typical eqinus gait, with zero heel strike with his foot remaining in a supinated position throughout the stance phase of gait. With regards to shoe wear there is only wear on the lateral border of the midfoot and forefoot.
My issue here is that this child has zero pain or complaints. His parents are concerned about his gait (as any parent would be). This child runs and plays happily with all of his classmates with no problems. I won't dilvulge what I decided to do as I'm curious as to people's responses but - do we leave the child as he is as his body will adapt or do we cast for bespoke devices to improve his gait from the low gear that it is to a high gear type gait (before I get jumped on by all and sundry I realise that a low gear gait is not necessarily bad).
I hope this stirrs some grey cells this morning.
Cheers,
James ;)
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