Unilateral idiopathic clubfoot

19 Nov

So we went to a pediatric orthopedist, about our pending baby’s pending clubfoot (I mean, the thing is, the diagnosis of unilateral idiopathic clubfoot was made at 20 weeks, with a sonogram technician who almost but then mostly caught it, and the attending on call, and even then it seemed a little squirrelly to me, but also, right, they were almost surely correct, unless they’re not, but we’re going on the assumption that the diagnosis is correct. Which is most certainly is. Unless it’s not. But I’m 95% sure it’s right. Mostly. Better to err on the side of preparation and caution). There’s some exhausting news, but almost all good news.

The good news is that in almost all cases, the problem is correctable. What they do is, when the baby is newborn (as in, in the first week or so of its life), they manipulate the foot, then cast it. The whole thigh. Then, after a week, you go in, they manipulate it a bit more, then cast it again. Repeat for 3-6 casts, depending on severity. At the last cast, they make an locally-anesthetized incision in the baby’s Achilles’ tendon, then cast it again. This cast stays on for 7 weeks. Then you are done with casting.

Then the fun begins. From there, you have to put the baby’s foot in a brace (you can see what the brace looks like). At first, for 23 hours a day. For a month or so. Then 18 hours a day for another month, reducing it gradually so that by 5 months, when the baby starts crawling, you are doing it only at night.

Herein lies the kind of exhausting news. The kid will have to wear the brace every night, at night, for a long time. Years. The problem is that there is a relatively high rate of recurrence if you don’t wear the brace, which would mean that the kid would need surgery to walk or not have arthritis, etc.. So either you wear the brace at night for 5 years, or you cross your fingers and hope you don’t need surgery, or that the kid doesn’t get arthritis in his/her 20s, etc. The brace is a much better choice.

Certainly not tragic. It’ll be part of the bedtime routine, that you brush your teeth, you put on pajamas, you wear the brace. Apparently, if you tell the kid it’s optional, they will not want to wear it. But when it’s just the routine they know, they’re more likely to just do it (right, I say this now, but I also get that it’s not nearly this straightforwardly simple).

The doctor says that after 7 yrs old, the bones of the foot are pretty much set as they will ever be. His ideal is that the kid would wear it until then, but realistically, more like 4-5 years. Depending on progress, severity, etc.

If there’s a humorous codicil to the experience at this point, it’s in baby mama’s and my varied reactions to the news. She had spoken to one pediatric orthopedist already, and he was all like ‘well, we’ll see what it looks like, and there’ll be a cast, or maybe a brace or whatevs. No big whup.’ And that made me feel like it was going to be a hassle but not really, and made baby mama feel like, WTF!?

The second pediatric orthopedist was all, ‘I strive for 100% correction, and this is likely a 3 month process, with a process that then lasts for 5 years, and if parents can’t commit to the 5 years, I don’t like to work with them. And here’s the probability of recurrence after 1 year’s use of the brace, it drops to 30% if you wear it for 2 years, 7% after 6 years. Here’s the brace, and what it looks like. I see 25 or so per year of these cases. Here’s the science. Here are my stats.’

And we walked out of the hospital, and I look at my wife and say, ‘damn, I guess I never realized this is going to take so much time and effort in our life. That guy was pretty hard-core.’ And she looked at me with the fanatical eyes of a woman in love and said, ‘That guy was AWESOME! I feel 100% more at ease about this!’

Apparently we have found a dude whose medical stylings perfectly match my wife’s MBA, detailed, project-management outlook. Go figure.


One Response to “Unilateral idiopathic clubfoot”

  1. Peter November 19, 2010 at 11:42 pm #

    I swear, I actually had a conversation that was identical to this post after I wrote this post. I’m not officially recycling my blog material in my real life. Scary scary.

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