I have an interesting case and I am looking for some treatment suggestions from colleagues who have faced similar issues.
A PT referred a 1.5 y.o boy to me. He has just started walking. Apparently he was born with his feet hyperdorsiflexed against his shins – pretty much the reverse of clubfoot by the sounds of it. Currently he is walking independently (with very little noticeable discomfort) with completely collapsed midfoot, navicular weight bearing, almost on the medial malleolus and the entire lateral border (almost half) of the foot is not touching the floor during weightbearing.
His ROM is still almost 70deg dorsiflexed and very “loose” bilaterally very soft end feel. Surprisingly I can obtain a decent foot position and arch development with very little manipulation. Windlass effect occurs if the calcaneous is held in neutral – as soon as I release the foot rockers immediately
The PT would like to try a SMO first to see if the foot will tighten up naturally. I would rather try an AFO but I am willing to go with a cheaper OTS Tx for a few months and see how he manages before trying a custom AFO. The problem is the father is demanding a cast for 30 days or 3 months (he kept changing) just like his daughter had 5 years ago when she was born with the same problem!! I was very surprised to hear this positioning is in the family – I have only heard of it once before. Both the PT and myself are against casting – if he was 2-3 months old it might have a chance but now that he is weight bearing we don’t think it will work. We are both trying to explain that this Tx could take years not just a few weeks or months.
I have been searching the web for ideas with no luck. So I have a few questions:
1) Is there a name for this position? Picture the top of the feet on the shin at birth.
2) Is there a genetic issue that results in this condition? If so, are there other common problems that may arise?
3) Has anyone successfully treated a child with a cast when they have already begun walking?
4) Any design ideas or treatment suggestions would be much appreciated!! I am especially interested to hear from people who have seen this before.
The father maintains that his daughters feet were “perfect” immediately after the cast treatment but I suspect tis isn’t the case. He also maintains that she was casted while she was walking also.
Thanks in advance for any suggestions you may have!
Cheryl Lewis BSc(HK), CO(c)
519-436-9670 CK Ortho Inc