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I have a pt who is only 2 yr old and was diagnosed with congenital TEV since birth.
She is currently been looked after by her paeditrician. Her doctor said the condition is mild and surgery and orthoses or splint will not be needed. However she been constantly walking on her toes due to ankle equinus and reduced hanstring flexibilty. She also has adducted forefoot and inverted hindfoot. I adviced them to do calves and hamstring m.m stretches and foot wear advices. Her concerned parents think their daughter might need orthotic therapy.
Now the issue here is their paeditrician think she does not need orthoses, should I in this case prescribe this young girl with a pair of gait plates? Can someone out there give me your expert advices? Thank you.
If you have seen anyone with untreated TEV reached adulthood, even if a mild case, I would be pushing the parents towards tendo Achilles lengthening at the very least. This should have been treated more aggressively at birth with casting, which would have been a relatively easy proposition at the time.
I would be respectfully disagreeing the paediatrician, particularly since this group of professionals rarely see the long term results of uncorrected foot deformity.
Orthotics will do little to 'correct' the deformity, but may assist in reducing some of the adductovarus moments across the STJ. TAL will get the heel to the ground, and is by far the most damaging force.
Later in life osseous correction may need to be considered.
***************************************** Remember, it's just a foot.
By the way you spell "paeditrician" I'll assume you're not in the states and have a referral issue. Is it safe to say you cannot just treat this patient without the "paeditrician" blessing? If so, does your paeditrician have some sort of advanced training in congenital orthopedic deformities that he (she) will not accept your recommendation?
Sounds like he should have been serial casted 18 months ago. Maybe an ortho consult would help.
Perhaps the next time you have a adult with a talipes equinovarus you should waltz the patient into the paeditrician's office so he can see what this deformity looks like in an adult.
The paeditrician thinks this patient will grow out of this, you don't. Tell the parents to make sure they contact the paeditrician in 15 years when the kid's a couch potato because he can't walk without pain.
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
I'm with LL. I'd be exploring who your expert Ortho's are in TEV in your area and gently encouraging (read here "forcefully") the parents to at least get a second opinion from someone that treats a lot regardless of the scale.
This isn't something, regardless of how mild you want to let linger.
thank you very much guys for replying to my thread. I think I will have a chat to the parents and get a more thorough medical history of the patient before I'll do anything. I might get them to seek medical advice from an orthopeadic specialist for a second opinion. I will review the patient in 2/12. Thank you.