Talipes Information and Parental Support Group
Date: 22 March 1999
From: Wendy and David Drummond
<drummondclan@flexi.net.au>
Throughout my pregnancy I worried something
was wrong with my baby. I worried that the bub would have dislocated hips as I did. A scan
at 20 weeks didn't pick up anything, but the worry was always there. Even when Keara was
head down, ready for birth from 30 weeks, I would say to David that I could feel something
that felt like an elbow up near my ribs. This of course turned out to be her club feet.
David asked me if I had seen her feet at birth, which I hadn't. I remember having to ask the midwife a couple of times what was wrong, as I had never heard of Talipes. The nursing staff gave us all the reassurance under the sun that we would have her up and doing ballet in no time. They were absolutely wonderful about it.
Because Keara was born late on Thursday night we didn't see a orthopaedic surgeon until day four. He told us that her feet were very tight but he would try casting them to see if that helped/fixed them. Here we entered the world of serial castings and this is where our story is slightly different from others I have read.
Keara had her casts changed three times per
week for the first six weeks. This involved a 1½ hour round trip each time, and of
course, the long wait at the hospital. Although her feet did straighten a bit it was
decided that they were still too tight and surgery would be required. We were then booked
in for surgery when she would be 5½ months old. By the time for surgery came Keara's feet
had turned again undoing anything that had been achieved.
February rolled around quickly, we had moved to Warwick in the meantime
making our travelling time a four hour return trip. The idea was to operate on her right
foot, go back in two weeks to have the pins removed and her left foot operated on then
return in 
another two weeks to have the pins out of her
left foot. We were to stay in hospital 2 or 3 nights each time. The surgery was to
"only" take 2-3 hours.
Things went wrong in the operating theatre. Keara was in there for 6 odd hours and when we finally saw someone they told us things didn't go as they had hoped but everything went O.K. We later found out her foot was tighter than they realized and the manipulating it into the desired position caused the skin to react and break down and the plaster they had put on had to be cut open straight away to release the pressure.
We were still on track to go home on day three until the Dr took a final look before discharging us. An infection had set in so intravenous antibiotics were given and we had to stay. The next Monday, a week after the first surgery, Keara was taken down to theatre again to have the left foot done and the plaster changed on her right foot. She was back in ½ an hour. The right foot was still not healed enough to" go in again " and we had to spend another week in hospital.
We had to go back to hospital every week for Keara to have her plaster changed under a general anesthetic. During these changes Keara's Dr wasn't happy with the way her wound was healing and suggested a skin graft would be needed, however the wound healed a lot the following few weeks so this was unnecessary. These changes went on for another two months until she was fitted for her first AFO toward the end of April.
June saw us heading back to have the left
foot done with even more worry in our heads. The Dr who had done all the preliminaries
tried to tell us it would only take 3 hours at the absolute most and he had never seen it
take that long. We knew and told him better.
A different incision was used this time and happily everything went smoothly. Keara was out of theatre in about 2½ hours with a drip, and antibiotics being given to prevent infection straight away. Keara was operated on Monday afternoon, and by Tuesday evening she was crawling all over the hospital with a sock covering her left foot, like she had not had major surgery 24 hours ago.
Keara then spent the next 6 months in AFO's 24 hours per day, coming off for baths only. Then she spent another couple of months in them at night only.
While this time passed a couple of other things happened. Her right foot turned again and in early December after a visit to the Dr it was decided that surgery was going to be needed again. That same afternoon Keara started walking for the first time at a bit over 16 months old.
Again serial plastering was going to be tried to stretch the foot as much as possible in a hope that surgery could be prevented. Both legs were to be cast.
Because Keara was walking at this stage, in February '98, the casts
were to be above the knee in a bent leg position. We were told she "will never be
able to walk in them", she soon learned how to. A new fibreglass flexible plaster was
used for this and again I peeled it off, much easier than POP to get off, the night before
our 
next visit. These also had to be changed every week so we were back to our 4
hour trips. Coming up to Easter the casts were to stay on for two weeks, which led to them
cracking. Keara started getting red around the tops of them until, a few days later I
decided that I hadn't dropped any food around the spot I'd been looking at for a while and
felt it, it was wet.
Without a second thought I ripped the casts off and underneath were red raw sores where she had had a reaction to the fibreglass because the casts had split.
The next day our GP gave us some cream and told me to wrap her legs in plastic cling film for an hour after I had put the cream on. The next visit to the surgeon resulted in Keara being booked in for June to have her right foot released again. We were able to get her sores healed in time for this surgery.
Again we fronted at the hospital with trepidation as it was "the problem foot" being operated on again. This time it only took about 2½ hours and all went well although the Dr said he never wants to operate on that foot ever again because of all the scar tissue etc. Despite being in fairly bad pain this time and being very upset, screaming and crying, something she didn't do the other two times, we only stayed in hospital for two nights and came home armed with a codeine based pain relief.
Keara amazed us yet again when she didn't
need anymore pain relief after the first week and, on day 11 after the surgery, she walked
again. Back to having casts changed under a general anesthetic saw us on the road every
week for the next two months. At the last change Keara was fitted for AFO's which she had
to wear 24 hours per day, taken off for baths only.
In August '98 we were told not to return for three months. This gave us just enough time to have bub number two who arrived in October with perfect feet. In November the Dr was happy with Keara's progress and she is allowed to have a couple of hours per day without the AFO's on.
Keara loves this time although having them on doesn't worry her at all
as she has had something on her feet virtually all her life. Keara also doesn't let her
feet stop her either with her favorite pastimes being running, 
jumping and climbing. Keara's AFO's have rubber soles on them so she doesn't
slip when walking and she managed to completely wear one pair out in three months from all
of her activity. Keara has also learned how to take them off so we have to keep an ear out
for the sound of velcro being undone.
People say how quick Keara is running around etc. I tell them that I may have to take the AFO's off to slow her down when she is outside. She doesn't seem to stumble or fall over any more than any other 2½ year old, but she is pigeon toed which her Dr said happens a lot with Talipes kids. I hope the pigeon toeing doesn't cause her any further problems in the future. Keara also has a very deep scar that goes underneath her right foot, causing it to be a different shape to her left foot.
We were to see the Dr again in early March but unfortunately he wasn't at the hospital so his registrar saw her. He had never seen her before and told us to keep up the same treatment and return in another three months, so it's still AFO's until then.
Updated 7 June 1999
We are back from another trip to
Brisbane to see Keara's Dr and the news is NO MORE DAY splints. She does still have to
wear them at night. As you can imagine we are really pleased with the news.
She is a potential candidate for problems as her feet are still very tight so the Dr wants
to keep a close eye on her, but we don't have to go back for another SIX months. Six
months is the longest time we have ever had between visits, what will we do with
ourselves?
Has anyone had any benefit from using a trampoline? We are going to get one for Keara's
birthday next month and I just wondered what anyone else thought of them. I did ask the Dr
today and he thinks it would be good for her.
Updated 23 November 1999
We
went back to see the specialist yesterday and he is quite happy with her progress.
It has been six months since we went and during that time she has only worn night splints.
He, the specialist, said she is quite good position wise, for a very bad case of Talipes,
and walks on the sole's of her feet quite well. Keara is in-toeing and this is
caused by the bone in her lower leg being twisted. At this stage he doesn't want to
go in and operate, rather wait until she is 6, 7 or 8 years old and see if she grows out
of it as some kids do.
Our big news is NO MORE NIGHT SPLINTS. Keara was so excited when I told her she
didn't have to wear her splints to bed she said "I can sleep in my feet".
Aren't they funny with the things they say?
We don't have to go back for another 6 months, unless we feel there is a problem.
All this spare time not having a 4 hour drive and waiting, waiting, waiting to be seen,
what will we do?
Our little boy, Tyler, is just starting to walk by himself at 13 months. I guess it
wont be long before he is up and running now. He has been slower than Keara in the
sense that once she got going she just went and didn't crawl anymore where as Tyler still
crawls most of the time but is walking a little more.
Updated 22 November 2000
It
seems a long time since we have been in contact about Keara's feet. I
guess everything had been travelling along smoothly.
Keara's right foot is still causing problems and at our last visit, November
13th, it was decided that she will have to go back into a splint at night.
This is going to be a tension splint rather than an AFO. From what I can
gather it will put pressure on the insides of her big toe and heel and push them
outward and on the outside of the middle of her foot pushing inward. This
is to try and correct the banana shape that her foot has grown in.
Keara's Dr seems to think the scar tissue that is extremely tight is some
of the cause, if not most of the cause, of the problem, hence the splint.
What we would like to try and find out is if anyone out there has had
alternative treatment on scar tissue, apart from surgery, that was effective?
Or if anyone else's Dr could think of other ideas to try before resorting to
surgery? Keara's Dr would like to try just about anything before he has to
operate again as he has mentioned the risk of her loosing her foot altogether.
Apart from the right foot causing problems, although not to Keara, she is still
as active and full of energy as ever. She has enjoyed almost a year of
Kindergarten and is looking forward to Pre-school next year. She has been
having swimming lessons for ages now, we have an indoor heated pool complex in
Warwick, and is doing quite well. She can ride a tricycle and is learning
to ride a bicycle and of course continues to climb as much as ever.
Our family is great also. We had another little boy arrive at the
beginning of July, so we now have two sons with great feet thankfully. I
hope someone has some ideas or suggestions of who I may be able to contact about
Keara's feet/foot.