Talipes Information and Parental Support Group
Mikaila's Story
Mikaila Delgado
by Mikaila’s dad, Leo <LALI@msn.com.au>
Mikaila Rose was born on the 14th of May, 1998 after a pretty
eventful and emotion draining delivery. My wife Leanne was induced 3 days earlier than the
expected due date, mainly due to the fact that Mikaila was classified as a big baby and
that my wife had above normal levels of amniotic fluids. In making matters somewhat a
little more complicated, our last ultrasound showed that Mikaila was in a posterior
position and not within a “bulls roar” of wanting to enter this world. The
induction was supposed to speed up the process. In trying to break Leanne’s waters ,
our obstetrician, miraculously picked up that the cord was prolapsed, that is, the
possibility of the cord being exposed before Mikaila’s delivery was possible
and we may have been in dire straits. In examining the risks at hand the decision was made
that we would have an elective Caesarean delivery.
We were both prepared for this due to the fact that we had never
closed our minds to the options of a Caesarean birth during the lead up to the delivery. I
think this is what got my wife through this challenge (she is petrified of needles and the
sight of blood). The dramas did not end there, I was gowned up and asked to wait in the
waiting room until my wife received her spinal block to numb her from the pelvic region
down to her legs. Unfortunately, this spinal block did nothing else but numb my
wife’s legs and feet but not her pelvic region, I was thus removed from the theatre
whilst they administered my wife with a general anaesthetic, I was called back in after
Mikaila was delivered. I nursed Mikaila for an hour before mum was allowed to see her. She
weighed 3.7kg or 8lb 15oz in the old scale , she measured 50cm.
I had prepared myself for the birth and at all times I had planned
to focus on Mikaila and not on Mikaila’s feet, unfortunately human nature kicks in
when you least expect it and I found myself worrying and checking her feet before anything
else including on how my wife was doing. Mikaila’s feet did not look all that bad to
me but it was evident that her left foot was more affected
than her right. Excluding the Talipes, Mikaila was not affected by
any other setback. 
Treatment commenced at day 2, whereby plaster casts were
administered to her tiny feet. These were removed and replaced every second day until my
wife was discharged from hospital (1 week) . The plaster casts were half casts and not
knee high.
During week two we visited an orthopaedic surgeon at Westmeads
Children’s Hospital in Sydney who we had visited prior to Mikaila’s birth.
Perhaps the only shining light we had was the fact that we knew about Mikaila’s feet
before she was born and my wife and I were able to inform and prepare ourselves on talipes
and it's treatment. 
The orthopaedic surgeon checked Mikaila’s hips ( thought to be
a little flex at birth) and found them normal, her feet were diagnosed as bilateral
Talipes (left = moderate and right = mild). He advised that the right foot would
definitely be corrected with plaster casting, whilst the left had a 50 - 50 chance of
requiring surgery. We were to continue with the plaster casting for another 4 weeks with
weekly changing. The casts this time were full casts, above the knees so that she could
not kick them off. The physiotherapists at the Children’s hospital were magnificent.
We found that removing the plaster cast was a challenge, keeping the
bath water warm for Mikaila whilst the casts softened was difficult. We also found that
she is usually a little unsettled on the night of her plaster casts we are not sure if
this is due to the dampness of the casts or just because she hates being put through all
the trauma of having her feet touched and manipulated. Having this problem as well as
Colic meant a lot of sleepless nights for my wife and I.
We visited the orthopaedic surgeon again ( at 5 weeks old) to
examine the progress. We were given some good news and some “not so good news”.
The good news was that Mikaila’s right foot seems to have been corrected. She will no
longer require plaster castings and has gone onto splints applied during the night only
and some home physio in stretching and
exercises etc. Her left foot though, although significantly improved
since birth, continues to be a 50 - 50 chance of surgery. Also we have been advised that
her left foot will definitely be smaller in size to that of her right and as such she will
require different size shoes when she gets older. The surgeon has advised that we
should maintain a positive view towards her progress and that he would not make a decision
on surgery for another 5 weeks when we next visit him. If correction is possible with
plaster casting alone she would possibly require at least another 8 to 12 weeks of
plastering thereafter. If surgery is required it will be after she is 4 months of age. He
took us through what was involved in the surgery, if this was to eventuate, and my wife
and I are praying daily that we do not have to go down this path. Time and faith will
tell.
4 weeks later
Unfortunately, on her next visit to the orthopaedic surgeon, the
news we received was not good. Mikaila at this stage will
require surgery on both feet. She is only 10 weeks old so the
surgeon has suggested that we maintain our current treatment of plaster changes weekly for
the left foot and splinting at night only for the right. This is to continue for another 4
weeks and we are then to see him again. If no substantial improvement has been made on the
left foot, then she will have a 3 weeks period where she will be free of plasters prior to
surgery. The left foot has improved 3000% since birth but it is still rigid and has not
come back to the neutral position, we are therefore not banking on any miracles in the
next four weeks. He (the surgeon) has advised that the left foot will probably require 8
to 10 tendons released to allow the foot to come back to a neutral position.
Mikaila’s right foot is at the neutral position but her
“heel bone” has not dropped and is still high. Apparently, this is caused by the
stretching of the Archilles tendon. Surgery on her right foot will be minor (if there is
such a thing at this age) where only 2 to 3 tendons will be released.
My wife and I are positive but petrified of the pain that Mikaila
will have to go through. The surgeon re-briefed us on
the surgery procedure and what was involved:
We are to keep a vigilant watch during the first 6 weeks in case of infection setting in under the plaster where the pins have been applied. The surgeon has advised that he thinks we will good a good result from the surgery ( better than 90% success ratio - although %’s do not mean anything to my wife and I anymore!). After this she should (keep fingers crossed) perfect little feet ready for walking by her walking age.
Updated 22 October 1998
Mikaila had surgery for both feet on the 24th
of September 1998. She was under for approximately 2and ½ hours. Giving her up for the
surgery and seeing her immediately after the surgery is by far, the most difficult event
my wife and I have had to endure. I now appreciate the emotional roller coaster that
parents ride during these times. 
My wife and I stayed by Mikaila’s bedside for the three days that she was in
hospital. She was most of this time "knocked out" with morphine and other
painkillers. They also had to administer Valium to control the spasm she was having
immediately after the operation. Pain killers or not, these kids still go through some
excruciating pain – I could see this in her face. It made me feel totally helpless.
This passage may sound a little negative, but I think if you are to use this in your
newsletters, parents should be prepared for the reality of this procedure.
Our surgeon advised that the operation was a success and he is confident that he has
attained a good result. We live in hope that she will not require any further surgery down
the track.
Mikaila had extensive surgery on her left foot compared to the right. She has two pins
inserted in her left and one in her right. Within three days the swelling had subsided and
we were allowed to take her home on Panadol only. She had a half cast/slab only for the
first week to allow for all the swelling to diminish before having to take her back for
day surgery for a full plaster cast. She now wears fluoro orange plaster casts on both
feet (not a good colour for a little girl) for the next 5 weeks.
We will return at this time where these plasters will be removed as well as
the pins. They will then re-apply further plasters for another 6 weeks. This all means
that by Christmas Mikaila should be out of plasters and using AFO’s at night only.
In the last couple of days Mikaila’s left foot seems to have picked up an infection
around one of the pins and she is now on antibiotics. This may mean that the pins come out
earlier than we expected.
Mikaila seemed to bounce back to her normal self after 3 days from the operation,although
we have noticed that she is uncomfortable with the plasters. She is now 5 months old and
wanting to sit up or play on her tummy etc. – things which are almost impossible with
these "big above the knee" plasters. She also had a period of 5 weeks without
plasters before the surgery and during this time she was enjoying full body baths –
now we are back to the old sponge bathing. She has also acquired the habit of kicking one
plaster with the other, we are not sure if she is playing or if whether she is itchy or
uncomfortable in them.
From a little girls point of view, I am sure that Mikaila has gone through and is still
going through some discomfort, but I know that she will not remember as she gets older.
From a parents point of view I can tell you that the procedure although heart wrenching,
is not as bad as I thought it would be. I think that the support a couple can give to each
other during these trying times makes the world of difference. When I felt down my wife
would pep me up and when she was feeling down I would do the same. I suppose this is what
got us through this challenge.
Updated 14 November 98
Mikaila had her casts and pins removed last
week, one week earlier than expected. The infection that had set in a couple of weeks ago
could not be terminated with antibiotics etc. Mikaila was very irritable those last couple
of days, and after seeing her feet once the casts were removed I knew why.
The whole process took 2 hours (removing plasters with electric saw, moulding her feet for
the AFO’s to be worn in 6 weeks and the re plastering of both her feet). During these
2 hours Mikaila cried hysterically for the whole time. She was inconsolable which meant
that my wife and I felt totally useless and vulnerable. We had tried to prepare her a week
in advance by turning on the hair dryer and vacuum cleaner around the house as much as we
could so that she would be used to the noise of the saw. Unfortunately, Mikaila is
petrified of any such noise which made the process that much harder.
Her feet looked very straight compared to the way they were prior to the surgery. The pins
had unfortunately punctured through the skin on the other side to where they had initially
been inserted and thus had partially infected in some areas. We could then understand why
she had been so irritable. The pins where removed and her feet where washed and aside from
looking slightly swollen and bruised, they looked fantastic. She had full movement of all
joints and toes and her scars where almost unnoticeable. They applied new plasters (hot
pink) which will stay on for another 6 weeks where they will be removed, so we are looking
forward to a plaster free Christmas and New Year.
Mikaila fell asleep right after the procedure, tired and exhausted from all the crying,
and then awoke to be her lovely little self. Her temperament and well being has improved
significantly since the pins where removed. She is now always happy, seems to settle well
for her night sleeps and is eating ‘us out of our home’. Although my wife and I
comprehend that we still have a long road to travel, we also feel much better about life.
We feel that for the moment, the worst is now behind us (surgery & removal of pins).
We look forward every day to the removal of those plasters and the ability to enjoy our
child in many other ways that perhaps other parents may take for granted, like being able
to give her a full bath for example.
Updated 2 December 1998
Mikaila is now 6 and a half months old and we recently
visited our Paediatrician for her growth and development check up. He advised that
Mikaila's had a low muscle tone and hence he inability to sit up "without the
wobbles" - we think this has to do with her plasters and the awkwardness she has when
sitting whilst her legs are bent. We are now undertaking sitting exercises for her
to strengthen those back muscles and to teach her how to roll over. We are counting the
days ( 14 days to go) when Mikaila will have her plasters removed ( hopefully for the last
time). She will then be placed in night AFO's only.
Updated 3 June 1999
Mikaila is now 12 months old and is crawling
and standing ( by holding onto furniture etc). I think when I last wrote she was 9 months
and as yet had not commenced crawling. Her feet although still maintaining correction do
have their problems. Her right foot ( the least severe prior to surgery) , now looks as if
it has been over corrected. When Mikaila stands she seems to be standing with the inside
of her right ankle. Her left foot ( most severe prior to surgery) still tends to
"banana in". We are not sure whether it is her foot that if bending in or
whether it is caused by Mikaila's other problem. I think I wrote when Mikaila was
just 6 months and had been diagnosed with low muscle tone. This still seems to be
prevalent. When she stands, she "wobbles" and is not able to stand for long
periods of time. She stands on her right foot initially and then "drags" her
left foot into position. She has very thin and "lax" calves. Our Paediatrician
advised that it ( the low muscles tone) is associated with either a nerve problem or a
problem with these muscles not developing properly. No one is sure whether this is
associated with Talipes and Mikaila's time in plasters. We now need to undertake a few
test with a Neuro to establish whether it is a nerve problem or a muscular one.
Through my readings on the TIPS site and others I have not come across a similar case of
either low muscle tone or over correction after surgery.
Meanwhile we continue applying nightly AFO's on Mikaila. She is such a sweet little girl,
never complains when we put these on her nor does she ever try to take them off. She knows
that it is all part of the routine.
Updated 15 December 1999
It
has been six months since we last wrote with regards to Mikaila's progress. In the last
six months she has improved out of site. She is now walking, running and doing every other
thing that a normal 19 month old is doing - including those vicious tantrums!.
Mikaila began to walk un aided at 17 months and her muscle tone and balance has improved
out of site since that date. She currently still wears her boot & bar to bed and an
AFO for her right foot during the day. If you recall from my last e-mail, Mikaila's right
foot was slightly over corrected after her surgery. The AFO is applied to help her
re-position her foot to the correct position when she walks. The results so far have been
excellent. Our Ortho. also gave as a very happy Xmas present in advising that Mikaila will
not require boots & bar at night as of Christmas eve. Her feet have maintained
excellent positioning and flexibility since her surgery 15 months ago. The signs at the
moment is that it is highly unlikely that they will turn back in again. We are crossing
our fingers and praying that this be the case.
Meanwhile, our battle continues in looking for ways of improving Mikaila's progress. Although we are still not "out of the woods" , I would recommend to parents who are now travelling the same path we took 19 months ago - to PERSIST and always strive at looking for new options on how to best treat their kids. I was very apprehensive with regards to the boots & bar and AFO's at the start, but looking back now I recognise that they have achieved a world of good for our daughter.