Colleagues

If I can bring you up-to-date on the progress of the baby girl with the
fixed ankle abnormality.

I referred this child to a consultant orthopaedic surgeon at a leading
children's hospital in the UK two weeks ago and forwarded the x-rays and
clinical findings. The opinion received runs;

"......she is a second child born at full-term by normal delivery. No
family history. She was born with her right hip flexed up and against the
chest but with no apparent knee of foot deformities. It took approx. three
months for the hip to come down. It was then noted that the foot did not
move normally. Clinically she now has full hip and knee movements both
sides. the right foot has a normal shape, but a jog only of
dorsiflexion/plantar flexion about neutral. Normal forefoot/hindfoot
alignment anmd moves toes normally on sroking sole of foot. There is no
evidence of thigh, calf or foot wasting. Normal body landmarks. Spine
normal.

....x-rays from six weeks ago appear to show normal bony elements to the
right foot in normal alignment.

She presents with an isolated foot contracture, possibly due to lack of
foetal movement and this would be a very minor form of arthrogryposis.
There is no evidence of any neurological abnormality or syndrome. In the
first instance she would benefit from simple passive mobilisation and this
can be supplemented by active movements when she starts standing and
walking. With the foot in a normal alignment there is no indication for
corrective surgery at this stage......."

I am very grateful for this opinion, as I have been with all those who
submitted replies on this forum in recent weeks. However, I still have
concerns at the diagnosis and proposed management, even though I greatly
respect the views and experience from those kind enough to offer them. If
this is simply a soft tissue contracture, I would have expected some degree
of movement due the elastic nature of these structures and also because the
foot, even if it had been fixed in some intra-uterine position, has now
been in 'neutral, for nearly nine months now, since she was born. There
also seems to be a difference of opinion regarding the interpretation of
the x-rays.

I don't wish to contradict any of the contributors, or indeed this surgeon,
but my gut instinct is to proceed with caution, especially where passive
mobilisation is concerned. The child’s health visitor referred her to me
because the paediatric physiotherapist could not elicit any movement during
earlier mobilisation sessions, and on that basis I am reluctant to advise
any recommencement of physiotherapy until I have an accurate diagnosis.

Am I being too cautious?

Mark Russell

-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server

All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.

to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]

Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------