Wednesday, June 10, 2015

Pediatric Orthopedics Update and 4 Years Ago

For the second time in Cameron's four and a half years of life, we made a trip to Dartmouth to visit a specialty other than Pediatric Neurology (the other time being the Pediatric Nephrologist when Cameron had problems with his kidneys after starting new meds). We saw Dr. Timothy Lee and Dr. Michelle Prince on Monday in Pediatric Orthopedics. Any visits not dealing with Cam's brain or other vital organs are always so much less stressful. The visit started in the waiting room when the receptionist asked if Cameron has had a cough recently, to which he promptly coughed...multiple order to get a fun mask. ;)

The main reason for the visit to Orthopedics was to address Cam's numerous falls, instability and imbalance on the right side of his body. I mentioned previously that it was discovered when he was about two and a half, that he has a foot drop in his right foot. This means that the front half of his foot does not lift when he walks, so all of the lifting comes from his hip and knee. He's got to lift his right leg higher than his left, because his foot drops, his toe drags, and it often catches on the ground, resulting in a fall.
Left: Normal stance vs. Right: Foot drop
So the first thing Dr. Lee did was evaluate the difference in Cameron's range of motion and strength between his left and right sides (legs and arms).
Cam obviously thought this was funny!

Then, Cam's favorite, he got to walk up and down the hallways so the docs could see him on the move. 

Besides the foot drop, he also has a severe supination in his right foot. As you can see in the lovely photo of Cam and I doing yoga, his right foot is turned in - that's the supination. It's caused by weakness in his peroneal tendon. This tendon, when strong, pulls the foot to the outside so that it's flat. When it's weak, like Cameron's, his foot naturally pulls inward and supinates.

So how do we fix all of this?? Well, Dr. Prince came in and explained that at this point, the belief is that the foot drop is neurological, it's not necessarily something that is happening because of a physical disability, so the orthopedist's job is to help him walk and run safely, not fix the neurological issues causing it. BUT, there is also an issue with his right achilles/hamstring being seriously tight. The tightness here is hard to evaluate while he's growing, because the tendon could be generally too short for his leg, or if it is just tight, then some stretching can help lengthen and loosen it up as he grows. Either way, the best way to help him lift his foot up and keep it flat, is with a hinged ankle-foot orthotic (AFO) customized to his foot.
A sample of what it may look like.
Dr. Prince believes Cameron will likely wear an AFO for most of his childhood, until he stops growing and they can better evaluate the length of his tendons. The AFO inhibits his ability to point his foot, thus preventing him from dragging and catching his toes on the ground. We'll see Dr. Prince yearly, at this point. I'll be bringing Cameron to Kiser Orthotics this Friday to begin the casting for his AFO. Yippee! We're hopeful that he'll notice the difference in his own walking and running abilities when he wears it, so he'll be more comfortable and confident...and will wear it without complaints (fingers crossed!).
Ironically, my grandfather, whom Cameron is named after, passed away 4 years ago today - 6/10/11. Papa had a foot drop too, (his was due to issues with nerves in his back) and wore an AFO. If Papa was still here, I can bet he would help Cam decorate his new brace and make him feel like the coolest kid in town! He'd probably end up with some Transformers or Cars stickers on his too. ;) Cameron was the first and only great grandchild that Papa got to meet, and I'll always treasure that special connection that Cam has with him. I miss and love you so much, Pop. Keep looking out for us!
8/28/10 - Cam wasn't even 24 hours old yet!
Papa was diagnosed w/ cancer the day after Thanksgiving 2010

1/4/11 - Snuggling with Pop after a fun wedding!

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