Most cases of complex clubfeet stabilize sometime between 12 and 24 months. All, of them, in fact, except two. Guess what? It is lonely at the top. Yeah, we have a one-in-a-million kind of guy. Kai turned three in December 2005. To date, his foot has had a relapse of cavus every six months or less since we left Iowa. He has had 6 sets of casts with a total of around 16 casts. The Mitchell shoes helped some, but we have gone back to the Markells for the time being and at this point they are working as well as anything or nothing.
Dr. Ponseti gave me the unfortunate news that no one has the answer for this. We have determined that the ATTT will not help because that complex of tendons is not the problem. There may be a possibility of a plantar facia release working, but Dr. Mosca is not ready just yet to do anything beyond casting.
Dr Pirani has expressed interest in seeing Kai, and we probably will take Kai to him if there is another relapse, just for a fresh perspective. At this point it couldn't hurt. In the mean time, I am still trying to gather information and help look for viable solutions. We know that someday this will all be behind us ... we just don't know when that day is yet. =)
In May 2008, Dr. Mosca performed a plantar fascia release and long toe extensor release on Kai's foot to relieve the persistent cavus that was causing Kai's heel to not even meet the ground when walking. The surgery was a raving success and no further intervention (casting, bracing or surgery) has been necessary in the 3.5 years since that time.
As of October 2011, Dr. Mosca in Seattle and Dr. Morcuende in Iowa City concur that Kai's foot is well corrected and functionally sound. He has no pain at all, and any differences between his two feet are superficial only. There really is a light at the end of the tunnel!
We moved to Iowa for other reasons in July of 2011. In May 2013, Dr. Morcuende was forced to repeat the plantar fascia release and did opening and closing osteotomies on Kai's midfoot to correct a bone deformity that was causing metatarsus adductus. He believed an ATTT would be necessary but I believed it would not be, so we came to an agreement where he would do the fascia release FIRST and if he still felt the ATTT was needed, he could do so. Well, as it seems has always been true, I was right. Dr. Morcuende was amazed at how successful the fascia release was. After 8 weeks of long-leg casting and 3 months of physical therapy for muscle atrophy and gait training, Kai's foot was just as perfect as it had been in 2008.
But, this is Kai. One in a million. Dr. Morcuende wouldn't put him in the follow up study for the original Ponseti complex group because he is the only one whose foot keeps "going back." He has said if he ever sees another foot like it, he will name the subgroup, "Kai foot." And that brings us to the last appointment Dr. Morcuende accepted scheduling for in 2016. He stated that the best he could offer was continued PT exercises and reconstruction if there was any further loss of flexibility after age 16 - recognizing it was already happening. He declined further check ups as not useful. Kai's foot simply doesn't make it through growth spurts without back-sliding. I suspect a trip to Seattle lie in the near future.