My life has been kind of crazy lately. I left an area where I had been practicing for almost 10 years in order to move to a new area and a new practice that offered me the opportunity of a lifetime.
Why does this have anything to do with this blog? I am on an extended, well earned vacation and am currently visiting family for some time back home in Canada where I grew up. Invariably as you all know, what happens when you visit your family? If your family is anything like mine, they tell the whole community that “My son/son-in-law will be in town and if you have any questions for him about your feet, let me know and I will pass it along.”
Since I am not licensed in Canada and do not carry malpractice insurance in Canada, I am very careful about what I say and generally do not really give out detailed information. Instead, I refer the people who ask to a local podiatrist who I know very well, was a mentor to me in college and got me interested in podiatry.
That being said, on this visit, I learned of an interesting case involving a young girl who has been having foot trouble for years. This was right up my alley. The initial presentation, as her parents explained to me, involved the young girl tripping a lot, complaining that her feet hurt her and that her big toe really points into the midline.
As I was waiting for the e-mail copy of the X-ray, I thought to myself: “Easy peasy. Probably a congenital adductor hallucis contracture. Make a small medial incision, transect a portion of the tendon and remove a small portion after the transection so it minimizes the potential for re-attachment. Done deal. Healthy, normal foot. Everyone’s happy.” I discussed this with the mom very briefly. I explained that without the radiograph, I might just be telling her something that is a little too simple but once the X-rays come through, I will be able to talk to her some more about it.
A couple of days later, the X-rays arrive in my e-mail inbox (see photo) and of course, they made a liar out of me. This young child had full blown, compensated metatarsus adductus.
Then I started asking some more detailed questions about her history. I come to find out that the girl had a cast on her feet for three years. Once she was out of the casts, she wore special splints that she slept in for another couple of years only to find out that none of this really did anything. So the parents decided that they had had enough of doctors and they would just “see what happens.” Now this young lady still trips a lot and has intermittent foot pain. She is also practicing ballet and although she enjoys it very much, she feels like her feet are holding her back.
So now what? She had casting and it failed. Mind you, I have no idea how casting occurred or whether it occurred correctly, and why this child had to endure being casted for so long. I could not get the names of the splints and exactly how the girl used them. She is clearly out of the casting phase of her potential treatment and is currently in that “gray zone” I discussed in my previous blog about metatarsus adductus (see http://www.podiatrytoday.com/blogged/when-casting-and-manipulation-are-n...  ). I then discussed the potential for surgical intervention when the child got a little older and her parents were mortified. How come no one had discussed this with them? Of course, the parents then had the flood of questions about the surgery, its recovery, complications, risks, etc.
One of the things that we really need to start focusing on is the niche market we are allowing to slip through our fingers. Podopediatrics is really an underserved part of our profession and it will continue to be so until education for those interested in it becomes more widely available.
I’m not talking about some of the lectures currently out there that talk about clubfoot repair, metatarsus adductus repair or the Ponseti technique for casting. I am talking about the barebones basics that our students are hardly getting in class, clinic and residency. You know how many office pediatric H&P lectures/workshops there have been this year at any conference? None. Especially when you are looking for an H&P workshop to help evaluate your pediatric population’s problems, there are none available.
If you are interested in this or have a line in your state society’s annual meeting and are looking for someone to help make this type of workshop happen, toss me a line via e-mail and I will do my best to make it happen.