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Tendon Stretching - Casting
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Non-invasive treatment
On
10th April and 8th May 2002, Keisha went to Queen Mary's hospital in
Carshalton for a tendon stretch. I had opted for non-invasive surgery so
she only had her feet casted in the correct position which involved
general anaesthetic and lightweight plasters. She was in casts for about
four weeks with the initial stretch and then went back in for a
further stretch and casting which stayed on for three weeks. She
was in a lot of pain and when the plasters were removed had an extremely
bad sore on her right heel. So whilst the treatment was quite successful
as her feet were able to flatten on the floor very nicely, we were unable
to do the intensive physiotherapy needed to maintain the stretch. She also
grew very quickly and soon the effects of the stretch wore off. Invasive treatment
We
saw the consultant in October and had an appointment for a percutaneous
lengthening of the Achilles tendon (to flatten her feet) and Botox
to the hamstrings (to relax them) for 4th December. Click
here to see photos of what happens up to anaesthesia. After the operationI was quite concerned for almost two weeks after the operation as Keisha could not walk with her walking frame anymore and it was very painful to watch her try. She would drag her feet along the floor together - her legs seemed very heavy, she'd had casts on before so I knew it wasn't the weight of them as they are relatively light. Then, two weeks to the day of the operation she stood up for the first time in her life unaided for about a minute. I'm surprised my delight didn't cause her to fall!
She
now stands up regularly on her own and has even taken a few tentative
steps - although we love seeing her do that we cannot encourage her to as
she needs to learn to hold her balance while standing up straight. She
still has a tendency to have her knees bent and bottom out so we play
games like catching bubbles to get her to stand up tall. She has intensive therapy twice a week from the physiotherapist and daily at home to build up the muscles she could not develop before the operation.
Her
casts will be removed on 15th January with a follow up
appointment a week later to see how she is doing and to fit her with new
splints.
All
in all it has been a great start to the New Year!
Update
21 March 2003:
When
Keisha had her casts removed we did have a set back and it was quite
disappointing for all of us - our newly independent little girl
could no longer stand up let alone walk. The Casts clearly gave her the
support needed to walk. Her behaviour then also started to deteriorate as
she became very frustrated and took this out on us and anyone else around
her. If this happens to your child also, try to be as supportive as
possible, obviously without allowing your child to do or say as they
please, as that helps no-one in the long run!
Distraction
helps a treat and also encouragement. Basically what we said to Keisha was
something along the lines of "You know darling, the casts just
helped you walk sooner, they showed you what you would be able to do all
by yourself if you practised your exercises that Pam gave you".
Sure
enough she was able to walk again about a month later, she wanted to do
her exercises and was constantly asking us to do them!
Keisha was not fitted with new splints and instead, her casts were cut in half (picture coming soon), in the shape of her splints. Every night we have to bandage them to her feet. We must also ensure that her feet are not left to hang when she is sitting, so they must always be propped up.
A point to note: When Keisha had her operation we were told not to let her walk or put pressure on her feet - so we didn't. No-one told us when we should start letting her put pressure on her feet and when we mentioned to the physio that we were having difficulty keeping Keisha off her feet, they were surprised and told us we should let her walk - we felt that they spoke to us as if we were cretins. Actually, we feel that most of the time so what's new! The reality is, as I'm sure you'll agree, we just don't want to get anything wrong so we expect them to tell us things. Not too unreasonable I would hope?
Basically, if you are unsure of anything - ask. Don't be afraid to do so, if you don't ask you won't know because you cannot rely on them to tell you everything (they are busy people after all!)
Update 13 April 2003Keisha is now tottering around all over the place although she doesn't walk totally straight. she no longer uses her frame at home and can manage around 25 feet on her own, but she keeps trying to walk as fast as she does with her walking frame - which means lots of falling over. You'll find that they become experts at perfect landings although sometimes the falls are more serious than others. I'm constantly at the ready to catch her, but she thinks its all a big joke while my heart is beating ten to the dozen!
Her Botox is starting to wear off a little, but the Achilles lengthening is still in effect as the walking is its own physiotherapy in terms of keeping the stretch. It is important not to become complacent when you see such great improvements and to keep the exercises going as they prolong the effects of the Botox and help maintain a relatively upright walking position.
Keisha will soon have night splints which will cover the whole leg and have hinges at the knee. This is to give her a good two hours of stretching while she is sleeping. I'll update the site with photos when we get them.
Update 26 May 2003 Keisha didn't get night splints in the end, instead she received Hamstring Splints - which frightened me no end when I first saw them. Click here to view some photos. |