Dr. Mark?I am directing this question to you because you were so instrumental in my wife and I finally getting my daughter?s issue of excessive femoral anteversion addressed.??Prior to her surgery, Kellie, who is 14, had been experiencing continuous knee and ankle pain with sports activities.??The pain really didn?t begin until she went through puberty around 12 years old and then it just progressively got worse from there.??She walked VERY pigeon toed as her hips rotated internally 80 degrees when walking and 15 degrees externally.??She also experienced significant ankle pain, mainly in the right ankle, with sports but it would always get better with rest.??We finally took her to Sinai Hospital in Baltimore to the International Limb Lengthening Center to be examined by a doctor familiar and very experienced in femoral osteotomies on kids.?? After meeting with him, Kellie was extremely confident and wanted ?them fixed? as she said.??She had surgery in June of this past summer.??The surgery was about 5 ? hours total.??She had bilateral de-rotational proximal femoral osteotomies with femoral rods and screws implanted as fixation.??Kellie based her excitement for the surgery on the hope of being pain free in her knees and ankles and on the estimated goals of being on the beach in August, skiing in December, and returning to softball workouts in January.??She wa sin the hospital for 6 days and then returned home.??She was able to stand and transfer only to the bedside toilet for about 2 weeks, and then her pain dramatically subsided and she began to move around more without pain, although remaining non-weight bearing except for transfer to toilet or shower seat.??At the 7 week mark we saw the doctor who advised, by Xray that the bones were healed and that she could begin using the walker or crutches and transition to full weight bearing as soon as she felt ok to do so.??She had also, by the way, been going to therapy at Sinai since her return home from the hospital, starting with pool therapy and continuing to land based therapy.??3 Days after the 7 week checkup, we went to the beach.??Kellie was walking the beach and riding the waves a day later.??She was sore with more activity, as would be expected, but also had a ?wobble? to her walk that was very pronounced.??The doctor advised that was due to the damage to the hip muscles in surgery and would take time to resolve.??He said she should be much better at 6 months and back to normal at 9 months.??In early September Kellie had the screws only removed as she was getting a painful ?catching? above both knees when walking or standing up.??The screw removal eliminated those symptoms.??Things progressed and she began complaining of right ankle pain almost constantly.??Her feet always turned dramatically in when walking and now they are straight when walking.??However, when I walk behind her, in addition to the wobble, it is easy to see why her ankles may hurt, especially her right ankle, as when she walks it appears as if her ankles are rolling inwards when fully weight bearing on each leg.??The right one is very noticeably worse than the left.??In addition, she has begun to complain of significant pain in her left hip/buttocks area.??Xrays reveal the left rod sticking up higher than the right one and the doctor has scheduled her for removal of the rods on January 4
th, which will be almost 6 months to the day from her original surgery.
??I know that was a lot of background info just to get to my 2 questions, but here they are.??First, how long does it typically take this wobble to go away and does it always go away so she can return to her sports activities???Secondly, just asking typically or generally as I know you are not diagnosing anything etc. without seeing Kellie, is it possible the ankle issues are related to the way her foot progression was her whole in relation to the new neutral angle???In other words, is it possible her foot/ankle muscles are weak and not supporting her???When her ankles roll in with each step her knees seem to follow.??Is it possible the hip muscle weakness is the cause of the ankle issue???Or is it more likely to be a structural issue with the foot and ankle itself???We still have to make her an appointment with a foot/ankle specialist.??All of her knee pain and left ankle pain is gone post surgery.??Now we have to have the rods out and then deal with what the ankles issue is and get rid of the wobble before she can return to running and softball.??My wife and I feel so bad for her and want to do what?s best for her.??We are just trying to mentally get our heads around the fact that the wobble will go away and the ankle issue can be fixed.??She has gone through so much.
Obviously, we will be asking her doctor these questions also, but I have respected you immensely and you were so instrumental in us just not ignoring the rotational deformity that I felt I would try and ask you and hope you had time to
answer.??Thanks so much for your time.
Source: http://www.thumpertalk.com/topic/992974-dr-mark-question-reference-femoral-anteversion/
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