Lauren and Katie doing their thing.
If someone showed you Lauren at physical therapy three months ago and Lauren at physical therapy now, you wouldn't even believe it was the same girl. PT visits used to be a 45 minute long battle between Katie (our physical therapist) and Lauren. I'm still not sure which one of them is tougher, I just know that they both stick to their guns. Well, what once consisted of Lauren refusing anything that was asked of her, crying, and occasionally throwing herself on the floor...is no longer. I'm not sure exactly how it happened but Lauren now fully cooperates most days and giggling can even be heard through out our visits. Lauren even thinks to do her home exercises all on her own sometimes. We've worked a lot on stretches and having Lauren walk with her foot flat. She has a new ankle brace, which has taken on the name "princess boot", and that has helped with her walking too. With the stretches, we progressed from ten degrees to forty degrees of movement in Lauren's forefoot. We were concerned though that we hadn't gained much movement with her heel and hindfoot so we scheduled an appointment for Lauren's check-up with Dr. Standard.
Dr. Standard didn't seem too concerned with Lauren's ankle movement, which surprised us a bit as we were anticipating that he might plan to go ahead with the Botox injection treatment that he'd mentioned before. He took a hold of Lauren's heel bone and showed us how you could see it move a bit. He was very content with the range of motion in Lauren's forefoot. Lauren, of course, walked for Dr. Standard with her foot flat instead of the heel walking and toe curling that she normally tends to do when she's barefoot. Dr. Standard joked that it was like when you take your car to the shop and it no longer makes a noise. He explained to us that Lauren's FH means that she has a type of ankle joint which makes for more movement in her forefoot than a normal ankle joint, but less movement in her hindfoot. It was difficult to hear that she probably wouldn't be able to gain more heel movement as we hadn't expected that it would be so limited, but it was good to have things cleared up about her ankle. Before, as we'd do Lauren's stretches and exercises, even though they didn't seem to hurt her, I'd worry that I was stretching her foot too much because it seemed that her forefoot moved so much more than mine. I'll feel better now doing her PT and having a better understanding of the movement her ankle joint allows for. Dr. Standard also said that she is curling her toes under as a way to compensate for the length difference and it's something that she'll overcome as she gets older.
Now for the really exciting news...Lauren's leg length difference measured 2.6cm. This measurement, done with Lauren's first set of "standing" x-rays, is the same as our last visit which means her FH leg has been keeping up with her other leg! The surgery she had done last November is known to stimulate bone growth and it's seems that is what happened in Lauren's case. Dr. Standard told us the plan would still be to not lengthen until her difference reaches at least 4cm. He said that her left leg could just "take-off" in growth at some point and then we could look at doing a lengthening, but until then it doesn't make much sense since it would over-lengthen her FH leg so much. However, Dr. Standard did feel that we need to look at doing a corrective procedure called an "eight-plate" in the next year. Lauren's knee/lower leg is in a valgus position, a.k.a. knock knee, and Dr. Standard feels that should be corrected to help center her weight over her ankle and foot. The eight-plate is a little metal peice that's placed on the bone during a simple out-patient surgery, it causes the leg to gradually grow into a straight position, and it's then removed via another out-patient surgery. A bonus about this is that by bringing her leg straight under her knee, Lauren will gain a little length on that side. That's kind of the strategy to all this...take whatever length you can along the way in order to save on the amount of actual lengthening needed later.
Our appointments with Dr. Standard always have a way of calming our worries and this was one was no different. Dr. Standard looked at Lauren and said when she's older, she's going to be one of the patients that he uses to show new parents who are deciding whether to choose lengthening and reconstruction. I can't help but tear up whenever I think of him saying that.
