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Clubfoot: What Parents Need To Know

Clubfoot: What Parents Need To Know

by | Jan 7, 2023 | Clubfoot & Foot Disorders

What is a clubfoot?
A clubfoot is a congenital (present at birth) foot abnormality. It is one of the most common pediatric orthopedic conditions.

  • The heel tilts in and down, and the forefoot is turned in.
  • Without treatment, it is possible for a child with a clubfoot to walk on the outside of the foot which may produce pain and/or difficulty walking.
  • A clubfoot is usually smaller than an unaffected foot.
  • The calf is also usually smaller on the side of the clubfoot.
  • One or both feet may be affected.

Why does it happen?

  • The exact cause of the clubfoot is unknown.
  • It cannot be prevented, but it is treatable.

How is clubfoot treated?
The goal of treatment of the clubfoot is to have a functional, pain-free foot with good mobility and strength. Two nonsurgical techniques are used in newborns and young infants:

  • Stretching, Taping and Splinting Program
    • Specialized physical therapy program consisting of stretching, stimulation and taping of the foot.
  • Serial (“Ponseti”) Casting Program
    • Involves positioning of the foot followed by application of a cast.
    • The cast extends from the toes to the top of the thigh, with the knee bent.
    • The cast is changed every one to two weeks in clinic.
    • After the casting program is complete, your child will wear a special brace full time for three months, then at night until two or three years of age.
    • Wearing the brace is crucial to prevent the clubfoot from recurring.
  • Surgery – If nonsurgical treatment does not completely correct the foot position or if the foot deformity recurs, surgery may be recommended.

Learn more about the care & treatment of clubfoot. 

Share Your Story: Strong and Independent

Share Your Story: Strong and Independent

by | Jan 4, 2023 | Scoliosis & Spine

Rhudi, a strong and independent 18-year-old from Natalia, Texas, had her life turned around when she was diagnosed with congenital kyphoscoliosis, a severe form of scoliosis that causes the spine to curve both to the side and forward or backward. Rhudi was an infant when her mom first noticed a curvature to her spine. Initially, Rhudi was monitored by a local South Texas orthopedist, but when she became a teenager, her spinal curve progressed, and they sought care and treatment from the experts at Scottish Rite for Children in Dallas.

Her condition took her away from her school, her friends and her family, but Rhudi’s parents were determined to get her the best treatment possible and to get her back home and active. In 2019, Rhudi underwent surgery with Daniel J. Sucato, M.D., M.S., which included the application of halo gravity traction, a device that attaches to the head and gently stretches the spine using a pulley device.

Rhudi was an inpatient at Scottish Rite while she continued treatment for her scoliosis and was in a wheelchair for about six months. While she was an inpatient, Rhudi made many friends and built relationships with the other inpatients and the staff who cared for her. During her physical therapy treatment, she was encouraged to go to college after graduating high school to become a physical therapist. She is now a senior in high school. She does all the things she loves, which includes Color Guard, mariachi, playing the violin and singing! She has learned a lot through her journey and hopes to keep helping others to work hard for their success.

“This hospital has taught me a lot and has made me who I am today. I have learned how to be a strong and independent person by working really hard for my successes.” – Rhudi

Learn more about our Center for Excellence in Spine.

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Adam Jamnik: Medical Student Research Fellow, Research

Adam Jamnik: Medical Student Research Fellow, Research

by | Dec 29, 2022 | Research & Innovation

Scottish Rite for Children offers a Medical Student Research Fellowship (MSRF) for medical students interested in gaining experience in clinical research. Fellows work with a lead faculty mentor throughout the year and several project supervisors who are pediatric orthopedic faculty at Scottish Rite. Fellows work as a crucial part of the research teams in various Centers for Excellence at Scottish Rite and are responsible for a variety of research projects.

Meet Adam, a MSRF at Scottish Rite in 2022 who works with Brandon A. Ramo, M.D., in the Center for Excellence in Spine.

What inspired you to apply for the MSRF position?
I am currently applying to residency in orthopedic surgery and have long felt that I would want to make research a part of my future career. Though I have had the opportunity to conduct research in medical school and as an undergraduate, I knew that a year-long research fellowship position would dramatically enhance my research skills, ultimately benefiting me for years to come. The MSRF position was a perfect fit for me. I am primarily interested in pediatric orthopedics, so Scottish Rite for Children, as a preeminent clinical and research facility, was always on my radar. I knew that the amazing physicians and research infrastructure here would provide me the support and learning opportunities to make the most of this year.

Have you always been interested in medicine and/or research?
I primarily became interested in medicine during high school, where I loved my science classes. During that time, I was also a ski instructor for children ages 3-7. That experience made me realize that I would really enjoy a job working with people and helping others.

When I was thinking of ways I could combine my passions for science and making a direct impact on peoples’ lives, medicine seemed like a natural fit. As for my interest in research, that began during college. The laboratory components for my biology and chemistry classes were great learning experiences, but I wanted the experiments I was conducting to further our understanding of the world around us and to have the experience of formulating my own questions. I ended up getting involved in two research labs — one that studied epigenetics and another that studied the interaction between hunger and sleep.

What is it like working at Scottish Rite for Children?
Working at Scottish Rite has far surpassed my expectations. First, I think the organization in general has an incredibly positive atmosphere. The people seem genuinely happy to come to work and are excited to help children dealing with orthopedic conditions. The attendings have given me invaluable career guidance and research mentorship. The research coordinators have been instrumental in supporting my projects and making sure I can make the most of my year here.

Can you share a few sentences about someone at Scottish Rite who has been a mentor to you and how they have impacted your experience? What project are you working on with that mentor?
One of my primary mentors at Scottish Rite is Dr. Brandon Ramo. From the outset, Dr. Ramo has supported me through every step of the research process. One of the projects we are working on is determining how adolescents’ experience with scoliosis has changed over the past two decades. During that time, Scottish Rite has given a survey (known as the SRS-30) to patients prior to their surgery to gauge their level of pain, how they feel about their appearance, activity levels and mental health. We determined that some of these metrics have taken a turn for the worse and hypothesize this may be related to changing societal pressures and norms.

How do you think this experience will impact your career path?
As I mentioned, I am hoping to make research a part of my future career. My experience at Scottish Rite has allowed me to further develop an understanding of the research process as well as the skills needed to conduct research, such as developing good research questions, selecting appropriate inclusion and exclusion criteria, identifying the variables needed to answer a given research question and ultimately publishing results. I am confident that this experience will improve the quality of the research that I conduct throughout my career and will likely influence the practice setting I ultimately select for my career.

What progress have you made towards your career goal since beginning the program?
I am applying for residency this year, and interview season just started at the beginning of December! My research experience at Scottish Rite will likely be brought up in all my interviews, so I am grateful that the team here has helped me have such a productive time thus far.

What is your favorite project that you are currently working on or have worked on at Scottish Rite?
My favorite project has been the one I mentioned earlier, on the evolution of SRS scores. Another project that I am proud of looks at the performance of magnetically controlled growing rods (MCGR), which is a newer scoliosis treatment for patients that are still growing. It involved reviewing hundreds of X-rays, but I am really happy with the end product and think it adds significantly to the conversation on a newer treatment modality.

What advice do you have for future MSRF participants?
My advice would be to really dive in! A year is a short period of time, especially in research when there are so many moving parts. Don’t be afraid to juggle a few projects at once because each project will demand different amounts of attention at different times.

What is one thing most people don’t know about you?
I love trying different restaurants! I am originally from New York, so it has been great exploring the Dallas food-scene.

Anything else you would like to add?
I would just like to reiterate my thanks to Scottish Rite! I am so grateful for all the resources they’ve provided me. The work that is done here for patients is absolutely incredible, and it is very rewarding to have played a small part in that. This one year will benefit me and my career for decades to come. I am confident that through those years, I will leverage this experience for the benefit of my patients.

We’re recruiting Medical Student Research Fellows for 2023! If you are a third-year medical student looking to take a gap year before applying to residency, take advantage of this unique opportunity! Only three positions are available for 2023.

Learn more and apply here on our Careers page.

University of Southern California Football Team Visits Scottish Rite for Children

University of Southern California Football Team Visits Scottish Rite for Children

by | Dec 28, 2022 | Events, Press Coverage

The University of Southern California Trojans took a break from their preparations for the 87th Goodyear Cotton Bowl Classic to visit patients and their families at Scottish Rite for Children in Dallas.

The visit began with a welcoming from Scottish Rite President and Chief Executive Officer, Robert L. Walker, who briefed the team about the pediatric orthopedic hospital. USC head coach Lincoln Riley then presented honorary captain Keegan Ratliff with a custom USC Trojans jersey.

Full stories below.
USC Football Instagram
Cottonbowl Classic Instagram
USC holds first practice at AT&T Stadium after visit to Scottish Rite, 247 Sports
Trojans Visit Scottish Rite for Children, Cottonbowl.com

What is Arthrogryposis?

What is Arthrogryposis?

by | Dec 20, 2022 | Hand Conditions

Arthrogryposis is a rare condition that occurs in one out of 3,000 births. It involves curved or hooked joints and limited range of motion for joints of the hands, wrists, knees, feet, shoulders and hips. Most children with arthrogryposis have normal intelligence and a sense of touch.

The full name is Arthrogryposis Multiplex Congenita.

  • Arthro = joints
  • Grypo = curved
  • Multiplex = different forms
  • Congenita = present at birth

Arthrogryposis is also known as Multiple Congenital Contractures.

  • Multiple = many
  • Congenital = at birth
  • Contractures = limited joint motion

In some cases only a few joints are affected and the range of motion is nearly normal. In severe cases many joints are involved, including the jaw and back.

The most common form is Amyoplasia.

  • A = absent
  • Myo = muscle
  • Plasia = abnormal growth or development

This condition involves multiple contractures in all of the limbs. The joint contractures are often severe and affect the same joint in both limbs.

What are the causes?
In most cases the cause cannot be identified. Joints that are unable to move before birth can result in joint contractures. When joints are not moved for a period of time, extra connective tissue develops. This fixes the joint in a stiff or locked position. It also causes the tendons connecting to the joint to not stretch to their normal length making normal joint movement difficult.

The causes for limitation of joint movement are:

  • muscles do not develop properly.
  • muscle diseases.
  • fever during pregnancy and viruses that may damage cells that transmit nerve impulses.
  • decreased amount of amniotic fluid.
  • the central nervous system and spinal cord do not form correctly.
  • the tendons, bones, joint or joint linings may develop abnormally.
  • a genetic cause in 30% of the cases.
    • Several genetic patterns have been recognized, but most cases are rare and recurrence varies with the type of genetic disorder.

What are the goals?
To assist your child in developing and achieving goals to maximize independence in activities of daily living and accessing his or her environment.

What is the treatment?
Treatment is tailored to the individual by a multi-disciplinary team of physicians (pediatrician, orthopedic surgeon, neurologist, geneticist), nurses, physical therapists and occupational therapists.

Treatments may include physical therapy, occupational therapy and/or surgery.

  1. The goal of physical therapy is to increase the range of motion and strength through functional activities and exercises. Assistive devices to help achieve goals may include splints, braces, crutches and wheelchairs. Parents are encouraged to become active participants in a therapy program and to continue therapy at home on a daily basis.
  2. The goal of occupational therapy is to learn activities of daily living such as feeding, bathing, toileting and dressing with assistive devices. These assistive devices include long handled utensils, hairbrushes, toothbrushes, bath brushes, toileting aids, etc.
  3. The goal of surgery is to correct the alignment of the upper and/or lower extremities so that the activities of daily living, such as standing and walking are possible. In some cases, tendon transfers are done to improve muscle function. For severely affected children, the extremities are positioned in a fixed standing or sitting position. The pros and cons for both positions will be discussed prior to scheduling surgery.

What to expect?
In most cases, the outlook is a positive one. The condition does not worsen with age. Therapy and other available treatments can bring about substantial improvement. The vast majority of children survive and live a normal life span. Many excel because they become experts at meeting and tackling challenges and are able to lead productive, independent lives as adults.