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The Power of Personalized Care for Bo’s Bright Future

The Power of Personalized Care for Bo’s Bright Future

by | Mar 25, 2025 | Clubfoot & Foot Disorders, Pediatric Developmental Disabilities

From the moment patients and their families walk through the doors of Scottish Rite for Children, they find more than just outstanding pediatric orthopedic treatment. They immediately enter a culture of care, just like 2-year-old Bo and his family did.

At 3-months-old, Bo and his family came to Scottish Rite for his diagnosis of sacral agenesis and clubfeet. Sacral agenesis, a rare type of spina bifida, is a condition which occurs when the lower spine around the tailbone, or sacrum, does not fully develop. This condition can affect a child’s legs, lower back, and digestive and urinary tract. He also has clubfeet, which means his feet were severely turned inward and pointed downward at birth.

Bo’s care team consists of multidisciplinary experts from Scottish Rite’s Spina Bifida Program. This team includes experts from Developmental Pediatrics, Neurosurgery, Urology, Orthopedics, Physical Therapy, and Orthotics & Prosthetics, among others to give Bo holistic care for his every individual need. 

For his clubfeet, Bo’s care is led by Megan E. Johnson, M.D. — medical director of Ambulatory Care, pediatric orthopedic surgeon and program director of the Dorothy & Bryant Edwards Fellowship in Pediatric Orthopedics and Scoliosis.

“One of my favorite things is to see how my son’s doctors and care team members treat him,” says Katherine, Bo’s mother. “They always remember who he is, and they even treat him like a celebrity. They never make us feel like he is another patient.”

Together, Bo’s care team collaborates to provide him with a wide variety of treatment. To correct his clubfeet, orthotists created custom ankle-foot orthoses, which are assistive devices used to stabilize the foot and ankle. This year, he received his first ever wheelchair, which was adjusted to allow him to mobilize more independently.

“Our overall experience is unlike anything I’ve ever experienced,” Katherine says. “Every single person at Scottish Rite is so amazing. You feel like you’re at home. You are somebody at Scottish Rite, and they truly show that they love my son.”

While Bo’s care journey is just beginning, he is on the right track. With his care team and family supporting him, Bo continues to make more improvements in navigating his conditions outside of the clinic. Now, his family shares that Bo’s favorite activities are wheeling around in his wheelchair and being the best big brother possible.

“For Bo, Scottish Rite for Children is a place where he can see children like him and be himself,” Katherine says. “For me, it means my son is getting the best care possible.”

Do you have a story? We want to hear it! Share your story with us.

Does My Child Have High Arches? How to Tell and What to Do

Does My Child Have High Arches? How to Tell and What to Do

by | Jan 14, 2025 | Clubfoot & Foot Disorders

Plantar fascia is tissue that stretches across the bottom of the feet. The tissue connects your heel to your toes. This tissue, along with other muscles and tendons, forms the arch of the foot. A long plantar fascia is present in lower arched feet, while higher arches have a shorter plantar fascia. Though many children with high arches (also known as a cavus foot deformity or pes cavus) have no issues or discomfort, this deformity can lead to foot pain in certain instances.

At Scottish Rite for Children, experts in the Center for Excellence in Foot are committed to improving the lives of children and adolescents with a variety of complex foot conditions through world-class, individualized care. Here’s what you should know to help your child manage their high arch to enjoy an active and healthy life.

 

Recognizing When Your Child Has Cavus Foot

Foot arch deformities, such as high arches, typically develop after age 3. Once high-arched feet develop, the pressure distribution along the bottom of the foot is altered, typically with increased pressure along the forefoot pad and sometimes the outer boarder of the foot. These deformities can be supple or rigid depending on the flexibility present across the arch and foot as a whole.

Whether the arch is flexible or rigid, issues related to pes cavus include:

  • Shortened foot length
  • Development of calluses on the ball, side or heel of the foot
  • Dragging the affected foot when walking (foot drop)
  • Foot pain that occurs when standing, walking and running
  • Frequent ankle sprains
  • Problems fitting feet into shoes
  • Significant space between the ground and the arch of the foot when standing
  • Toes clenched like a fist (claw toes) or bent (hammertoes)
  • Walking primarily on the heel and ball of the foot instead of using the whole foot

If you suspect your child has high arches, seek medical attention. These deformities are often related to an underlying neurologic problem, can be progressive and may result in foot pain and disability.

What Arch Height Means

High arches are the opposite flat feet and don’t always cause foot or arch pain, ankle instability, or other problems. In fact, some young people with high arches don’t experience any effect on their quality of life. These children may benefit from conservative treatment or no treatment at all.

In other cases, a high-arched foot may indicate a neurologic problem or other serious health issue. According to the American College of Foot and Ankle Surgeons, conditions that may cause high-arched feet include:

  • Cerebral palsy
  • Charcot-Marie-Tooth disease and other hereditary neuropathies
  • Structural orthopedic abnormalities
  • Muscular dystrophy
  • Spina bifida
What to Do If Your Child Has High Arches

An accurate diagnosis helps uncover a potential neurologic issue causing high arches. To make a diagnosis, your child’s provider may do the following:

  • Discuss your child’s personal and family health history and symptoms
  • Evaluate your child’s foot, walking ability, coordination, neurologic system and how your child’s shoes wear over time
  • Take X-rays for a clear view of the foot bones

If a child’s high arches are rooted in a neurologic condition, his or her provider may examine the entire leg and obtain other tests, such as genetic bloodwork, brain and spine magnetic resonance imaging (MRI) and/or nerve conduction studies which look for slow, weak signals in your child’s nervous system.

 

Treatments for Cavus Foot

No treatment may be needed if your child’s high arches are flexible or don’t affect quality of life. On the other hand, proper treatment for symptomatic high arches reduces symptoms and prevents future complications.

The goal of conservative treatments for high arches is to relieve pain and support the foot. Options include:

  • Different shoe choices. Sometimes, all that’s needed is the right pair of shoes for different orthopedic needs. Shoes with wider heels and more support may improve stability of your child’s foot and ankle as well as reduce pain.
  • Foot braces. A specialized brace can help manage foot drop. It also provides extra support for the foot and ankle that helps reduce symptoms of high arches.
  • Off-the-rack shoes may not have the interior support needed for high arched feet. Custom orthotic devices provide added cushioning and support.

When conservative treatments don’t give children improved stability and reduced pain, surgery may be necessary. The goal of surgery is to flatten the foot by lowering the arch. Surgical options include:

  • Bone realignment. The surgeon cuts and properly realigns bones. Known as an osteotomy, this procedure may treat one or more bones in the foot.
  • Fusion procedures. Joint movement in the foot can cause pain with high arches. Fusing the joints together can help reduce or eliminate joint movement and pain.
  • Plantar fascia release and tendon transfer surgery. If a problematic high arch stems from the plantar fascia, a surgeon can release the tissue. If other muscles or tendons cause the arch, a surgeon can release or move those muscles or tendons to provide more balanced control of the foot.

Specialized treatment options may be recommended for high arches associated with underlying health conditions.

 

Can Kids Outgrow High Arches?

Without treatment, acquired high arches are likely to remain in place throughout life and, if due to an underlying neurologic cause, may get worse. In the absence of an underlying nerve or muscle condition, high arches typically do not become more severe. As your child gets older, consult his or her provider about any changes in your child’s foot health.

 

Does your child have high arches, flat feet or other foot abnormalities? Find a foot expert at Scottish Rite for Children for an accurate diagnosis and appropriate treatment plan.

Cooper the Trouper: On a Mission to Mobilize

Cooper the Trouper: On a Mission to Mobilize

by | Nov 20, 2024 | Clubfoot & Foot Disorders, Hand Conditions

Previously published in Rite Up, 2024 – Issue 3.

by Kristi Shewmaker

“I can’t wait for you to see the little tricycle up in the ceiling,” BJ said to his wife, Ashley, when they arrived at Scottish Rite for Children in January 2023. Ashley and BJ Burton drove from their home in College Station with their 2-month-old son Cooper to see Scott Oishi, M.D., FACS, hand surgeon and director of the Center for Excellence in Hand.

BJ was referring to the “Flying Machine,” a giant dirigible, or airship, powered by aviators and teddy bears that hangs from the ceiling in the Atrium of Scottish Rite’s Dallas campus. The “Flying Machine” has delighted children and families since 1978. It represents mobility for the patients of Scottish Rite. BJ remembered it fondly from his time at the hospital as a child when he received treatment for a rare form of congenital arthrogryposis, a condition that affects the joints and causes contractures that limit movement. His case affected his hands and feet.

When Ashley was 30 weeks pregnant, a 4D ultrasound revealed that Cooper’s hands were, in BJ’s words, “drifting.” Ulnar drift is a hand deformity that occurs when the joints contract and cause the fingers to bend toward the pinky finger, a symptom of arthrogryposis. “We noticed his hands first, so we started to prepare ourselves,” BJ says. When Cooper was born, BJ saw that his feet were deformed as well. “I knew they weren’t clubfeet because I had clubfeet,” he says. “The people at the hospital didn’t know, and they were spitting out all kinds of disheartening things. Obviously, that’s not what you want to hear less than 24 hours into the birth of your child.”

At Scottish Rite, where BJ had found hope years ago, Dr. Oishi evaluated Cooper and confirmed a diagnosis of arthrogryposis. The Burtons learned that when Dr. Oishi came to Scottish Rite, his mentor was hand surgeon Marybeth Ezaki, M.D., who was BJ’s physician when he was a child. Scottish Rite for Children was the first pediatric orthopedic facility in the United States to employ full-time hand surgeons. “It was really comforting for me,” BJ says. “Knowing that I got great care at Scottish Rite, I knew that care would transition to Cooper as well.”

For Cooper’s hands, Dr. Oishi prescribed splints to wear at night and at nap time to stretch his fingers and keep his thumbs from tucking into his palms. For his feet, Dr. Oishi referred the family to Anthony I. Riccio, M.D., pediatric orthopedic surgeon and director of the Center for Excellence in Foot.

Dr. Riccio diagnosed Cooper with congenital vertical talus, a rare, complex foot deformity that causes the sole of a child’s foot to flex in a convex position, forming a rocker-bottom appearance. A bone in the ankle, the talus, connects the lower leg bone, or tibia, to the foot. “The talus is normally positioned at about a 90 degree angle to the tibia, but in a congenital vertical talus, the talus points straight down,” Dr. Riccio says. “Because the talus is the central and most important bone in the ankle and foot, the bones around it fold up on either side, resulting in a V-shaped foot.” Affecting 1 in 10,000 births, the condition can occur in children with no other conditions, as well as those who have a variety of syndromes, like arthrogryposis. “We had never heard of vertical talus,” BJ says. “I knew that Cooper would face challenges, and I was torn apart because I felt responsible.”

“I was terrified that he wasn’t going to be able to walk,” Ashley says, “but I remember Dr. Riccio saying, ‘He will be able to walk. He will be able to play baseball,’ and that meant a lot to us.” The Burtons are a baseball family. BJ coaches varsity at A&M Consolidated, a local high school.

Cooper would need surgery on both feet, but first, Dr. Riccio prepared him for the operation by gently stretching and realigning his feet through manual manipulation and casting. For two months, the Burtons drove back and forth from College Station every week as Cooper received a series of seven casts. When Cooper was 6 months old, he underwent surgery. Dr. Riccio ensured that his joint was aligned, stabilized it with a pin and then released his Achilles tendon, which brought his foot into the correct position. Cooper came out of surgery with a long cast on each leg. After six weeks, the casts were removed, and he wore a boots and bar brace, which is comprised of special shoes, or boots, that are connected by a metal bar that kept his feet in the corrected position. He wore the brace 23 hours a day until he pulled up to stand when he was 10 months old.

To promote walking, Cooper transitioned to wearing an ankle foot orthosis (AFO) on each foot during the day and the boots and bar at night. “He started walking along the couch and pushing his little push toy,” Ashley says. And then, at 14 months old, Cooper walked on his own. “We thought he was going to be severely behind developmentally, but he’s right on track,” she says.

Today, Cooper is walking all over the place. “Nobody would ever guess he went through bilateral foot surgery,” BJ says. “He’s already hitting a ball off a tee and running to the front door like it’s a base, and then he comes back with a huge smile on his face!”

Dr. Riccio says, “The outcome is exactly what I hoped it would be — it’s a perfectly aligned foot.” Cooper will continue to wear the AFOs as he grows and the boots and bar at night until he is 4. Because the condition can recur, Dr. Riccio will monitor Cooper’s feet as he gets older, and Dr. Oishi will continue to treat his hands. “We definitely found the best of the best at Scottish Rite for everything,” Ashley says. BJ concurs, “The moment we got there, we just knew that this was the place we were supposed to be.”

Nico is Spreading His Wings!

Nico is Spreading His Wings!

by | Sep 9, 2024 | Clubfoot & Foot Disorders

3-year-old Nico, of Mission, and his family travel more than 500 miles to receive treatment at Scottish Rite for Children. “We make that effort to come this far, because it’s worth our drive,” Nico’s mom, Mary says. Nico was diagnosed at birth with clubfoot and arthrogryposis — a rare condition that causes stiff joints. Mary found comfort in the arthrogryposis support groups she found online. Her conversations with other families led her to schedule an appointment for Nico at Scottish Rite.

Nico receives care from our experts in hand, clubfoot, occupational therapy and orthotics. Even when he’s facing a challenge, Nico’s joyful personality shines. He is always greeting and waving at everyone he meets at Scottish Rite. “I think Nico is going to grow up to be an entertainer,” Mary says. “He is such a social butterfly!” 
When surgery was proposed as part of Nico’s treatment plan, Mary felt assured. “We were always confident about surgery,” Mary says. “The outcomes our care team told us were always what we received.” Nico has had two surgeries to combat his arthrogryposis: an Achilles lengthening surgery on both legs in 2022 and a wrist surgery in 2023. 

Nico has made remarkable progress, and there is no stopping him now! Mary says she is thankful to Dr. Scott Oishi and Dr. Anthony Riccio for their attentive care. With their help, Nico can now walk by himself. He’s also working with occupational therapists Amy Sitabkhan and Grace Evansco to develop more independence by learning daily tasks such as eating and clothing himself. “I wish I could take Scottish Rite’s occupational therapists back home with us,” Mary says. “Everyone is so helpful, and we are so blessed.”

We like to say all our patients become part of the Scottish Rite family. For Nico, this is especially true. He and his family are now part of our Hand in Hand support group, and it’s been so fun to watch Nico come out of his shell. We look forward to seeing everything he accomplishes in the future!

 

Do you have a story? We want to hear it! Share your story with us. 

What to Do When Your Child Has Pigeon Toes

What to Do When Your Child Has Pigeon Toes

by | May 31, 2024 | Clubfoot & Foot Disorders

Most feet point forward, aiming at their destination — but not all. Although this condition can cause concern for parents, intoeing, or pigeon toes, is common. Intoeing occurs when children have feet turned inward toward one another. Here’s what you should know to help your child manage this condition and enjoy an active and healthy life.

Why Children Experience Pigeon Toes

Pigeon toes can exist at birth but often become noticeable later in childhood. There are three main causes of intoeing, all of which usually resolve without treatment at different times in a child’s growth. These causes include: 

  • Metatarsus adductus. While in the womb, your baby’s position may force the front of the foot to turn inward. This position can result in metatarsus adductus, a condition in which the toes point inward while the outer edge of the foot is curved outward. Metatarsus adductus is a common cause of pigeon toes in newborns and infants. In rare cases, the condition can cause the foot to look like clubfoot. This condition usually resolves spontaneously by age 2.
  • Internal tibial torsion. In this condition, your child’s tibia, or shinbone, twists and turns the leg inward. This is also related to “packaging” of the legs in an inwardly twisted direction while in the womb. This condition usually resolves spontaneously by age 6.
  • Femoral Anteversion. With femoral anteversion, your child’s thigh bone, the femur, turns inward, causing the feet and toes to point inward as well. This condition usually resolves spontaneously by age 9. 

Intoeing often runs in families. Because of its genetic root, preventing pigeon toes is not possible. 

When to See a Provider

Thankfully, being pigeon-toed does not cause pain, and most infants and children grow out of the condition without requiring treatment. The bones correct themselves as the child grows older. However, some cases of intoeing do not resolve on their own and require medical care. 

Your child’s provider may refer you to a pediatric orthopedic specialist if:

  • Your child’s intoeing is accompanied by other foot abnormalities.
  • The foot cannot straighten out easily and feels stiff.
  • The intoeing causes pain, limping, swelling or difficulty walking.

How to Treat Pigeon Toes

The vast majority of children with intoeing due to any of the above causes will correct their rotational differences without any treatment whatsoever. When intoeing is severe and has persisted beyond the expected age at which the condition causing the intoeing should have resolved, treatment may be considered.

Your child’s provider will consider several factors when determining the most appropriate treatment. These include the cause and severity of the intoeing, your child’s age and how the problem affects your child’s daily life.

Based on this information, your provider may recommend one or more of the following pigeon toe treatments:

  • Serial Casting. A cast on your child’s leg and foot can, over time, correct metatarsus adductus. Your provider may use a series of casts as your child’s treatment progresses to continue straightening the foot.
  • Stretching. Babies with metatarsus adductus may benefit from gentle stretching. Parents can perform this physical therapy technique at home. If appropriate, your provider will show you how to stretch the foot in a way that encourages it to straighten out. 
  • Surgery. Older children with severe symptoms that don’t respond to other treatments may require surgery. During surgery, an orthopedic surgeon cuts the twisted bone and resets it in the proper position. Surgery is typically for children older than 9 who have difficulty walking due to intoeing.

You may see advertisements for special shoes or exercise programs designed to address the conditions that cause intoeing. However, the American Academy of Orthopedic Surgeons has stated these are not effective. Your best resource for help with pigeon toes is your child’s provider or orthopedic specialist. 

If you are concerned about intoeing, schedule an appointment with a foot conditions specialist at Scottish Rite for Children.

Clubfoot Treatment: What Are Your Child’s Options?

Clubfoot Treatment: What Are Your Child’s Options?

by | Apr 26, 2024 | Clubfoot & Foot Disorders

If your baby is diagnosed with clubfoot, your first question may be, “What can we do?” Fortunately, effective nonsurgical clubfoot treatment options are available, and most children don’t need an operation. A pediatric orthopedic surgeon can help you decide what treatment makes the most sense for your child.

The Basics of Clubfoot Treatment

One of the most common foot-related deformities that may be present at birth, clubfoot occurs when your child has an inward-turned, high-arched foot. It isn’t painful for your baby, but if left untreated, the condition can lead to foot pain in the future. In addition, untreated clubfoot can cause an abnormal gait and restrict activities later in childhood.

Usually beginning soon after birth, clubfoot treatment can provide correction to the condition, so your child’s foot will have normal function, and your child will be able to walk without pain. With a pediatric orthopedic surgeon’s help and your commitment to following the treatment plan, clubfoot doesn’t have to be a permanent deformity. Treatment can help prepare your baby to walk, run, jump and skip through childhood.

The Ponseti Method: The Gold Standard of Nonsurgical Clubfoot Treatment

For many babies, correcting clubfoot involves a multi-step treatment called the Ponseti method, which is named after the orthopedic surgeon who pioneered it. This treatment starts with stretching and casting.

Over four to five weeks, your child will see a pediatric orthopedic surgeon for weekly manipulations. This gentle stretching gradually moves the foot into the correct position. After each session, the surgeon will apply a full-leg Ponseti cast to help the foot maintain its position.

A tight Achilles tendon contributes to clubfoot, and most patients receiving the Ponseti method have an Achilles tenotomy procedure. This procedure is quick and simple, is done in the clinic and is not major surgery.

With local anesthesia numbing the back of your child’s ankle, his or her orthopedic surgeon will cut the Achilles tendon to loosen it. The cut is so small and precise that it won’t require stitches. Afterward, your baby will wear a cast for three weeks while the tendon heals to the correct length.

Clubfoot can return, even with treatment. Your child will have to wear a brace with a metal bar attached to special shoes for four years. He or she will start out wearing the brace 23 hours a day. Once your baby begins pulling to stand the brace is used during nighttime hours only until it’s time to stop bracing.

The French Method of Clubfoot Correction

The Ponseti method isn’t right for every child. In some cases, another nonsurgical clubfoot treatment, the French method, may be a better fit. For this treatment, you’ll work closely with your child’s orthopedic surgeon and a physical therapist.

  • The physical therapist will teach you how to gently manipulate, tape and splint your child’s foot, which, over time, moves it back into the correct position. You’ll repeat this routine daily for three months.
  • After three months, your baby will likely need to have an Achilles tenotomy to release the tendon.
  • Following the tenotomy, you’ll resume manipulating, taping and splinting the foot each day until your child reaches age 2 or 3. Your pediatric orthopedic surgeon will monitor your child’s progress and let you know when you can stop the daily regimen.

Treating clubfoot takes dedication, but the payoff is worth it. Your effort can set your child up for a lifetime of activity without foot pain.

Wondering what’s next for your baby after a clubfoot diagnosis? Schedule an appointment with a foot and ankle specialist who can recommend a treatment plan.