The Story of Scott's Feet - update July 2003

Well, after being told in August 2002 that Scott would need repeat surgery, it is now July 2003, Scott is aged 2 1/2 years old, and he has finally undergone the two revision surgery operations.

As with the first round of operations, the first operation was the medial release, releasing the tendon on the inside edge of the feet, and the second was to lengthen the Achilles to allow the foot to come up more and stand flatter on the floor.

We found ourselves much more relaxed about the idea of surgery and anaesthetics this time as we knew what to expect and knew that however hard it it was at the time, Scott would come through smiling within a few days. My main anxiety this time round was about how we would cope with a 2 1/2 year old in casts, and how Scott himself would cope. Additionally I was dreading the verbal onslaught, as this time round he could obviously voice his feelings, needs, etc. I had contacted various people and had been reassured that children are resilient and adapt easily. However, these things are easy to say but hard to really believe! I needn't have worried though. Scott complained a little after the first operation, but not the persistent moaning I had expected. The casts were full length, knees bent in a near sitting position. Within 24 hours Scott was sitting on the floor, playing happily and moving around on his bottom. We went home the afternoon of the day after surgery, much sooner than we expected as Scott's level of pain wasn't too bad and could be controlled with Calpol and Nurofen (unlike the days on morphine we experienced first time round). We got home, I plonked Scott on the floor, then thought "Now what!" He needed to be carried everywhere or lifted on and off chairs, and was considerably heavier in plaster casts. However, the next day he decided crawling was a  good way to get around and seemed to accept that he couldn't walk or climb. By the Friday (3 days after surgery) he was whizzing down the slide (we had to put him on of course) and swinging on the swings!

Two weeks after this operation, we were back in Southampton General for the Achilles release. Scott was fine right up until we reached the ward, then became very distressed as he realised what was going on! Fortunately we were first on the list, and there was little waiting around before we were on our way down to the theatre. Unlike the first operation when they put him under the anaesthetic through the needle in the hand, this time the anaesthetist opted to use gas first due to Scott's distress. We went for some breakfast, then wandered back to the ward, and  were surprised to be told that we could go and collect Scott from the theatre. We had a big surprise when we got down there as he was in below the knee casts! The surgeon had only released the Achilles on the right (the worst) foot, saying that for the minimal correction he could achieve, it was better to leave the left foot and assess it over time. This seems sensible, as the left foot looked pretty good anyway, in my opinion.

The level of pain was even less with this surgery (only one foot done, and less invasive surgery). We stayed overnight for observation, got dynacast on the casts in the morning (still only purple available and Scott wanted blue!), and were home by lunchtime! By the evening (this is the day after surgery) Scott was walking around the house! We used the little cast sandals at first, thinking that he would need them for gripping on the smooth laminate flooring at home, but soon he was happily getting around with or without them on all surfaces!

Scott will be in casts for 12 weeks in total, with a change of casts (under general anaesthetic) half way through. So he will be out of plaster in mid September and we will see how improved his feet are then. We have already been advised by Mr. Clarke, the consultant, that Scott is likely to need further treatment in the future. Scott's feet are particularly "tight" and lacking flexibility. Treatment could be further surgery, or more likely, the use of the Ilizarov fixator frames, which wouldn't be applied for some years yet. We realise that Scott's feet will never look completely normal, and any further treatment needs to be carefully considered - the hospital team kept using the term "diminishing returns", that  is to say, each subsequent treatment will produce a lesser improvement, and we will reach a point when we accept that the feet are OK and functional, and that further treatment isn't worthwhile.

Meanwhile, Scott is cheerful and uncomplaining. He can virtually run in his casts, and has even been dribbling a football round the park. There could be challenges to come, but I now understand all the parents who told me that children will  cope and adapt.

17th July 2003.

I'll give another update after the casts come off.... Now updated, click here

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