Toby's Annual Check-up with Surgeon

Last Wednesday Ronnie and I had our appointment with Paul at Gainesville Prosthetics. We can't believe it's been 3 months since we've been there. Toby's Mickey Mouse leg got a 1/8 inch extension, and they are mailing us a larger foot. He will now have a 15cm foot - which is about a size 7 1/2 or 8 toddler shoe. So...they're mailing us the foot, right? Think about this.... I mean - how many people do you know that can say, "Guess what I got in the mail today?....a child's foot!!" Which means that my wonderful husband has to take the old one off and put the new one on. Scary!!! I think he can do it. I think he can...I think he can! hehe

The socket is getting a little snug on his residual limb so we may need to start using a thinner sock. Ronnie is also going to make his size 14 cm foot a sandal foot...meaning he will permanently glue a wedge to the bottom heal so he can run around with flat sandals on. We find out that we shouldn't be using the temporary heel wedges in most of Toby's shoes. Many children's shoes have a raised heel, so inserting a wedge when not needed could lead to the hyper extension of his knee. Thank God it hasn't really affected Toby thus far. We also talked to Paul about our newest, more prominent issue - the Hip Rotation...which I will expand on below when I talk about our appointment with Dr. Woo.

So Wednesday was great! Yet again! Paul and DeAnna are wonderful and we love going (not driving) to Gainesville to see them:) We had dinner with Paul and spent the night at his house. Toby adores Paul! It looks as though, depending upon growth spurts, that Toby won't need a new leg for a couple of months.

Our annual appointment check-up and x-rays with Dr. Woo (Toby's orthopaedic surgeon) was Thursday. Mama and Papa came down to meet us for the appointment. After checking in, Mama and Ronnie had to go in to Radiology with Toby for his x-rays. I couldn't go in of course and I knew he would do better with them anyway. Mama said they taped his legs down. Sounds terrible....but it was quick, 5 minutes at the most, and Toby got a lollipop from Mommy when he was finished. The scanogram was done from his waist down. The x-ray showed the hips, femurs (thigh bones), Tibias, and Fibula bone. The x-ray also contained a measuring tape so we could compare the length discrepancy for all the bones. This is the first of annual measurements to track and record the femur length difference.

Dr. Woo came in to meet with us and right away wanted to see Toby walk/run down the hall. He quickly noticed what we were talking about regarding Toby's hip. First we reviewed the x-rays and he was very happy to report a minimal 7mm difference in Toby's femur bones. This is wonderful news!! If the differential percentage of this remains the same each year, Toby will most likely not need a lengthening. If the difference at age 10 is less than 5cm, lengthening will not be done. We may have to slow growth in his left leg at that point. They can slow the growth of a bone by placing a clip on the growth plate for a specific amount of time. It's surgery but it's better than lengthening to us!

Dr. Woo laid Toby down on his belly so he could rotate his legs side to side, which Toby wasn't too happy about. After that Dr. Woo said immediately what we've feared. We've noticed for at least two months now that Toby has been "throwing" his leg around to the side when walking/running. His Physical Therapist even mentioned his hip flexor and Paul mentioned hip rotation. When he walks, runs, etc. it's very clear that his whole leg points in. It's very pronounced with a prosthetic I guess because his foot is stationary facing forward. You can only adjust the foot outward so much on the leg.

There is actually a medical term for it. It's call Femoral Anteversion. CLICK HERE to read more about it. So....what does all this mean? We knew that there was always a chance that the hips could pose an issue relating to Fibular Hemimelia....but this is a separate issue. Something new...and a little worrisome for us. Dr. Woo sees hundreds of pediatric orthopedic patients...of all severities. Some children go to him just for a foot or a leg pointing in or out. He says that when he does see this hip rotation it's mainly in first born children because of the curled-in position in the womb. He said it's usually the left leg in most children. Toby's rotation is in his right leg. We think maybe he was more comfortable with that leg curled in under his left leg because of the bowing tibia. Maybe....maybe not.... we'll never know:). Also keep in mind that first born babies always have a smaller home inside than subsequent babies. Dr. Woo says most children grow out of this by natural growth and strengthening of the muscles around the socket/hip joint. It's not a muscle thing so there's nothing we can do with PT. Worst case scenario is that Toby could need hip surgery to fix the rotation - somewhere around age 10.

Toby's tibia length difference is 6.4cm which is again wonderful news! The larger the length discrepancy between the two tibias, the better fitting his prosthetics will be. The conversion is 2.5 inches. So right now, if we hadn't done the amputation, Toby would be wearing a 2.5 inche lift on his shoe and we would continue getting larger lifts every few months. Remember he wouldn't have had his first lengthening until the age of 4 or 5. WOW! He would have a hard time doing all the crazy running, skipping, and climbing he does.

Dr. Woo mentioned that in the future Paul will be able to design a leg for him that will help with the hip rotation. Overall the appointment was great. Great news about the femur, knee, hip bones, and nubby pad. We are so happy that Toby has come to far. We are very proud of him! He is such an inspiration to us!

Love, The Kings