On Wednesday we paid a visit to the orthopedic surgeon. (not that she needs surgery, but because that's just who you see.) The visit was interesting! The last time Angela saw an orthopedic specialist was when she was 7.
Angela does not have hip problems that are common among young ladies with Down syndrome. Usually if they have problems it's that their hips are very loose and dysplastic. Angela's hips are well formed and tight in the socket. Although she does have a bump on eat femoral head consistent with CAM impingement, it isn't bad enough to need surgical intervention. What she does have is a iliotibial band which is too short, causing it to stretch too much when walking or sitting, which causes the pain.
I did see on the X-rays that Angela's growth plates on her hips are indeed completely closed. This means that at 4 ft 8, Angela is completely done growing. She is a very tiny young lady.
As for her feet, most people with Down syndrome have flat feet or poorly formed arches. Angela has never followed "the rules" and her feet are no exception. Her arches are exceptionally high. Not only that but her feet are very small for her body. All of these things combine to give her problems with balance, a toe the catches when she walks, etc.
When Angela was little she wore inserts in her shoes. Now that she's older and having more problems it's time to give her a little more help. Angela's favorite part of the day was the casting that took place so she could be fitted for orthosis.
First her left foot was casted. Although this foot has a high arch the ankle still pronates so needs support. She will have an SMO made for this foot.
Her right leg, the problem leg. This leg with the shortened tibia also has a "drop foot". This makes her toe catch on the ground while walking, causing frequent falls...and injuries to go with it. This foot/leg was casted for an AFO with dorsiflexion assist. That means the ankle of the brace will be spring loaded to allow flexibility and help her foot to come up when she lifts her foot. It will also be built up a bit to compensate for the lightly shorter tibia. In addition it will include a plantar stop which will prevent her from walking by jamming the ball of her foot into the ground causing HUGE callouses that eventually rip and are very painful.
We'll go back in a couple of weeks to pick up Angela's braces. Next week will bring another round of orthopedic visits when both Axel and Asher will see the specialist. Now that Axel is very active for the first time in his life AND he's gone through a rapid growth spurt, we're starting to see some minor problems with his feet. Asher has terrible feet! Because he was in a crib so long his feet were not able to develop normally. His arches are nonexistent and when he walks his bit toe curls under his first toe. He walks better in shoes than he does barefoot but it is clear he needs some additional support to his feet. Next week will be fun for sure!