IT'S YOUR CHILD - What to do?
The most compelling question asked by any parent when discussing treatment options is "what would you do if it were your child".
Such a powerful question to throw at any clinician who happens to be a parent. In truth the depth of the question only really came to the fore in 2018 when my daughter's pain meant more need to be done.
Let me explain. Firstly, I am a Consultant Podiatric Surgeon with a special interest in paediatric foot problems. I spent three years writing an MPhil on the subject not to mention training others in the use of a minimally invasive surgery to correct flexible flat foot.
Secondly, I am a father of twin girls, one with perfectly good feet, the other with severe flexible flat foot. From the age of four she has had nothing but the best in terms of orthoses.
Despite this, as parents we were conscious of increased aches and pains to her feet and legs. An increased reluctance to walk and participate in walking / running. These are the very features described in my own research and lectures.
For years I have performed a procedure called "Hyprocure" for the correction of flexible flat foot deformity in both adults and children alike.
In truth I have now lost count of how many of these I have performed in this country but it's a large number. The operation itself is very straight-forward and involves a 1cm cut on the outside of the ankle through which a guide wire is placed. A stent is inserted over the wire allowing the stent to be carefully placed in a gap between the talus and calcaenus (heel bone).
MAKING THE DECISION
Making the decision for my own daughter should have been easy but in truth it was far from it. I know the operation is straight-forward, the risks are small, the implant can be removed if unsuccessful, no bones or tendons have to be cut. Despite all my experience the decision to put my own daughter forward for surgery was tricky. Of course this is because the decision is being made as a dad and not as a surgeon.
In the end commonsense prevailed and after careful discussion with the prospective patient, sister and mom, it was agreed the Hyprocure was a sensible way forward.
Aged 12 my daughter elected to have this procedure undertaken using local anaesthetic only. This involved three injections around the ankle. The choice between local and general needs to be carefully considered in youngsters with a lean towards general if there is any doubt. As someone who operates on children routinely it riles me to hear of youngsters being distressed when having even minor things like nail surgery undertaken.
There is huge evidence to confirm that such traumas result in life-long negative response to future exposure to medical interventions.
Within ten minutes or so the stent was fitted and Carys returned to the recovery ward bandages in place.
Postoperative pain management was straight-forward. The application of local anaesthetic provides some degree of protection from postoperative pain through regulation of the spinal pain pathway resulting less pain in like for like surgeries compared with surgery under general anaesthetic. Another benefit is that the patient remains pain free for several hours post-surgery allowing time for oral medicines to take effect. For Carys this involved basic level analgesia with Ibuprofen and Paracetamol.
Recovery following Hyprocure requires an initial period of non weight-bearing with crutches, no more then three days or so. This is followed by a period of progressive weight-bearing and home exercises. Mention should be made of her twin sister Phoebe
who rose to the challenge of being her personal House Elf for at least three weeks, well beyond any medical need.
Timing with children often involves surgery around holiday time and her first foot surgery took place at the very beginning of the school holidays.
For me this was the very first time I had lived a patients recovery day by day. As the Consultant, patients are typically packed off home and seen at intervals of 1-2 weeks initially which then often extends to six week blocks. Whilst I always try to provide detailed recovery information, this experience highlighted to me just how important it is to provide quality postoperative information and access to help for patients and carers postoperatively.
Only three to four weeks later Carys was running around pain free on Chesil beach. Here's her little video so soon after her first foot surgery.
She is now recovered from both foot surgeries and back to walking over a mile each way to school, using a hover board (highly recommended) and doing all the things she wants.
The feet are superbly aligned, the aches and pain are gone.
Having been in clinical practice for some thirty years I learnt a great deal from this experience both as a Consultant Podiatric Surgeon, but also as a dad.
Submitting your child for surgery is a huge responsibility and requires total faith in the planned procedure and surgeon.
I have seen the pain severe flexible flat feet can cause and I know the benefits Hyprocure can bring.
So thank you Carys for giving me permission to share our story x