Advice from an intern

A parent of a child with PFFD send me this e-mail. I thought it was applicable here and have quoted it.

I worked for one month as an intern with a physiatrist. During this time there were many things that came up that I felt to be very applicable for children with PFFD that I think is not so easy to find out otherwise.

1. The gait is pretty much established by the time a child is 4 years old. Any prostheses used to this time should be integrated as early and often as possible to help the child develop the gait that requires the least amount of extra energy expended.

2. Knee strain can often result from the crouch walking that many children with PFFD use to compensate for the shorter leg. This knee strain can develop to be patellofemoral pain syndrome or [[patella alta]]. Both of these conditions are fairly painful and do not present until the early teens but often can cause a setback in terms of the willingness of the child to continue usual activities.

3. Weight bearing stimulates growth. This may seem obvious but seems to support the idea that wearing a prosthesis as much as tolerated is warranted because more even pressure on the affected leg, similar to what the other leg is experiencing will favor the maximal amount of growth that the shorter leg will be able to attain.

4. For fitting over prostheses a shoe with a nice square toe box and is relatively wide width is good. K-Swiss makes shoes like this

5. Some stores will often let customers buy two different sized shoes instead of buying two different pairs. Von Maur department stores are known to do this.

6. A polypropylene and cotton blend sock will prevent blisters and skin breakdown that can occur from little legs being in a prosthesis for hours at a time.

7. "W-sitting" is bad for the hips. This is where, if you are looking at your child from an aerial shot, the hips and knees resemble a W (butt on the ground, knees pointed toward each other and heels pointed away from each other). (image to be put here later)

W-sitting can lead to a subluxation of the hips. Sitting cross-legged or with the legs in front of the hips is much better for the hips to stay in alignment. On a similar note, carrying your child over one hip with legs straddling the hip is also a good position to encourage proper hip positioning.