Interaction between a well informed mother and her fetus with CTEV (Clubfoot) deformity

Here is a dialogue between a well informed mother and her fetus about CTEV (Clubfoot) deformity. This is all because of the modern sophisticated technology which makes it possible to diagnose certain illnesses before birth by means of USG. Mother takes an opportunity of this modern technology to learn about CTEV deformity before the advent of her special kid named Angel, who will be one amongst the live 1000 infants with idiopathic CTEV (unilateral) deformity.

On a cool sunday in the afternoon, mother during her third trimester makes it a point that she interacts with her fetus about all possible plans that she has for her baby who after birth will be welcomed with honour by family, friends, doctors and therapists. This kind of a dialogue is continued on every weekends till birth.

Mother: Dear Angel are you awake baby? What are you doing?
Angel: Zzzzzzzzzzz.......Zzzzzzzzzzzz......Ah.......Ah........Ah.......mum! have woken up by ur alarm!
Mother: Do you know baby how many plans do we have for you after your birth which we have scheduled in the maternity ward of K.E.M Hospital on one of the cool saturdays of December.
Angel: Oh really! May I know about all your plans. If you permit me I will add mine too as soon as I am born.
Mother: Of course you will be part of our plan and one amongst the decision maker by co-operating with us. Angel you will be one of the special amongst 1000 live infants. As you have a special congenital anomaly known as idiopathic CTEV deformity of your right foot. This part of your body will be the most special and the rest of the body will be common and similar to all the average normal babies.
Angel: Why only right foot of mine will be special and why not whole body of mine be special? If that would have been a case..........then I would have been the most special amongst 1000 babies.
Mother: But still you will be special with a star on your right foot. First of all you will be welcomed by your father, grandmother, grandfather and your little sis with roses; in the hospital and at home. You will recieve beautiful new born baby cards and you will be captured in a photograph with all of us.
Angel: Thats fine with me.......one star hm....hm.....but very special.....as am gonna get roses, cards and photographs!...........mmm..........mmmmmmmmmmm.
Mother: Do you know for your right foot there will be a special program designed by Dr I.V.Ponseti of Iowa, as soon as you are born. The special treatment program will be offered by one of the popular pediatric orthopaedic surgeons of mumbai. I have fetched the list of popular pediatric orthopaedic surgeons from pediatricians, gynaecologists and therapists of K.E.M Hospital. To name one of them is Dr Binoti A. Sheth.
Angel: Oh really.........mum you are so well prepared. Now just tell me about the entire program in detail.
Mother: I know you will be healthier baby with more than 2.75 kgs of weight. So for the first 2-3 days you will be caressed with gentle touch and manipulation. In the first week itself the pediatric orthopaedic surgeon will apply the first Ponseti cast on your right foot. May be of pink or white colour. Is it fine for you?
Angel: No. I want blue and pink both.
Mother: No problem. I will request our pediatric orthopedic doctor to do the needful. You will be called every week for consultation in the OPD to change over to a new cast so that you will not feel itchy and your foot will become more and more supple, free and well oriented just like your left foot. On the day when the 6th cast will be applied we will be informed about a special gift for you. I mean to say a splint. Also in the proces if you are hurt by rashes our pediatric orthopaedic surgeon will guide us needfully.
Angel: Oh really! I will get many gifts! Who will be giving it to me mum.
Mother: The gift will be offered to you either by an Occupational Therapist or by an Orthotist. We have an option. There are many variety of splints available in the hospital and in the surgicals outside the hospital; To name few of these: steenbeek foot abduction orthosis, dennis brown splint, modified plastic ankle foot orthosis, dobbs brace and so on...!
Angel: How about a modified plastic ankle foot orthosis or may be dobbs brace..?
Mother: OK. We will decide with our therapist and pediatric orthopaedic surgeon. Just hold on...You still have many more programs to have fun with..! Now you may have to be with either an Occupational Therapist or a Physical Therapist. Our therapist will teach us how to don and doff the splint and will tell us the times when to remove the splint for keeping your tender little foot clean and tidy. Later you will enjoy the tickles during gentle stretching exercises, peroneal (few of the muscles of your foot) stimulation exercises and so on........till you become 4-5 years old.
Angel: Oh really! You have a 5 year plan for me. And what about the splint...will it remain with me for 5 years?
Mother: No. You will be wearing this splint for about 6 months to a year with intermittent splint and exercise protocols. Later if needed the splint will be worn by you during the night time. But the exercises will continue atleast till 5 yrs of your age. I will take you to the beach to have fun with sand & water when you learn to walk. We will buy attractive sturdy sports shoes for you to walk without tumbling down on the floor/ground.
Angel: Mum you didn't mention the name of the therapist......did you?
Mother: There are many in the list again fetched by me from pediatric orthopaedic surgeons: They are Dr Medini Padhye, Dr Asha Chitnis, Dr Snehal Deshpande, Dr Jyothika Bijlani.........one new comer in the field of pediatric orthopaedic rehabilitation is Dr Punita V. Solanki. She is new but we might approach her as she is in KEM and well informed about CTEV deformity.
Angel: Thats good mum. Thank you. You have worked so hard for me to make me the happiest kid on earth; with your tender care and love.
Mother: Most welcome Angel. Thats my duty and responsibility towards my sweet little baby. But you still have to follow up with the doctor and the therapist after 5 years just to confirm that you are hale and hearty without any troubles in your life.
Angel: Mum you just told me that I am special then where does this trouble come from.
Mother: You are right Angel. You are special but troubles may come to anybody. So before it may catch hold of you...we will protect you and make you the most strongest and healthiest budding athlelete...........so that you can win laurels and medals for us and for yourself.
Angel: Alright mum. Let me come to your world full of surprises and see you soon in person. Let me enjoy the big list of programs and fun that you have planned for me. See you soon. Have a Fun Filled Healthy day. (This dialogue is just before birth).

"An attempt to educate patient's parents about CTEV deformity in brief in a dialogue form" More information can be gathered from one of the experienced pediatric orthopaedic surgeons and therapists who are well versed with congenital anomalies!
Successful outcome is solely based on the compliance on the part of the family members/caregivers; right from the time of birth till the child learns to jump, skip, hop and run.