hypophosphatemic rickets

hypophosphatemic rickets

Algonquin Orthopaedics

9/6/2000

Good morning all,

I received this email from a mother with a young girl in the UK. She has
asked me for some information regarding brace manufacture. I've provided
the usual information as you would expect but feel she needs to contact
someone closer to home. Can anyone on this list serv provide assistance or
suggest someone who could? I will forward any replies to her.

Thanks for your time.

Cameron Renwick, C.O.(c)
Algonquin Orthopaedics
228 Main ST. West
Huntsville, Ont., P1H 1Y1
www.orthotics.on.ca

~~~~~~

Hi Cameron
Thank you for your prompt reply to my email requesting info on bracing for
hypophosphatemic rickets. I thought I might give you more history on my
daughters bow legs. Zara was born 16.4.98 and was diagnosed this February
with HPRickets. Since taking her meds she has grown a couple of centimetres
and is now 83 cm tall. According to clinical examination by an orthopaedic
surgeon, she has marked symmetrical bowing of both legs with an inter
condylar distance of 5cm. (however this was recently measured at 7.5 cm, by
her primary carer- minor discrepancy) The tibio femoral angle on the couch
is 20 degrees, but standing, as indicated by x-rays taken 3 weeks ago, the
angle is 30 degrees. Hypophosphatemic rickets causes softening of the bones
and until the rickets is under biochemical control her legs will not
straighten and may take several years to, if at all.There is bowing both
above and below the knee on both legs. Zara walks with a very wide gait and
waddle and often falls. I have noticed that the bowing has yet to improve
and there is a more severe bowing on her lower right leg. Today I received
a letter from another consultant orthopaedic surgeon - my second opinion,
who has agreed to try bracing at night only. He is concerned about her
mobility and general development which he believes may be compromised by
day bracing. I had to search far and wide in London to find an orthopaedic
surgeon who is open to using braces at all. It seems to me that bracing for
bow legs is a controversial subject, highly unpopular and surgeons rarely
brace in the UK. I am relieved that this OS is at least prepared to brace
at night. He will refer me to the head orthotist at Great Ormond Street
Hospital where my daughter is currently being treated. The orthotist there
has made braces for children with Blount's Disease, but was happy to
receive 12 medical research papers I gave to him on bracing. I anticipate
that she will be getting a KAFO with a single medial bar, but I hope to
find out more about the different types and the latest light weight ones
with hinged knees. The only papers I could locate contained photos of old
heavy braces. From the brief discussion I had with the orthotist he seems
open to finding light modern braces, but I suspect he would appreciate me
being informed and discussing options. Depending on future consultation I
am also considering finding day braces as well if there is a possibility of
making ones that do not limit mobility too severely. I am hoping that her
legs will straighten sufficiently to avoid future osteotomies as indicated
by both Orthopaedic surgeons Zara has seen. Could you suggest manufacturers
or types of KAFO's based on the information I have given you? Or could you
point me towards other links? Thanking you and looking forward to your
reply.

Rita Ali 2/161 Drummond St London NW1 2PB United Kingdom tel: 44 207 387
1904