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Have you ever heard of a contraption called a Taylor frame for deformed club feet?

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Q: Have you ever heard of a contraption called a Taylor frame? It's used to treat severely deformed club feet. Our adult children are Peace Corps workers coming back to the U.S. with an 11-year-old child who is in these contraptions. We just wanted to be prepared to meet this child by knowing a little more about him before our first face-to-face contact.

A: The device you mentioned called the Taylor spatial frame is used to help correct severe foot deformities in the fastest time possible with the fewest side effects, problems, or risks. In remote areas of the undeveloped countries, children born with clubfoot (known as congenital talipes equinovarus) often don't get the early, traditional treatment provided our children in the United States.

The clubfoot is unmistakable. The foot is turned under and towards the other foot. The medical terminology for this position is equinus and varus. Equinus means that the toes are pointed down and the ankle flexed forward (sort of like the position of the foot when a ballet dancer is on her toes). Varus means tilted inward. The ankle is in varus when you try to put the soles of your feet together.

This twisted position of the foot causes other problems. The ligaments between the bones are contracted, or shortened. The joints between the tarsal bones do not move as they should. The bones themselves are deformed. This results in a very tight stiff foot that cannot be placed flat on the ground for walking. To walk, the child must walk on the outside edge of the foot rather than on the sole of the foot. Over time the foot becomes even more deformed from the force of the child's body weight on the foot while standing and walking.

The Taylor spatial frame comes into play when surgery has been done to realign the bones. The frame combined with traction applies a slow, gradual corrective three-dimensional force. This device makes it possible for the surgeon to start with just 30 per cent surgical correction of the bones. By providing a slow change rather than a sudden shift in anatomical alignment, damage can be avoided to the nerves and blood vessels in the area.

After surgery and a short time in traction, the lower leg is kept in the Taylor spatial frame. That makes it possible to avoid using a lower leg cast but still allow the child to stand up and even walk. The open frame (instead of the closed cast) makes it possible to maintain good blood circulation to the foot and toes. They can also monitor pulses, toe movement, skin color, and skin temperature.

Eventually the child will be transferred to leg braces to help hold the improved alignment of ankle bones and soft tissues.

Reference: Atef Hassan, BS, MBs, MSc(Ortho), and Merv Letts, MD. The Management of the Neglected Congenital Foot Deformity in the Older Child with the Taylor Spatial Frame. In Journal of Pediatric Orthopaedics. January/February 2012. Vol. 32. No. 1. Pp. 85-92.

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