• Dr. Michael Rivera

Foot Surgery Helps Adolescent Teen Girl with Asperger Dance Again


Background

In 2015, my office received a call from a mother desperate for our help. She hoped to get treatment for her 19 years old daughter, Jane, who was suffering from Asperger’s Syndrome.


Jane was born with Convex Pes Plano valgus, a severe flatfoot condition in which some bones are deformed, causing chronic pain and discomfort. It is a problem commonly encountered in pediatric orthopedics and is generally considered as caused by the collapse of the medial longitudinal arch in the foot.


Flat feet could negatively affect one’s quality of life, only getting worse as time passes if left untreated. For Jane, her condition got to the point where she had to use a walker and had custom prosthetic inserts in her shoes, which did not allow her to walk normally.


Jane is not alone; It was found that 42% of children are born with this condition. Age, gender, obesity, cerebral palsy, syndrome of Down are known risk factors for the development of growth, and musculoskeletal changes. Almost 20% of the adult population has pes valgus.


Jane’s determination to live the life of her dreams was stronger than that of most teenagers in the autism spectrum I had treated. Jane loved to dance and exercise because these activities did not hurt her too much, which was impressive given her condition.


All Jane’s mom desired was for her daughter to have functional feet—for her to be able to dance, exercise, and have the lifestyle all parents want for their children. However, as Jane got older, she was getting no positive results with the treatments that she had undergone her whole life.


Problem

Jane’s mom felt that her daughter was somewhat trapped. For several years, she had taken Jane to several specialists. However, she had not seen any significant improvement, to the point both mother and daughter felt they could not trust any physician or doctor.


The treatments Jane had gone through had been more trouble than helpful and only served to fuel their fears regarding the situation.


In the most severe stage of the flatfoot syndrome that Jane displayed, the ankles are at risk of developing arthritis and injury to the deltoid ligament, which is the most critical area in the ankle because it provides the most support. In the worst cases, this ligament becomes stretched and causes the ankle to lose strength and utility.


Jane was a highly intelligent and perceptive individual, so to see someone as brilliant as she is, burdened by this condition was just painful because I felt the condition was treatable.


The problem also stems from another underlying issue: Many doctors would rather not see patients that are autistic because of the possible communication challenges. According to Spectrum News, they are less likely to have their routine health needs met and are often misunderstood or ignored as a result.


Since patients in the autism spectrum need special one-on-one care, doctors often are unprepared to provide proper treatment, so such patients are at risk of getting other ailments or having preventable conditions worsen. Many institutional and university-level medical hospitals may not want to touch a case like this because of the high level of personal attention and care it requires.


Assessment

A colleague I had mentored knew that I had done pediatric work at Columbia University Hospital and that I had performed this kind of specialized reconstructive work. I have seen many cases like Jane’s in the past.


When that colleague referred Jane to me, I did not hesitate to take her case. Hospitals can create much stress since most patients in the autism spectrum function best in calm, and predictable environments, so I wanted to customize her plan of care and give her what I could to improve her situation.


After our assessments, I believed she was cognitive enough to withstand the procedures she needed to undergo.


Treatment Plan

Jane’s mom and I reviewed a variety of treatment options. We decided to proceed with surgical intervention.


The surgery that we planned to perform on her was a triple arthrodesis, which consists of fusing the three main joints of the hind feet. The objectives were to relieve pain, improve the stability of the foot, and correct deformities.


The first surgery on her left foot was performed on January 22, 2015. Following a successful surgical procedure, Jane was admitted to the hospital for four days to monitor her progress.


Jane fared exceptionally well as she followed the proper physical rehabilitation. As a result, her foot healed beautifully, and she had no pain or discomfort afterward nor any adverse secondary effects.


After a 6-month recovery period, we decided to proceed with the same operation on her right foot on August 7, 2015. She was admitted for three days this time because the expectation was better than that for the first operation.


Success

By November 2015, Jane not only had completed her recovery, but she also had been one of the quickest healing patients I had ever had. By December 2015, Jane was dancing, walking, and exercising with no problems; she had enrolled in a dance class, and the successful treatment had improved the mother-daughter relationship.


Although Jane and her mother had tried to find a solution, Jane’s Asperger’s Syndrome required a more in-depth relationship building than other cases. People in the autism spectrum need a patient level of care that, unfortunately, is unavailable at many healthcare institutions.


If Jane’s mother would have left this untreated, she would have gone into what is called Traumatic Degenerative Secondary Arthritis into her joints called the subtalar joint. She would have had to use larger prosthetic inserts inside her shoes and sneakers and probably be bound for the rest of her life in a wheelchair or a walker.


I believe many people like Jane are cognitive enough to understand what they need to do as patients. With just a little bit of understanding and insight into who Jane was, she was treated for the condition that she had suffered for so long and finally was able to live the life that she wanted.


This surgery not only dramatically improved Jane’s and her entire family’s quality of life forever, but it was a blessing for me, too. Seeing Jane so happy and vibrant inspired me.


A Letter from Jane


Jane wrote me a letter afterward thanking me for giving her the means to live the life she always wanted. Here is what she wrote:


"First off, I want to thank you. I want you to know that my passion is dancing, and I always restricted from that and all everybody else restricted me from that because of my feet. They always tell me if I kept dancing due to my flat foot, I would be wheelchair bound. These are the years of seeing pediatric orthopedists. I never dreamed it was possible to have my feet surgically fixed. Now I know it was your job too as you do amazing miracles. I can’t thank you enough. Thanks to you, I can now dance without being scared, so I can go for long walks and do exercise and who knows where I’d be tomorrow. Another thing is, due to my past medical history, I never really trusted or liked any of the past physicians or doctors. They would traumatize me with different treatments that hurt more than helped. I was kind of scared. You know what I mean? After everything was done and said, now I see what you do for you don’t do it for money. You do it to make a difference in the world. And you really inspired me this past year. This surgery has taught me so much and I have shared it with many people and that’s what has led me to write this letter to you in gratitude and thankfulness for you. After who knows how many more visits, I have left with you, I doubt we’d cross paths again. That’s why I want to give you this letter. So, if you ever feel down, you can re-read this letter and remember me. I know I’ll always remember you, the doctor who humbly performs miracles and the best doctor I’ve ever come across. Thank you very much for everything. My new feet are wonderful, with no pain and no discomfort."

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