NAVIGATION

The Story of A Brave “Little Star” Standing Up

Guangzhou in April is rainy, hot and humid.

Today is the day of Xiao Lei’s follow-up visit.

01

Xiao Lei’s world

Most children can raise their heads at 3 months old, sit at 6 months old, and walk at 1 year old.

However, for Xiao Lei, a girl with clubfoot, her developmental journey is significantly more challenging due to her condition.

Clubfoot is a complex bony soft-tissue deformity that is mostly congenital or neurogenic, and to a lesser extent can be caused by trauma [1]. Xiao Lei’s case is congenital, due to a congenital musculoskeletal defect, the feet resemble a horse’s hoof, with the heels unable to touch the ground, and there is extreme inversion.

 

                     

Note: Pre-operative information of Xiao Lei

In addition to the aforementioned factors, Xiao Lei’s nutritional status and growth and development are not as optimal as those of typically developing children of the same age. This not only impairs his ability to run, jump, and play freely, but also restricts his capacity to move his body independently. To facilitate his mobility, he requires the assistance of the social workers from the charity organization, who help him move slowly.

02

Meet  Guangzhou United Family Hospital

Prior to her encounter with Guangzhou United Family Hospital, which was made possible by the United Foundation for China’s Health, Xiao Lei had no recollection of ever having walked on solid ground. In this environment, a group of individuals with benevolent and compassionate natures were resolute in their determination to alter the course of her life.

“The first thing we felt at the time when we saw (Xiao Lei) was that we needed to go and treat her as soon as possible so that this child could stand and walk as soon as possible. Because early standing and walking is very important for the child’s physical and mental development.” Dr. Yan Hua carefully studied Xiao Lei’s case.

Note: Dr. Yan Hua examines Xiao Lei.

As an orthopedic surgeon who mainly deals with children’s locomotor system injuries and deformities, Dr. Yan Hua has dealt with many cases of children’s lower limb deformities in his career of more than 10 years, but “Xiao Lei’s case is a relatively more serious kind of lower limb deformity in children.”

If a child with congenital clubfoot is not accompanied by other disorders, usually after regular treatment by a specialized medical institution, the child can have the normal appearance and function of the foot, which will not lead to disability and affect the movement and life in the future. On the contrary, if there is no timely intervention, the child will have difficulty in standing, delayed walking, unstable gait and other problems during development, affecting walking and life.

In Xiao Lei’s case, the earlier the intervention, the better the outcome.

03

3 Months, 2 Surgeries

In November 2023, Xiao Lei finally arrived at Guangzhou United Family Hospital.

Although it was the first time we met, the medical and nursing team had been combing and discussing the case more than a month in advance, and were already very familiar with Xiao Lei’s situation.

 

Pathologic changes of congenital clubfoot manifest as varying degrees of bone deformity and soft tissue contracture fibrosis, and progressively worsen with age. Therefore, treatment varies according to the clinical manifestations and severity of deformity at different stages, requiring individualized, stepwise treatment plans [1,2].

After consultation and evaluation by various doctors, it was decided that Xiao Lei would undergo staged treatment.

Half a month later, Xiao Lei underwent her first surgery.

“We started with a minimally invasive release, and after the first surgery, the child’s deformity gained a partial improvement as we expected.” Dr. Yanhua described.

The treatment of clubfoot is a long process, and after the first minimally invasive release, the team of healthcare professionals would do manipulation and casting on Xiao Lei every two weeks on an outpatient basis. Through this slow process, the shortened soft tissue is lengthened.

 

    

 

“Typical of newborns with clubfoot, we can even achieve complete correction of a deformity with this manipulation and cast (treatment).”

Dr. Yanhua further explained, “But for older children like Xiao Lei, in addition to the shortening of the soft tissues and joint dislocation, there is also a deformity of the skeletal system itself that has no way to be corrected by manipulation, and this is something that must be addressed surgically.”

Three months later, the second stage of surgery began.

“For the second stage of surgery, the main surgical modalities we did were bilateral lengthening of the Achilles tendon, release of the ankle and posterior talonavicular joints, lengthening of the posterior tibialis muscle, release of the talonavicular joint, and a rotational osteotomy of the distal heel bone. The name of this procedure is a bit long, and in fact the surgical steps are very numerous and complex.”

In the end, it took Dr. Yanhua’s team six hours to successfully complete the second stage of the surgery, “The whole operation was very delicate and there was very little intraoperative bleeding.”

04

The first step in her life

Clubfoot is relatively easy to treat in the neonatal stage, and cure rates are currently high in China. However, the treatment of older, refractory clubfoot with complications such as multiple joint contractures is more complex.

At Guangzhou United Family Hospital , doctors and nurses from Pediatric Orthopedics, Pediatric Internal Medicine, Nutrition, Psychology, Anesthesiology, Ward Teams, Operating Room Teams, and Neurosurgery broke through the challenges time and time again, working in unison and in their respective areas of expertise, and ultimately helping Xiao Lei take her first real step in life.

“After the surgery, the child’s deformity improved as we expected, but it was still a great surprise when we actually saw significant progress in the child’s (lower limb) function during follow-up visits.” Dr. Yanhua and the healthcare team were delighted to witness the step-by-step changes in Xiao Lei.

Not: The  fifth week after surgery

                                                                                    

By the second week after surgery, Xiao Lei was able to sit on a shorter stool, and her feet were actually on the ground for the first time.

At week 5, Xiao Lei was able to walk with a walker and an external brace, and for the first time, she was wearing a dress – she had never been able to wear a dress before when her bottom was on the ground.

After the operation, Xiao Lei’s vocabulary and linguistic complexity increased markedly. Her utterances became more nuanced and evocative, reflecting a growing curiosity and longing for the world.

 

Not only is Xiao Lei, but Dr. Yan Hua and the medical staff at Guangzhou United Family Hospital are looking forward to her future. “We are so happy to see Xiao Lei take her first steps, and we are confident that she will keep going and getting better and better.”

05

Healing Brings Hope

In China, a large proportion of children and adults in difficulty have congenital diseases, severe or disabilities, and they often need to undergo multiple surgeries or long-term rehabilitation to reach a relatively stable physical condition so that they can be adopted by their families or integrated into society.

UFCH’s Charity Medical Program provide life-saving surgeries, emergency care, and well care to our 50+ charity partners across China.

References:
[1] YANG Huaqing,ZHANG Hongyue,ZHANG Yaohua,et al. Classification and surgical treatment strategy of clubfoot[J]. Chinese Journal of Clinicians, 2021, 49(8):5. DOI:10.3969/j.issn.2095-8552.2021.08.001.
[2] Li Pan Ruan Youquan Kang Yangyang Rao Yu. Selection of treatment methods for clubfoot in different age groups[J]. Journal of Clinical Orthopedics, 2022, 25(5):657-662.
Image source: United Family Healthcare
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