DD's foot issue, need advice please

[Dream]

DD's 20mo. She has eczema and she's in the habit of scratching for everything, like if she's hungry, pooped, sleepy etc. As a new born she was able to turn a feet sort of inward and use her feet to scratch the knee area. I don't know whether this is the reason but both her feet are turned inward. When she's standing her two toes are almost touching. I did bring this to her ped attention 3-4 times but he brushed it off saying it'll fix itself. But I'm worried. Yesterday she was walking outside and sort of tripped over her feet couple of times.

I really want to get a second opinion. How do I go about it. Her insurance need a referral from her PP to take her to a specialist and I doubt her ped will give a referral since he keeps saying not to worry.

How can I find a good specialist? I'm in Queens, NY. And am I looking for a Orthopedic Pediatrician or another speciality? The only other mom I know had the same problem with her DD is making DD wear left shoe on her right feet and visa versa. Said she tried that on her older son and it worked out. I'm scared to try something like this, scared that it might raise other problems down the road for her.

Any advice is appreciated. Thank you.

[HIU8]

Is your ped open to you asking for a referral (as in, I would really like to have this looked at even though you say not to worry)? I'm not used to having to get referrals so I didn't know if your ped would just give you a referral if you asked or not. Plus, for some reason, my peds office is always asking if people need referrals (seems they do it at the front desk).

[Dream]

I don't know what the procedure is and didn't want to create an awkard situation. I changed 2-3 ped before settling with this ped and he's been good. Except for this one thing he's taking lightly.

I would like to find a specialist and then call the front desk to find out about a referral. My next problem is finding a specialist. There's places like NYU joint desease center or Orthopedic Surgery centers etc which I feel would not be ideal for my situation.

[lmh2402]

How can I find a good specialist? I'm in Queens, NY. And am I looking for a Orthopedic Pediatrician or another speciality?

i would reference NY Mag's top doc issue for pedi orthopedist

also, do you have a local neighborhood listserve where you can post and get recs from other parents? i use mine for exactly these kinds of questions. and then i cross reference with NY Mag

why do you feel like HSS isn't right? is it b/c you aren't sure she has a joint disease? this is where our pedi sent us when DS fractured his arm in Feb...

they were excellent...

good luck!

[Dream]

I'm sorry, what does HSS stand for? I don't know of a local list server. And no, I don't know whether she has joint desease or not. It just sound so big. Are you in NY?

[lmh2402]

ok, i just quickly looked at the NYMag listing and i'm shocked they don't have pedi orthopaedics as a category

but if i were you, i would go through the CVs for all the pedi docs on the websites for HSS and HJD. and i would also check out the prthopaedics department at morgan stanley children's hospital up at columbia pres

if you want, if you don't have a local listserve, i can post a question to my neighbrohood group tonight when i get home. and PM you any responses that i get

[lmh2402]

I'm sorry, what does HSS stand for? I don't know of a local list server. And no, I don't know whether she has joint desease or not. It just sound so big. Are you in NY?

i'm in brooklyn

hss is hospital for special surgery it's another specialty hospital for orthopedics

they are big institutions - but they draw some of the best doctors around

when i pick a new doc i read through all the CVs to get a feel for their training. and when possible, i try to cross reference with NY mag and also with personal references from friends and/or neighbors

[Dream]

Thanks, yes please, if you can, do post in your list server.

I only read about NYU Joiny Diseases, which is in Manhatten.
http://www.med.nyu.edu/orthosurgery/patient/findadoc/callback.html

I don't mind Brooklyn either, probably easier to drive to rather than driving to the city.

You mentioned Morgan stanley children's hospital, do you have to go through a doctor affiliated with the hospital or can we make appointments directly?

Thank you so much.

[lmh2402]

sure, i'll post tonight

all three - HJD, HSS and morgan stanley children's - are all in the city

for all three, you should be able to call and make an appointment - you don't need to have a doctor already affiliated with the hospital in order to see one of the specialists.... i think that's what you're asking, right?

however, it depends on your insurance whether you will need a referral

the doctor's office should be able to help you figure that out

PLUS - with regard to worrying about upsetting your pedi...i think you shouldn't worry too much about that

if you like your doc. and you trust them, than you should call their office and ask them for a referral. don't worry about what they would do in your shoes (whether they don't think it's a big deal). if you want to see a specialist, they will give you the name/number of the person they reco.

i've done this several times already with my ped - she didn't think something was a big deal. i disagreed and wanted it checked out. told her thanks, but give me a name of a specialist anyway...and she always did

i would bet your doc won't be personally offended if you ask for a reco

[Dream]

Thanks again. I'm going to call them to see which one accept her insurance.

[rlu]

It can be a big deal. Our ped told us all babies feet turn in and not to worry. DS is 6 now, they are still turned in. When Ds was 2 or 3 we did take DS to a pod and then pediatric orthopedic surgeon. Basically the pod has us do the wrong shoe on the foot thing which didn't do anything. Then pod suggested we get straight last shoes, pricey and we didn't but got the closest we could get. Then the pod had us get inserts (the insurance had to be convinced on that) and that didn't help. Finally pod suggested we see pediatric orthopedic surgeon who looked at DS and said issue was not just the feet but ankles and hips so everything we had done was pointless.

DS doesn't trip more than any other kid now, but I don't think skiing will be very easy for him and skating will be more difficult. Basically he will adjust and live with it.

[Dream]

It can be a big deal. Our ped told us all babies feet turn in and not to worry. DS is 6 now, they are still turned in. When Ds was 2 or 3 we did take DS to a pod and then pediatric orthopedic surgeon. Basically the pod has us do the wrong shoe on the foot thing which didn't do anything. Then pod suggested we get straight last shoes, pricey and we didn't but got the closest we could get. Then the pod had us get inserts (the insurance had to be convinced on that) and that didn't help. Finally pod suggested we see pediatric orthopedic surgeon who looked at DS and said issue was not just the feet but ankles and hips so everything we had done was pointless.

DS doesn't trip more than any other kid now, but I don't think skiing will be very easy for him and skating will be more difficult. Basically he will adjust and live with it.

Sorry to hear you DS has to go through this. So if its the ankle and hips then it can't be fixed?

[DrSally]

I would see an orthopedist. I took DS into the ped b/c his feet were turning out while walking. I did a lot of reading on it. You'll want to make sure it's not tibial torsion. It is true that most cases will resolve on their own as the child gets older, but if it's interfering with her walking (tripping), then I would have it looked at just to be sure.

ETA: Like pp, I have also read that it's not really about the shoes, but about how the bones in the legs may be turned (tibial torsion). Did your ped examine DD's legs? Our ped took a good look at DS's legs, hips, ankles, and feet. He didn't notice any torsion or flexibility problems. Also, his feet didn't turn out while running (not as self-conscious as walking), so he thought it was not something to worry about.

[noodle]

My DD's feet turned in pretty severely. The problem was not in her hips, legs, or ankles, but mid-foot, and was called metatarsus adductus. The pediatrician insisted (repeatedly) that they would straighten themselves out, but when she was almost 2, she literally tripped over her own feet and chipped a tooth. I took her to a pediatric orthopedist who put her in casts that day. He took scans of her feet pre-casting and we could see her metatarsals were overlapping. He said if we'd waited much longer, she would have required surgery, but as it was, she did fine with a couple of months in casts and about a year in night braces (Wheaton KAFO) and straight-last shoes.

I'm not sure how your insurance works, but could you have a consultation with an orthopedist (paying for it yourself) and then ask your pediatrician for a referral if treatment is needed?

[Katigre]

In additon to the above, what steps are you taking to reduce your DD's excema? Often it is food related (I know it always is for me - when I eat foods I'm intolerant of my eczema flares terribly, when I avoid those foods it's very minor). Dairy is a major culprit FWIW.

[DrSally]

My DD's feet turned in pretty severely. The problem was not in her hips, legs, or ankles, but mid-foot, and was called metatarsus adductus. The pediatrician insisted (repeatedly) that they would straighten themselves out, but when she was almost 2, she literally tripped over her own feet and chipped a tooth. I took her to a pediatric orthopedist who put her in casts that day. He took scans of her feet pre-casting and we could see her metatarsals were overlapping. He said if we'd waited much longer, she would have required surgery, but as it was, she did fine with a couple of months in casts and about a year in night braces (Wheaton KAFO) and straight-last shoes.

I'm not sure how your insurance works, but could you have a consultation with an orthopedist (paying for it yourself) and then ask your pediatrician for a referral if treatment is needed?

Scary! I'm glad you went to the Ortho and everything turned out alright.

[rlu]

Sorry to hear you DS has to go through this. So if its the ankle and hips then it can't be fixed?

The surgeon's suggestion was that it really can't be "fixed", especially at a young age. She suggested waiting until DS is 8 or so and see if the condition is truly affecting his ability to get around. Surgery might be considered, but not at that age. DH's memory of the appointment is different from mine - I thought she might consider surgery at age 8, but DH says she didn't say that at all. At any rate, DS's feet both turn in, the left more than right, and it is much more pronounced when he is tired.

The pod had thought it was medatarsal (sp?) adductus, as a pp explained, so that was why he had us do all those things since it was too late to cast.