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II. Griffin
352
Letters to the Editor
the simpler measures described above, and occasionally the splint, to reverse the abnormal pressures of sleeping in the fetal position. Thus the natural direction of growth is permitted to occur, avoiding the conversion of a flexible positional deformity into a structural one, which may be corrected only by years of growth. JUDD SHIELDS, M.D.~ ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN PI~IILADELP HIA~ PA,
I I . Griffin
To the Editor: The opinions expressed by Dr. Shields in his letter to the editor are interesting, but I believe the indiscriminate use of the Denis Browne splint or Filaner bar attached to shoes should be discouraged. Such devices help very little in correcting the usual deformities for which they are now used and will produce a valgus strain on the feet, ankles, and knees. If worn for a long period, significant harm may result.
August 1963
There is little to recommend in the use of these devices in the treatment of metatarsus adductus. The flexible metatarsus adductus will usually correct with nothing more than manipulation into abduction 10 to 15 times after each meal. In the more rigid metatarsus adductus, application of plaster casts is needed to correct the deformity and a bivalve cast worn at night to maintain the correction. The patients who do not respond to manipulation, but whose feet are not rigid may need to wear abduction cast shoes for varying periods of time. T h e attachment of the shoe to a bar adds little to the effectiveness of the abduction shoe. Internal tibiaI torsion usually corrects with growth and needs no treatment. Most children who toe in, do so as a protective mechanism for pronated feet, and not because of internal tibial torsion, and of course, the continued use of the Denis Browne splint in these children only aggravates the pronation. PAUL P. GRIFFIN~ M.D. CHILDRE1N~S MEDICAL GENTER~ BOSTON~ MASS.
Letters to the Editor
the simpler measures described above, and occasionally the splint, to reverse the abnormal pressures of sleeping in the fetal position. Thus the natural direction of growth is permitted to occur, avoiding the conversion of a flexible positional deformity into a structural one, which may be corrected only by years of growth. JUDD SHIELDS, M.D.~ ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN PI~IILADELP HIA~ PA,
I I . Griffin
To the Editor: The opinions expressed by Dr. Shields in his letter to the editor are interesting, but I believe the indiscriminate use of the Denis Browne splint or Filaner bar attached to shoes should be discouraged. Such devices help very little in correcting the usual deformities for which they are now used and will produce a valgus strain on the feet, ankles, and knees. If worn for a long period, significant harm may result.
August 1963
There is little to recommend in the use of these devices in the treatment of metatarsus adductus. The flexible metatarsus adductus will usually correct with nothing more than manipulation into abduction 10 to 15 times after each meal. In the more rigid metatarsus adductus, application of plaster casts is needed to correct the deformity and a bivalve cast worn at night to maintain the correction. The patients who do not respond to manipulation, but whose feet are not rigid may need to wear abduction cast shoes for varying periods of time. T h e attachment of the shoe to a bar adds little to the effectiveness of the abduction shoe. Internal tibiaI torsion usually corrects with growth and needs no treatment. Most children who toe in, do so as a protective mechanism for pronated feet, and not because of internal tibial torsion, and of course, the continued use of the Denis Browne splint in these children only aggravates the pronation. PAUL P. GRIFFIN~ M.D. CHILDRE1N~S MEDICAL GENTER~ BOSTON~ MASS.