Bilateral Walking Casts – Achilles (Heel Cord) Stretch

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E had outgrown her AFO from Dr. Paul Jordan (New York) early in the year.  It’s not that she grows that quickly… it’s just that we got busy with life… and she started complaining when we would put the AFO on.  Taking a closer look, it was apparent that the arch support was no longer in the right spot.

We took some videos and sent them to Dr. Jordan for evaluation.  He replied that E definitely needed a new AFO – it didn’t come up nearly high enough on her calf and wasn’t in the right position on her foot.  Yikes, mommy guilt.

Our dollar is really low right now and another trip to New York was just out of the question for us financially.  So we decided to pursue things locally this time, despite my nervousness to do so.  After all the referrals and consultations were completed…we had ended up going without an AFO (using off-the-shelf Chipmunk UCBL’s instead) for about 6 months.

Don’t try this at home, folks.  Not sure how time slipped by on me so quickly, but it did.  And suffice it to say, going without an AFO when you need one, is not a good thing.  E lost a lot of range in her ankle (passive dorsiflexion), and her foot definitely started to form that c-shape curled inwards again.  Had my neglect destroyed her foot forever?!?!?!

Enter a new PT who saved the day!  The PT suggested a round of serial casting to try to get that dorsiflexion range back in her ankle.  I was interested in following Dr. Paul Jordan’s bilateral walking cast protocol, and the PT was supportive of this.  We had amazing help from the local hospital cast technicians and our new orthotist as well!

E ended up having bilateral walking casts for almost 4 weeks, being changed every 1-1.5 weeks with an increase in stretch each time.  Why bilateral?  To keep the sensory stimuli the same for both feet.  To prevent limping and decreased weight bearing on the right.  We need that good weight bearing to provide the stretch… The PT just mirrored the angle the Rt ankle could achieve and set that same angle on the left.

Here’s the protocol for anyone interested.

Serial below the knee casting is used for correction of mild contractures and muscle shortening of the Achilles group and with some elongation (growth, not stretch) of the hamstrings. Casts are also applied following surgical lengthening of the Achilles. No crutches are needed – in fact, not desired if the purpose is to gain or retain length of the posterior leg muscles.

Did it work?  YES!!!!  E was able to gain about 15 degrees increased range over the 3.5 weeks.  She moved right into her new set of AFOs, to provide support for the newly elongated muscles.

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I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Perhaps our coinciding struggles have been finely orchestrated to lead you to this one moment: The Bridge to God.

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“Praise be to the God and Father of our Lord Jesus Christ. The Father of compassion, the God of all comfort, who comforts us in all our troubles so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow into our lives, so also should the comfort of Christ overflow.” (2 Corinthians 1:3-5)

 

Adult Braces Journey

This week I added braces to my list of mid-life activities checked off…  I know it’s not part of E’s journey, but since she will have braces in her future (we have seen Panorex’s of her permanent dentition!), I am able to get a sense of what it will be like for her!

I have a class II bite, some overbite and overjet, with a few slightly rotated and crowded teeth.  Nothing too major, but no perfect smile.  In fact, I have been somewhat ashamed of my smile most of my life.  Braces had been suggested to me as a child, of course, but this was back in the day where they pulled lots of teeth…which frightened me.  As an adult I had gone for several orthodontist consultations over the years, but each time was told I would need orthognathic surgery (break my jaws and wire them in different positions).  I found some online videos of the procedure, which is quite intense.

Fast forward to this year.

I’ve had some major clenching and grinding issues (bruxism) over the last decade and was clenching so hard on my night guard that I was dislocating my jaw.  I didn’t know this, of course, but knew my jaw hurt just as bad whether I wore the guard or not.  I had some panoramic x-rays done, and they showed that the little hook parts that hold your TMJs stable are just….missing.  Did I grind them off?  I don’t know.  They aren’t there now.  Also, my bite changed from all my teeth touching to only two of my teeth kind of touching at the very back.  All from the night guard chomping.

Enter a new dentist, who told me that bruxism is highly associated with sleep apnea in petite women particularly.  I was sent for some sleep studies and low and behold, have been diagnosed with mild to moderate sleep apnea.  I knew I had insomnia, but the apnea was a surprise…

I also went for an orthodontic consultation, to see if braces could help with the bruxism.  The orthodontist told me he actually didn’t think that braces would help with the clenching at all, and perhaps would only improve the TMJ issues slightly by stabilizing my bite.  He recommended that I pursue treating the sleep apnea instead.  I was intrigued.  He didn’t push braces at all.  When I asked, he said that yes they could fix my bite, and that it would involve no extractions or surgery, but would only take 15-18 months with conventional braces.  Orthodontics has come a long way!

I am fairly excited at the prospect of having straight, aligned teeth after all these years!   I also hope it will help my TMJ issues, joint stability, and reduce my bruxism.

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BRACES – DAY 0

I can’t say I was nervous to get braces on, they seem commonplace enough that I was pretty sure I knew what to expect.  It took about an hour and a half to go over the financial arrangements, the mouth care instructions (electric toothbrush, flossing apparatus, scary photographs of what your teeth will look like if you don’t brush and rinse a billion times a day), and the actual braces placement.  The placement itself took about 30 minutes.

First, they polish your teeth just like at the dentist.  Then they pull your cheeks out with retractors to keep your teeth nice and dry and prep your teeth for the glue.  I read the bottle.  It said enamel etcher, which disturbed me… It tastes like they are painting realemon on your teeth (very citric acid-ish).  They then paint a sealant on, let that dry, then the orthodontist glues each bracket on the outside of the teeth.  I didn’t have to get any metal rings around my molars.  Each bracket with glue is cured with blue light for about 20 seconds.  Once the brackets are all in place a wire is threaded through.

My braces are the Damon low torque.  My roots don’t have to do a ton of moving so I am fortunate I guess!  The wires are self ligating, which means no elastics around each bracket to hold it in place, the teeth will freely move along the archwire as treatment progresses.  This, they say, will make the treatment faster (Damon braces are about 6 months faster) and hurt less.  The archwires are memory wires, and exhibit low pressure as they try to return to perfect arch position.

Day 1 – My mouth felt weird and the brackets felt enormous!  My teeth didn’t hurt at all…slight discomfort maybe…until I tried to chew.  Wowza.  I guess teeth start changing almost immediately, as biting anything (even pasta or the middles of bread) was quite painful!!  Tried the electric toothbrush and almost hit the ceiling.  Will stick with gently brushing conventionally for a few days until my teeth settle down.  Tried to floss between two teeth and almost cried.  Abandoning flossing for now as well.

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Day 2-3 – oatmeal, mashed potatoes, and rice.  Getting tired of white mushy food….  Can now brush a few teeth with the electric toothbrush.  No flossing.

Day 4-6 – I can now chew on my right back teeth fairly well, soft foods like pasta, scrambled eggs, and even cooked veggies.  I’ve done some guacamole and hummus scooped up by a soft wrap.  I still can’t bite with my front teeth, and it hurts to chew on the left.  My teeth are more sensitive to cold now, which I wasn’t expecting.  I have to rinse with warm water and cut back on the ice in my drinks!  Weird.

I may end up with scurvy…  Miss eating whole fruits.

Brushing about half my teeth with the electric toothbrush.  (The very back ones).  The front half of my mouth can’t take the vibrating!   Able to floss my top teeth now with dental tape.  The fancy flossers they sent are thicker and hurt too much.  It takes seriously 10-15 min to floss half my teeth!  My bottom teeth seem more crowded and it is painful (sharp shooting pain) to try to get the floss through.

Day 7 – I swear my most tipped tooth has rotated slightly!  I never really noticed how angled forward it was until I saw how the archwire did a 30 degree angle to get through its bracket.  This morning when I looked in the mirror I noticed right away that this tooth looks different!  Still has a ways to go but I am so excited that I can start seeing small changes at only 1 week!

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BRACES – DAY 14 – Two weeks done!

Perhaps my weight loss would be going better if I hadn’t moved into the fall drinks – eggnog and pumpkin spice lattes🙂

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Eating still hurts.  I am so surprised!  I can still only chew on my right side, and nothing too substantial.  Although I have been gumming up the restricted list items – even popcorn…. With no ill effects🙂. I am being very careful to avoid sticky things (caramel) and things I have to bite (chips, cheezies, popcorn kernels), but it seems perfectly fine to suck on chocolate!

I found out I am in the “leveling and aligning” phase of treatment.  This usually lasts about 3.5 months with the Damon braces, or about 6 months with conventional.  I can tell at least one of my teeth is rotating to be closer to the archwire alignment.  I am glad that there is some very minor movement noticeable already (end of week 2), but it is hard not to be impatient!  I read on an adult message board for braces (archwired.com) that some people noticed a lot of movement around week 3 so hoping for some good stuff this next week or two.

I can tell from the archwire that my bottom incisors are supposed to move down, like into my chin.  As I already have a gummy smile I am hoping my top teeth have to move up a bit but the wire doesn’t look like it.  Perhaps that could only be fixed surgically by shaving down my maxillae, in which case I will pass🙂

So far, braces – kind of annoying to eat, but otherwise perfectly fine!

I have a few product recommendations:

  1. X-Pur OPTI-Rinse fluoride rinse.  I have been using the 0.05% daily and the 0.2% once a week.
  2.  97d6921bf5aadeef284463f05be1c26f_ra,w380,h380_pa,w380,h380
  3. MI Paste – topical available calcium.  I have only remembered to use this a few times, but would use it regularly if I remembered.  I’m not sure the best frequency, but probably alternating with fluoride as they both work to strengthen the enamel.  I believe they attach at the same spots chemically.MI_Paste_Image-258x258
  4. Interdental brush – in the smallest mini size you can find.  I have been using these little buddies instead of flossing… I *should* do both, but these are SO MUCH FASTER!  I reuse them, and clean them with either mouthwash or soap and water in between.a89e91e606d367d5b94370a1a3c5d6d1
  5. WaterPik – This is awesome if you want to cheat and try to carefully eat popcorn.  (I’m not advocating this, but admit to doing it – the kernels can pop your wires out of place so I carefully and gently munch the puffy bits and spit out the kernels). This little buddy squirts out all the popcorn residue which ends up EVERYWHERE stuck in your teeth and braces.
  6. waterpik-ultra-water-flosser

I’ve been reading about the treatment sequencing for Damon braces.  The different archwires are used in different phases of treatment.  Here is the link for anyone interested!  I got my wires changed about a month ago for the first time, and have now completed 3 months of treatment.

Phase 1: Initial Light Round Wires – align teeth and bracket slots just enough to move to the second phase of archwire progression.  This wire was super thin and bendy (0.014 Damon Copper Ni-Ti) to start tooth movement, leveling, and begin arch form development.  They applied cement on the biting surfaces of both my back molars to prevent my bite from hitting the brackets; however, the left side fell off the first day and they didn’t replace it.  I was in this wire for 8 weeks.  Not much movement occurred – a few rotations and a few teeth slightly moved.  I was using thin, light elastics only at night as directed like this, both sides:

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BRACES – DAY 56 – Two months done!

Phase 2: High-Technology Edgewise Wires – starts working on torque, root angulations and levels, completes rotation control, continues arch form development, consolidates space in the anterior segments, and prepares for the third phase.  This wire was WAY thicker and firmer than the first (0.018 x 0.025 Damon Copper Ni-Ti).  Movement started right away and my teeth really hurt again for a good week or two (only used Tylenol Day 0 and 1).  4 weeks in and I have new gaps, my midlines are aligned, my bite is totally wonky.  This wire is a powerhouse.  I continued with light, thin elastics on both sides as above, only at night.  I was in this wire for 9 weeks.

I asked about wearing the elastics only at night, as everywhere online I have read suggests that movement that occurs during elastic wear is stalled and even reversed in the time spent out of elastics.  I was tempted to wear the elastics all day long because of this, but they advised against it at the office as I didn’t have much movement necessary (1-2mm).  It could in fact move my teeth TOO much if I wore them all the time.

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BRACES – DAY 121 – Four months done!

I completed Phase 2, and started Phase 3.

Phase 3: Major Mechanics – posterior space closure, anteroposterior dental correction and adjusting buccolingual discrepancies.  (0.019 x 0.025 SS Preposted)  This wire wasn’t so much thicker, but FIRMER than the previous wire (being stainless steel).  It again hurt to chew for a good week or two!  At this point I had an open bite on my right side from the cement bite block on my back molars.  They drilled this off and gave me a different elastic configuration to close the open bite on my right, similar to this but on my right eyetooth and first premolar:

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On the left they gave me a heavier duty elastic to go from top eyetooth to bottom molar.  The stronger elastics made me clench my teeth really hard and aggravated my TMJ so much I couldn’t sleep, so I phoned the office and asked for lighter elastics which they mailed out to me.  These still hurt more than the previous configurations I had been using, but were bearable (and I still had to only wear them at night).

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BRACES – DAY 179 – 6 months done

After 8 weeks I again got my wire changed, this time to a (0.018 x 0.025 SS Preposted).  Still stainless steel, but a bit thicker.  I had sensitivity for a week after for chewing again.  By this point the open bite on my right is probably about half resolved.  My midlines are aligned quite well, although my bottom teeth are perhaps overcorrected.  I no longer have an overbite or an overjet.  I have several gaps on the bottom that had opened up in the last two months.  They placed a powerchain along all my bottom teeth to close these gaps (mine is on the bottom, but a powerchain is just a long connected rubber band around each bracket):

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I have noticed the gaps on my bottom teeth start to close within 2-3 days.  By my next appointment I am anticipating that all my gaps will be closed (they were less than 1mm), and that my midlines will be aligned again.  My open bite will likely be closed completely on the Rt.

What remains is that it looks like several of my bottom teeth near the front have had brackets not placed quite right.  One tooth sticks up a little too high, one a little too low and is slightly angulated.  This still needs to be addressed.  My bite also isn’t completely comfortable; as in, my teeth don’t feel like they are quite lining up perfectly when I bite.  I hope at the next appointment I can move to the finishing and detailing phase.

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Phase 4: Finishing – finishing and detailing phase.  Will update as I get to this phase.  (0.019 x 0.025 SS Preposted)