Extremity Project and the Facebook Kid

Last month, as we were preparing to for our mission to Vietnam, we received a message through our Facebook page from a woman who was conerned about her younger brother.
Dear Mr/ms,

I have a younger brother. His leg was painful. Everything is ok now. Only when he walk he must be on tiptoe. He can not walk as other children.

Doctors from "Cho Ray" hospital told that he is encephalomalacia. Now he is too young to know about that. Please help him!

Thanks for your watching,
I am waiting your feedback.

Best regards,
I looked at her profile and found that she lives in Da Nang, which is 620 miles (1000 km) distance from Can Tho, which translates to 17 hours by car. Dr. Lehnert asked if she could send video of her brother walking, which she quickly did and provided more information.

Please see my video at attached file. He was born in 2007. Now his age is 8 years. First we take him to hospital when he can not use his right hand. I'm not sure the time from September 2011.

After he stay in Da Nang hospital 1 month, doctor inform that He need to move to " Cho Ray" hospital in Ho Chi Minh. Here after time he can use his hand, He can write. From that to now his right leg must be on tip toe when he walk. Until now he is too difficult to walk.

We stay in Quang Nam, Vietnam. I work in Da Nang city. We stay far away Can Tho but if you can help us. We will try to go there

She and Dr. Lehnert continued to communicate. We wouldn't be able to get to Da Nang, but if there was a way she could bring him to Can Tho, the medical team could evaluate him. (North to South, Vietnam is not a particularly small country.)

Just as we were finishing the final evaluations on Tuesday, she arrived with her brother. I don't actually know how they got here, but she was obviously physically and emotionally exhausted from the journey. It's not a trivial amount of travel, especially in a country in which the transportation infrastructure is nothing like the Western world.

Her brother was the final patient we evaluated in the two days scheduled for screening. The doctors had some information from the video, which gave them an idea of his issues, but a physical exam is always the best way to evaluate a patient. They diagnosed him with equinus of the right foot and put him on the Thursday surgery schedule.

In non-medical terms, equinus describes "toe walking." The Achilles is too short or too strong and pulls the heel up so that the patient cannot put his or her heel to the ground. Its often present when a baby is born, but not always obvious until a child starts walking. It's also sometimes the result of polio with the muscle contractions that often result.

Yesterday, Dr. Spanko and Dr. Ngyuen performed the surgery for him and he's recovering at the hospital. The actual surgery for equinus is usually quite simple and involves releasing the calf muscle or Achilles tendon and straightening the foot to 90 degrees while it heals. All in all, the boy's surgery took 42 minutes. He'll use crutches for four weeks to avoid putting any weight on the angle, then will move into a Cam walker boot for month, during which time he'll start stretching to improve flexibilty of the joint.