A Thought Experiment Regarding PTEV Syndrome

First, let me just say this post is a prelude to something I suspect will take much longer and far more detail to explore, but wanted to get the raw idea down before it slips from my increasingly ephemeral mental moorings. You have heard me talk about the issue with our lower leg musculature, how the cell structure is radically different than in non-clubby legs. What has only just occurred to me, in thinking about this at some length, is that the very act of changing/altering our initial TEV toward a plantigrade position, through castings, bracings, and surgeries, may be setting us up for future pain issues because of the very nature of that cellular deformation.

If we look at how muscles work, by stretching and contracting to provide motive power, it is clear there is a level of elasticity that is critical to those functions over the course of one's life. If the elastic nature of these muscles is altered, that is, less elastic, then changing the position of the bones acts to alter the oppositional nature of the muscle groups, as well. This means that some of these muscle groups are likely to be subject to more stretching while the opposing group becomes more contracted, while at rest. In a normal muscle, such a change would be offset within a short period by the ability of the muscles to strengthen and grow. But if our muscles, already atrophied at birth, cannot grow or strengthen as readily, and as seems obvious for some clubbies, not at all, then there is less ability for the muscles to make those necessary adaptations.

This would suggest that the kinds of muscle pains (not joint pains, specifically, but in the muscle bodies themselves) some of us clubbies, especially as we age, experience may be the result of this musculature aspect of post-club foot syndrome. This non- or less-elastic nature may also explain why there is the propensity in some clubby children for regression of the positional aspect of the syndrome, where additional TALs are performed. If the original tendon lengthening or repositioning proves insufficient, perhaps it is not the amount of change that is the issue, but the act of making that change causing even further reduction of elasticity within the muscle body itself. By increasing the posterior group's length, the anterior group is thereby shortened. Both muscle groups, then are being forced to perform something they are poorly suited to perform.

This requires far more research and analysis, of course, but I wanted to put this out to stir the waters and get it down for further consideration.