The girls have figured out biting to get their way. It started with Miriam biting Shira to get Shira to give back a toy or to get out of her way. Then Shira would bite back because she was upset. I usually comfort the bitee first with kisses. The biter gets a stern "NO BITE!!!" And the the biter usually bursts into tears, which ends up in comforting too. Last night Miriam bit Shira, Shira runs to daddy, Miriam comes over and points at Shira's leg to show him where she'd been bitten! I've been told that twins will continue biting for a while at this stage and the only thing I can do about it is try to prevent it.
When Isaiah was 1.5yr, our pediatrician mentioned he may need special shoes. At 2.5, we took him to a specialist and he was diagnosed with Hallux varus
. A brief description from PodiatryNetwork.com: "Hallux varus is a condition in which the great toe is pointing away from the 2nd toe. This can be considered the opposite of a hallux valgus or bunion deformity. In contrast to a bunion, however, the 1st metatarsal remains in its anatomical position while the great toe is deviated towards the middle of the body.
Hallux varus most commonly occurs as a complication from bunion surgery. However other causes can lead to this condition. These include: congenital deformity, tight or short abductor hallucis tendon [Isaiah's problem]
, trauma, absence or surgical removal of the fibular sesamoid.
The presenting symptom is most commonly pain. This can occur from the toe rubbing against the side of the shoe. Occasionally, this deformity can also lead to problems with ingrown nails as the nail fold is pushed into the nail border by the shoe.
The diagnosis of hallux varus is fairly simple as the great toe can be seen to be deviated away from the 2nd toe [the specialist knew in 30sec what the issue was!]. A careful history will often assist in determining the cause of the hallux varus.
This is a condition that is not uncommon in children. A congenital deformity is most commonly the result of a tight or short abductor hallucis tendon. This tendon attaches to the side of the great toe. It opposes the pull of the adductor hallucis tendon that is on the opposite side of the great toe. By working together, these tendons assist in keeping the great toe straight. However, when the abductor tendon is tight, it will overpower the adductor tendon and pull the toe toward the midline of the body. The diagnosis can be made by attempting to reduce this deformity manually and feeling the tightness of the tendon.
The fibular sesamoid is key structure in the development of a hallux varus. Because the adductor hallucis tendon attaches to this structure, any disruption of the fibular sesamoid can lead to a hallux varus. This can result from a condition referred to as agenesis of the fibular sesamoid. In this condition, the fibular sesamoid fails to develop from birth. Therefore the normal attachment of the adductor tendon is absent, causing the abductor tendon to pull the toe medially.
Treatment of this condition is dependent on the cause. In children with a tight adductor tendon, treatment should be focused on stretching this tendon. This can be done with stretching exercises, splinting of the toe and straight or reversed last shoes. If conservative care fails to correct the deformity, surgery may be necessary. This is performed by selective sectioning of the tendon with a small incision on the side of the toe. The toe is then splinted in a neutral or straight position."
Isaiah just needed special shoes. Good thing we live where special made shoes are 1/4 the price of shoes in the USA! It was a difficult age to start shoes like this when we live where no one wears shoes in the house. Plus the shoes were hot, needed socks, etc, and the boy just loves to run around barefoot. We found a pair of sandals to compensate for rainy days. At his checkup with his regular pediatrician last week she said she thinks that once he outgrows his shoes that he won't need them any more.
But then the twins. They've got it too. And MUCH WORSE. Shira's is not as bad because she's been walking longer. One foot is turning in more than the other. Miriam's is really bad. I've been doing the foot stretches like I did with Isaiah. The pediatrician feels that no amount of stretching and regular walking will correct something so extreme, so we will go back to the specialist and have both girls put in corrective shoes. Obviously this is a genetic thing and we suspected early on that this would be a repeat condition like Isaiah. At least at this age (now 15mo), they love shoes! I bought them their first shoes (sandals) for outside play a couple days ago and they wanted to wear them all day. Shira insisted on going to sleep with them on!
When Isaiah's shoes were made, the shoemaker said the blue color was out of stock, so he could make them "pink & white" or "red & white". Obviously, red and white.... and they looked like clown shoes when they were done. Thankfully the girls will have a pink option!