My research involves orthopaedics. I do both basic and clinical research and bring the research into clinical practice. I have pioneered the use of Botox (the same medicine used for wrinkles) in the treatment of clubfoot and continue to advance its use through research. I also focus on using gait analysis, measuring how people walk, and doing research on how people walk normally and with certain conditions such as clubfoot. I also conduct research into hereditary multiple exostoses (HME), a condition where people develop multiple bony bumps on their skeleton.
Idiopathic toe walking and Botox: Randomized control trial of Botulinum Toxin A to treat idiopathic toe walking
This trial is being conducted in collaboration with Dr. B. Sawatzky. The normal pattern of gait in those over three years old is a heel toe pattern. Those who walk on their toes beyond age three are felt to have an abnormal gait pattern. Toe walking can lead to achilles tendon contracture which may lead to additional problems. The traditional treatment is to cast the foot and stretch the heel cord. This study is to examine whether injection of the gastrocnemius muscle to weaken it and then cast the foot to stretch the heel cord is more effective than casting alone (with placebo injection).
Genotype phenotype correlations in HME
HME is cause by mutations in one of two genes EXT1 or EXT2. We have found an association between a more severe presentation of the condition (phenotype) and the underlying mutation (genotype). This study was done on a small group of families and provided valuable information. The next step is to examine a large number of families to increase the scientific and statistical evidence behind these findings. This research has translated into a change in our care for HME patients to a more regimented whole body review of their condition.
Clubfoot follow up
We have found that injecting Botulinum Toxin A into the tricep surae muscle complex of the leg can replace the Achilles tenotomy in the Ponsetti method of treatment of Clubfoot (Journal of Pediatric Orthopaedics 2005; 25(2):229-235). We are currently following the long-term outcome of this treatment and integrating the knowledge into the clinical practice of the Clubfoot Clinic at BC Children’s Hospital.Honours & Awards
Robert E. Salter Research Award, Canadian Orthopaedic Foundation – 2003