|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 3 | Page : 308-309
Intimate partner violence: An abominable factor affecting brace compliance
Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
|Date of Web Publication||24-Dec-2018|
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dharmshaktu GS. Intimate partner violence: An abominable factor affecting brace compliance. Int J Acad Med 2018;4:308-9
To the Editor,
Intimate partner violence is an irrational and punitive act which is linked to psychological trauma to the person and the family. Low-socioeconomic status, illiteracy, and job dissatisfaction are among multiple reasons that trigger this impulsive behavior. In most of the cases, women are at the receiving end of it. At certain occasions, this activity can be extended to the child in the house and may lead to various presentations. Unfortunately, child-witnessed domestic violence is not given its due consideration despite having far-reaching consequences over the child's future personality and social behavior due to altered neurobiology. We incidentally noticed this uncommon hidden element as a cause to inappropriate adherence and compliance to braces in the treatment of a child.
A 3-year-old male child was brought by his mother for the treatment of bilateral foot deformities. He was managed by us for his bilateral congenital, untreated, and idiopathic clubfoot. The successful outcome of conservative care with weekly corrective plaster casting was achieved after a total of 10 cycles resulting in corrected feet. He also underwent percutaneous tendoachilles tenotomy as standard practice for the equinus correction followed by a final cast of 3 weeks. After the removal of final cast, the mother was explained, and proper application and maintenance of foot abduction brace were demonstrated to her. All through the treatment, the father of the child was never seen attending the baby. The child came for monthly follow-up for initial 3 months and then, the visits were irregular. Proper brace wearing and good plantigrade walking were confirmed on telephonic communication with the mother. A year later, the child was brought to us, and as the child was walking normally, there was a hint of relapse of his equinus deformity supposedly with improper brace wear. On deeper asking, she revealed that her husband and she had occasional and sometimes, the husband beats her up and has broken two of the brace. She was asked to replace broken braces with newer ones on next visit [Figure 1]. The counseling of his husband was done in, and he was explained the importance of treatment for the child. On further follow-up improved compliance and care of brace was noticed.
|Figure 1: The broken clubfoot brace (above) and consecutive mutilated (below) brace of the same child affecting the proper application and compliance|
Click here to view
The bracing is an integral part of clubfoot treatment and parents are advised to ensure cooperation and compliance as advised to them. It is often seen that children with good adherence to braces are less likely to get and relapse or recurrence of their deformity and this is also reflected in various studies. It has been reported that the ability to consistently and properly apply brace is crucial for the success of conservative treatment.
This short case snippet highlights an uncommon reason for treatment failure, and that is avoidable to a certain extent. The lessons drawn from this case are important for future management of similar cases. Home visits and education of parents are key areas to ensure proper child care and treatment. Because future personality of the child is altered along with neurobiological maladaptation as an aftermath of domestic violence and resultant posttraumatic stress, organized community outreach, and sociopolitical collaboration are warranted to ensure safe childhood. A detailed history of the relationship and behavior of parents toward each other is added by us along with other things in the checklist of cases involving children. These lessons can be applied to every case that requires a part of home-based therapy as a management protocol.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms whereby the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patient(s) understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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