Reina's Progress in Michigan
by Jonathan Van Zytveld
“Zapatos!” Reina exclaims, pointing out the shoes of the Dora the Explorer doll cradled in her arms.
“Where are your zapatos, Reina?” asks her host mother, Carol Nyeholt.
The 4-year-old from Honduras turns slightly in her chair to point out her shoes, which lie on the floor, connected to each other by a metal brace. She grins as she turns back to Carol.
“There,” she says.
Reina lives in the mountain farm village of Caserio El Cacao, Honduras, but after she was born with clubbed feet, her parents sought help from Healing the Children and a Grand Rapids podiatrist.
Reina arrived in Michigan last July and settled into the home of the Nyeholts, her Hudsonville host family. At that point, she walked on the tops of her feet instead of the soles. She had gotten quite accustomed to it, Carol said.
"She could walk, run, jump, and dance," she said. "There's nothing she can do now that she couldn't do before."
But knowing the long-term debilitating effects of clubfoot, the Nyeholts accompanied Reina to Foot & Ankle Specialists of West Michigan, where she was cared for by Dr. Michael David and other specialists.
She underwent an Achilles tenotomy to lengthen her tendons, which had become stiff and inflexible, complicating her walk and affecting her gait. After several weeks of healing in molding casts, Reina took up her metal-braced shoes as part of a non-invasive process called the Ponseti method.
Four months later, the difference in her mobility is striking.
"Reina's gait has improved dramatically," David said. "Her heel is making contact with the floor and she's walking toe to heel. She is still learning to manage her new gait, but it is a 100 percent improvement from her pre-treatment stage."
Carol said the improvements extend even further.
"She is doing a lot better," Carol said. "She has put on weight, grown taller, and learned a lot of English."
Reina was initially shy upon arriving at the care facility on Friday, Jan. 17. She buried her face into Carol's shoulder, occasionally glimpsing out to survey the waiting room with her dark brown eyes.
"I broke the news to her earlier that she would have to come here," Carol said. "I said 'no tears, no tears, no one is going to hurt you.'"
After she was given the Dora doll, Reina brightened considerably. Asked by her host sister, Brooklyn, 15, if she wanted to dance, she grinned.
"Mañana," she said. Tomorrow.
Shortly after, David began the examination, holding her tiny feet and feeling the tension in her tendons.
"Children with club feet never have normal-looking feet, but we expect to help them function like normal," he said.
David removed Reina's shoes and asked her to walk to demonstrate her mobility. A Dora sticker was her reward, and she moved quickly across the floor as employees stopped to watch.
"Right now, the wide angle of her gait shows she's still tight in her heels," David said. "I think her gait will improve, but she's still not walking normally. That could just resolve itself, but we want to get her feet to a 90-degree position."
David discussed Reina's options with Carol, and the pair decided to perform another tenotomy to ensure against relapse. After healing, Reina will alternate between her shoe braces and a specially molded ankle-foot orthosis.
David said he normally would not perform the additional surgery, but felt the procedure was necessary since he will be unable to monitor progress after Reina's return home, which is tentatively scheduled for the spring.
"I would like to continue to monitor her progress, but because she doesn't live here, she might tighten up when she leaves," he said. "Her family might stop using the brace, and then we could get a relapse. We just want to make sure she gets the optimal correction."
Performing the quick outpatient surgery will likely improve her walk, Carol said, and Healing the Children is in no rush to get Reina home.
"They just said 'we want it done right,'" Carol said.
The Nyeholts have sent weekly emails to Reina's parents but have received little response, likely due to their residency in an adobe dwelling without running water or electricity. A representative from Healing the Children informed Carol they are doing well, but miss their daughter. Reina is scheduled to return to Honduras in the spring.
Reina declined David's request for a hug, but compromised for an enthusiastic high-five. When asked if she would ever give him a hug, Reina grinned.
"Mañana," she said.