Fetal clubfoot is a congenital foot deformity in which the foot is curved toward the middle of the body. Treatment with casting is usually successful, but the use of a brace after casting is recommended to prevent the deformity from coming back. In fact, recurrence is five times as likely in children who don't consistently wear the brace as recommended.
Clubfoot recurrence can be difficult to treat in toddlers and young children. As children get older, they are more likely to become upset by the casting procedure. Also, the feet are less flexible with age and successful correction can be more challenging for older children. For these reasons, we stress the importance of using the brace as prescribed. If your child has problems keeping the brace on, call your doctor or the Orthotics and Prosthetics Department.
What to Expect
Our patients begin their treatment with our orthopaedic surgeons after diagnosis. We work closely with Orthopaedic Surgery and our physical therapists to use the Ponseti Method on each patient we see. The Ponseti Method involves a series of weekly casts, physician directed Achilles tendon release and orthotic management.
Clubfoot braces, called Denis Browne bars or Ponseti AFO’s, consist of two shoes connected by a bar. Both feet are braced, even if the clubfoot is only on one side. Generally, the clubfoot is turned to the outside more than the unaffected foot. For young infants, the brace is used full time (except for bath time) for three to four months, then with naps and at night for up to four years.
Research has shown that children who wear the brace as prescribed are less likely to need additional treatment. If your child has difficulty tolerating the brace, or pulls out of the brace frequently, notify your orthotist right away so they can provide tips, make necessary adjustments or change the brace type as needed.
How the Brace is Worn
The clubfoot brace should be worn with thin cotton socks. Thicker socks make it easier to slip out of the brace. If your child pulls out of the brace easily, try wearing the brace with no socks. You can also remove the tongue from the Markell shoe and just use the laces. The ankle strap should be very snug. Make sure your child's toes are showing out the end of the brace.
It may be easier to put the brace on the more severely deformed foot first (or the clubfoot, if only one foot is affected). Make sure the heel settles down into the shoe. Do not use any lotions, powders or creams on the foot. These products can make the foot slide around in the brace and cause a blister.
Adjusting to a New Brace
Children are often fussy as they adjust to a new brace. During the first week of brace wear, check your child's feet every three hours to look for red spots or other skin irritation. If you notice skin changes, let your doctor or orthotist know. Check your child's toes frequently to make sure they are all showing.
If possible, try to remove the brace for skin checks at times when your child is content. That way, your child will not connect crying to brace removal. If your child cannot be consoled and there is no other explanation, you can briefly remove the brace to make sure there are no skin changes.
Tips for Success
Once your child is done with full-time wear, make sure the brace always goes on before naps and at bedtime. This way your child understands that when it's time to sleep, it's time for the brace as well.
Show your child how to move their legs by gently moving the bar up and down. This shows your child that they are free to bend at the knees and hips, now that the casts are off.
Many baby stores carry car seat strap covers designed to pad car seat straps. These can be used to pad the metal bar of the brace so you child doesn't hit the bar on their body, furniture or others.
Please note: It is important that once your baby or child has the brace (e.g., Dennis Brown Bar, Ponseti Boots, AFO’s) that they bring it to every orthopaedic and orthotics appointment. Without the brace, the team will be unable to assess the effectiveness of the treatment
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