Clubfoot Bracing
The Department of Orthotics and Prosthetics works with the Division of Orthopaedic Surgery & Sports Medicine to treat babies and young children with clubfoot. Fetal clubfoot is a congenital foot deformity in which the foot is curved inward. Treatment with casting is usually successful, but the use of a brace after casting is necessary to prevent the deformity from reoccurring. In fact, the recurrence rate decreased from 56% to 11% for those who consistently wore their brace as prescribed.
Clubfoot recurrence can be difficult to treat in toddlers and young children. The feet become less flexible with age, and successful correction can be more challenging for older children. For this reason, 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 to schedule a follow up appointment.
What to Expect
Children begin treatment for their clubfeet with the orthopedic physician upon diagnosis. The orthopedic physician performs the Ponseti Method of casting. The Ponseti Method involves a series of weekly casts, an Achilles tendon release if deemed necessary by your physician and followed with prescribed orthotic management. Our orthotic team collaborates with the physician in order to ensure there is a smooth transition from casting to bracing.
About Clubfoot Braces
Clubfoot braces, called Ponseti AFO’s, consist of two shoes connected by a bar. Both feet are braced, even if the clubfoot is only on one side. The AFOs are positioned outward. If there is a single clubfoot, that AFO will be turned outward more than the unaffected foot. The brace is used full time (except for bath time) for three to four months. Typically, children will then progress to wearing the brace for naps and nighttime only. This can last for up to four years. Research has shown that children who wear the brace as prescribed are less likely to need additional treatment.
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 without socks. It is recommended to put the AFOs on first and then connect them to the bar. Bend the knee when applying the AFO to ensure the heel is down. You can check by looking through the circular opening on the side of the AFO. Fasten the ankle strap so that is snug. Your child’s toes should be visible near the edge of the footplate. 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.
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 without socks. It is recommended to put the AFOs on first and then connect them to the bar. Bend the knee when applying the AFO to ensure the heel is down. You can check by looking through the circular opening on the side of the AFO. Fasten the ankle strap so that is snug. Your child’s toes should be visible near the edge of the footplate. 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 may require some time to adjust to the new brace. During the first week of brace wear, check your child's feet during diaper changes to look for red spots or skin irritation. If you notice skin changes, let your doctor or orthotist know. Check your child's feet frequently to make sure they have not slipped, and that the heel is secure at the bottom of the AFO. If your child is unusually fussy in their brace after the first week of treatment or pulls one or both feet out the brace frequently, notify your orthotist. They can provide tips or make necessary adjustments to the braces as needed.
Make an Appointment
After receiving a prescription for an orthosis, you can call our office at 312.227.6210 to schedule an appointment with an orthotics specialist. We can provide our services at the following locations:
Philanthropy
Your support is vital in helping us continue to make a difference in the lives of patients and families. Lurie Children's relies on philanthropic funding to enhance its programs, services and research for children. To learn more, please e-mail the Ann & Robert H. Lurie Children’s Hospital of Chicago Foundation at foundation@luriechildrens.org or call 312.227.7500.