Re: Using the foot abduction brace

[Guest guest]

Very well said ! I would like to point out a minor typo - you stated that

the " norm " at this time is reverse last Markell boots where I beleive you meant

STRAIGHT last Markell boots.

Thanks so much for taking the time to type this up for the new users. It is

sometimes very hard to know how best to approach the new parent who is facing

issues because of a doctor or orthotist that is not performing up to par.

Angel

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

Very well said ! I would like to point out a minor typo - you stated that

the " norm " at this time is reverse last Markell boots where I beleive you meant

STRAIGHT last Markell boots.

Thanks so much for taking the time to type this up for the new users. It is

sometimes very hard to know how best to approach the new parent who is facing

issues because of a doctor or orthotist that is not performing up to par.

Angel

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

Very well said ! I would like to point out a minor typo - you stated that

the " norm " at this time is reverse last Markell boots where I beleive you meant

STRAIGHT last Markell boots.

Thanks so much for taking the time to type this up for the new users. It is

sometimes very hard to know how best to approach the new parent who is facing

issues because of a doctor or orthotist that is not performing up to par.

Angel

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

Yep- my typo- it should have said Straight last, not reverse last.

> Very well said ! I would like to point out a minor typo - you

stated that the " norm " at this time is reverse last Markell boots

where I beleive you meant STRAIGHT last Markell boots.

>

> Thanks so much for taking the time to type this up for the new

users. It is sometimes very hard to know how best to approach the

new parent who is facing issues because of a doctor or orthotist that

is not performing up to par.

>

> Angel

>

> Using the foot abduction brace

>

>

> As a 4 year veteran of various clubfoot support boards and the

> Ponseti method, I'm going to attempt to type some of my

> personal " OBSERVATIONS " and things I've picked up along the way

> pertaining to the foot abduction brace (also known as DBB)- please

> don't flame me or get upset with any of the text below- just take

it

> or leave it (or parts thereof) if it pertains to your child's

> situation.

>

> 1) Almost all families who have posted on the internet about major

> issues with the brace are working with doctors who are new to the

> method, who are modifying or only using parts of the method, or

> orthotists who are not setting up the brace properly. Very rarely,

> if ever, have I heard of families who have severe or chronic issues

> with the brace when they are treated by the U of Iowa staff and

> American Prosthetics & Orthotics in Iowa City. Bracing seems to be

a

> non-issue for the families who are in experienced hands, where

> bracing can be a nightmare for families who are not working with

> experienced staff. An exception would be children with a-typical

> clubfeet where the regular straight last shoe could cause issues

> regardless- but the new sandals seem to have helped this

> group of children also; it will just take some time for doctors to

> get experience in diagnosing these cases.

>

> 2) The child's foot **must** be completely corrected in order to

wear

> the brace comfortably. It seems that some doctors (even those with

> good reputations and experience) can " think " the child's foot is

> corrected, when, in fact, it is not. There cannot be an attitude

> of " this is as good as this foot is going to get- let's try the

brace

> and hope that we can maintain it (or improve it) " . If your doctor

is

> new to the Ponseti method, is modifying the method, or if you're

just

> not 100% confident that the foot is corrected, you should consider

> seeking a second, third, or fourth opinion on the foot/feet. Even

> pictures or video sent to a doctor can help in diagnosing

uncorrected

> feet or problem areas, though a physical examination is really the

> best.

>

> 3) The FAB must be set up correctly for the child to be

comfortable.

> The shoe can be a straight last shoe, reverse last shoe, regular

high-

> top shoe glued to a board, or sandal........but

> the " standard " at this time is the Markell reverse last shoe. The

> inside edges of the heels of the shoes should be set at a distance

> equal to the width of the child's shoulders. The shoe for a

clubfoot

> should be set at an outward rotation of 70 degrees, but the parent

> must ensure that the last cast that was applied also rotated the

foot

> outward to this angle. If the foot wasn't casted at that angle,

then

> it won't be comfortable in the brace at that angle. A non-clubfoot

> should be set at 25-45 degrees. There is a slight bend to

facilitate

> the front of the foot flexing upward on the clubfoot. We have

heard

> of cases of orthotists setting up the brace wrong- even when the

> doctor has given correct instructions.

>

> 4) The FAB is the preferred brace because of it's success in

> preventing relapse. The brace keeps the foot rotated outward and

the

> forefoot pointed upward to maintain the correction. The AFO and

> Wheaton brace cannot maintain the outward rotation. The KAFO is

not

> preferred due to the potential of causing muscle atrophy in the

calf

> since the knee is tied in with the foot/ankle.

>

> 5) Unfortunately, there's no " guideline " or prediction about how

well

> your child will adjust to the brace- however, some things to keep

in

> mind are: the foot/leg will most likely be sensitive to the touch

and

> muscles will be sore when the last cast is removed, the foot may

> also be swollen when the last cast is removed, red marks are okay

but

> they should fade within a half hour of the shoe being removed,

> movement between the shoe and foot is what causes blisters, you can

> punch more holes in the strap as the leather stretches, saddlesoap

> can be used to soften the shoe leather, sometimes a custom foam

> (plastizode) insert is used to keep the heel down, the foot should

be

> flat in the shoe before strapping/lacing up, be on-guard for

blisters

> and pressure sores and deal with them immediately. Teach the child

> how to kick their legs in unison when wearing the brace.

>

> I guess what I'm trying to stress is that if everything is " right " ,

> the child shouldn't have any major problems with the brace, and the

> brace should never cause pain. It's just unfortunate that many

> parents have to struggle to get things " right " and they may end up

> being more educated than the orthotists and doctors they're working

> with. Bracing is crucial to prevent relapse, and it's in the

child's

> best interest for the parent to persevere in their attempts to get

> everything on track. We've had many families come to this board in

> desparation, barely clinging to their sanity, but after some

> troubleshooting (addressing both minor and major issues) they got

> their bracing issues resolved and their life back to " normal " .

> To all the new families- please ask questions- and feel free to

> search the archives using key words in your search (you have to

keep

> hitting the next button to scroll through the posts one section at

a

> time), the files, photos, and links sections.....

>

> I hope this is useful to some.....I feel fortunate that my daughter

> had zero issues with the brace, we were prepared for the worst

> (tolerance-wise) since she first wore it at the *mature* age of 5

> months old! I feel for the families who have struggled and

continue

> to struggle to get the brace right for their child- I hope this

board

> can continue to help them diagnose problems and get the support

they

> need. I know this is a major issue, because it never goes away or

> dies down as a topic on our board- it's a constant problem that we

> see with so many new families.

>

>

>

>

>

>

[Guest guest]

I just wanted to mention that our orthopedist told us that if the child is

in reverse last shoes, the rotation should be set at 45 degrees. The reason

for this is because the shoes are already bending the foot/feet outward and

a 70 degree rotation is going to really turn the foot/feet outward and make

it really uncomfortable for the child. My understanding was that the

foot/feet actually end up being rotated more than 70 degrees if reverse last

shoes are set at 70 degrees. Straight last shoes are set to a 70 degree

rotation. Not trying to start an argument or anything, just mentioning what

our doctor told us when I questioned why 's reverse last shoes

were rotated to 45 degrees instead of the 70 degrees I had been hearing

about. Once he was able to fit into the straight last, the doctor did

change the rotation to 70 degrees.

I would suggest that anyone who has the reverse last shoes set at 45 or 70

and are thinking about changing the rotation or just want to make sure it's

set where it should be, email Dr. Ponseti and ask him what it should be, as

I am only stating what I was told by our doctor. I would hate to see a

child uncomfortable because reverse last shoes were rotated too far, but

also don't want to see anyone change the rotation on their child's reverse

last shoes based only what I've posted about what our doctor told us.

Now a question. We have the red adjustable bar. I've seen mention about

the bar having a bend in it? I don't notice a bend in ours. Is this bend

only on the nonadjustable bars or should ours have one....or is the bar

actually made with the bend and I'm just not seeing it? The area of the bar

on either side where the shoes go on are up a bit higher than the rest of

the bar....is that the bend I'm reading about?

and

BCF 03/25/2004

DBB 23/7

Using the foot abduction brace

> 3) The FAB must be set up correctly for the child to be comfortable.

> The shoe can be a straight last shoe, reverse last shoe, regular high-

> top shoe glued to a board, or sandal........but

> the " standard " at this time is the Markell reverse last shoe. The

> inside edges of the heels of the shoes should be set at a distance

> equal to the width of the child's shoulders. The shoe for a clubfoot

> should be set at an outward rotation of 70 degrees, but the parent

> must ensure that the last cast that was applied also rotated the foot

> outward to this angle. If the foot wasn't casted at that angle, then

> it won't be comfortable in the brace at that angle. A non-clubfoot

> should be set at 25-45 degrees. There is a slight bend to facilitate

> the front of the foot flexing upward on the clubfoot. We have heard

> of cases of orthotists setting up the brace wrong- even when the

> doctor has given correct instructions.

[Guest guest]

Good point about the angle with the reverse last shoes. I am glad

you brought that up, because we hardly hear of people using the

reverse last shoes, though I know there are some cases where they're

needed.

The bend is in the bar near the ends on the red bar. If you look in

the files section, in the bracing folder, there are pictures of my

daughter's brace (unilateral cf) there- look at the side view picture

and you can see the bend for the left foot's shoe. I believe that

the bend for the one-piece gold bar is closer to the center of the

bar, but I've never personally seen one, so I cannot vouch for that.

> I just wanted to mention that our orthopedist told us that if the

child is

> in reverse last shoes, the rotation should be set at 45 degrees.

The reason

> for this is because the shoes are already bending the foot/feet

outward and

> a 70 degree rotation is going to really turn the foot/feet outward

and make

> it really uncomfortable for the child. My understanding was that

the

> foot/feet actually end up being rotated more than 70 degrees if

reverse last

> shoes are set at 70 degrees. Straight last shoes are set to a 70

degree

> rotation. Not trying to start an argument or anything, just

mentioning what

> our doctor told us when I questioned why 's reverse last

shoes

> were rotated to 45 degrees instead of the 70 degrees I had been

hearing

> about. Once he was able to fit into the straight last, the doctor

did

> change the rotation to 70 degrees.

>

> I would suggest that anyone who has the reverse last shoes set at

45 or 70

> and are thinking about changing the rotation or just want to make

sure it's

> set where it should be, email Dr. Ponseti and ask him what it

should be, as

> I am only stating what I was told by our doctor. I would hate to

see a

> child uncomfortable because reverse last shoes were rotated too

far, but

> also don't want to see anyone change the rotation on their child's

reverse

> last shoes based only what I've posted about what our doctor told

us.

>

> Now a question. We have the red adjustable bar. I've seen mention

about

> the bar having a bend in it? I don't notice a bend in ours. Is

this bend

> only on the nonadjustable bars or should ours have one....or is the

bar

> actually made with the bend and I'm just not seeing it? The area

of the bar

> on either side where the shoes go on are up a bit higher than the

rest of

> the bar....is that the bend I'm reading about?

>

> and

> BCF 03/25/2004

> DBB 23/7

>

>

> Using the foot abduction brace

>

>

> > 3) The FAB must be set up correctly for the child to be

comfortable.

> > The shoe can be a straight last shoe, reverse last shoe, regular

high-

> > top shoe glued to a board, or sandal........but

> > the " standard " at this time is the Markell reverse last shoe. The

> > inside edges of the heels of the shoes should be set at a distance

> > equal to the width of the child's shoulders. The shoe for a

clubfoot

> > should be set at an outward rotation of 70 degrees, but the parent

> > must ensure that the last cast that was applied also rotated the

foot

> > outward to this angle. If the foot wasn't casted at that angle,

then

> > it won't be comfortable in the brace at that angle. A non-

clubfoot

> > should be set at 25-45 degrees. There is a slight bend to

facilitate

> > the front of the foot flexing upward on the clubfoot. We have

heard

> > of cases of orthotists setting up the brace wrong- even when the

> > doctor has given correct instructions.

[Guest guest]

What Said!!!!!! Except for the first couple of days with the DBB, there

should be no histerics, no constant crying or obviously unhappy baby. I want to

stress that the baby's foot will be sore and the shoe will be stiff when you

first put it on. Do yourself and your baby a favor and give the little tyke

some Tylenol to take the edge off. They will probably be good as new by the

next day. My child, the first night was miserable, even with Tylenol, but after

she went to sleep we held her all night and when she got restless, we changed

her position. By morning, she was rested, naturally happy and that was the end

of the problems with the DBB. She got a couple of red spots while we were

figuring out how tight is tight enough and I just put a little desitin on the

sore spot and it was all better the next day.

Robin & Rose

3/12/03

Right club foot

kitaki m_kitaki@...> wrote:

Very well said ! I would like to point out a minor typo - you stated that

the " norm " at this time is reverse last Markell boots where I beleive you meant

STRAIGHT last Markell boots.

Thanks so much for taking the time to type this up for the new users. It is

sometimes very hard to know how best to approach the new parent who is facing

issues because of a doctor or orthotist that is not performing up to par.

Angel

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

What Said!!!!!! Except for the first couple of days with the DBB, there

should be no histerics, no constant crying or obviously unhappy baby. I want to

stress that the baby's foot will be sore and the shoe will be stiff when you

first put it on. Do yourself and your baby a favor and give the little tyke

some Tylenol to take the edge off. They will probably be good as new by the

next day. My child, the first night was miserable, even with Tylenol, but after

she went to sleep we held her all night and when she got restless, we changed

her position. By morning, she was rested, naturally happy and that was the end

of the problems with the DBB. She got a couple of red spots while we were

figuring out how tight is tight enough and I just put a little desitin on the

sore spot and it was all better the next day.

Robin & Rose

3/12/03

Right club foot

kitaki m_kitaki@...> wrote:

Very well said ! I would like to point out a minor typo - you stated that

the " norm " at this time is reverse last Markell boots where I beleive you meant

STRAIGHT last Markell boots.

Thanks so much for taking the time to type this up for the new users. It is

sometimes very hard to know how best to approach the new parent who is facing

issues because of a doctor or orthotist that is not performing up to par.

Angel

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

What Said!!!!!! Except for the first couple of days with the DBB, there

should be no histerics, no constant crying or obviously unhappy baby. I want to

stress that the baby's foot will be sore and the shoe will be stiff when you

first put it on. Do yourself and your baby a favor and give the little tyke

some Tylenol to take the edge off. They will probably be good as new by the

next day. My child, the first night was miserable, even with Tylenol, but after

she went to sleep we held her all night and when she got restless, we changed

her position. By morning, she was rested, naturally happy and that was the end

of the problems with the DBB. She got a couple of red spots while we were

figuring out how tight is tight enough and I just put a little desitin on the

sore spot and it was all better the next day.

Robin & Rose

3/12/03

Right club foot

kitaki m_kitaki@...> wrote:

Very well said ! I would like to point out a minor typo - you stated that

the " norm " at this time is reverse last Markell boots where I beleive you meant

STRAIGHT last Markell boots.

Thanks so much for taking the time to type this up for the new users. It is

sometimes very hard to know how best to approach the new parent who is facing

issues because of a doctor or orthotist that is not performing up to par.

Angel

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

Thanks, from us, too, , for your explanation and help for those

having trouble.

I really feel for those who have been put in the situation of

battling with a brace set up improperly or put onto not fully

corrected feet; it's a prescription for frustration and failure.. It

also doesn't help the perception of the method, if people think

problems are inevitable, when they are not, and should not be.

We are one of the families who had NO trouble with the brace,

anywhere along the way. Even the first night wasn't bad, and my

daughter was " older " , almost 6 months. We never had a single blister.

Was it Joanne who calculated a while ago how many times the brace

will have been put on by the time a child reaches a certain age? I've

often wondered about that, but never stopped to actually figure.. =)

it's mind boggling isn't it? It became such an ingrained part of our

routine it's like teeth brushing or anything else done every day...

like the thousands of times we have buckled the car seat straps or

changed a diaper.. =) and the results have been so worth it..

My daughter just had her 4 year old checkup today, and the

pediatrician just shook her head in amazement at how great her foot

looks and moves, and as she hopped and tiptoed around the room. I

think she said something like, " you'd never know.. "

Thanks again,

and Claire

[Guest guest]

Thanks, from us, too, , for your explanation and help for those

having trouble.

I really feel for those who have been put in the situation of

battling with a brace set up improperly or put onto not fully

corrected feet; it's a prescription for frustration and failure.. It

also doesn't help the perception of the method, if people think

problems are inevitable, when they are not, and should not be.

We are one of the families who had NO trouble with the brace,

anywhere along the way. Even the first night wasn't bad, and my

daughter was " older " , almost 6 months. We never had a single blister.

Was it Joanne who calculated a while ago how many times the brace

will have been put on by the time a child reaches a certain age? I've

often wondered about that, but never stopped to actually figure.. =)

it's mind boggling isn't it? It became such an ingrained part of our

routine it's like teeth brushing or anything else done every day...

like the thousands of times we have buckled the car seat straps or

changed a diaper.. =) and the results have been so worth it..

My daughter just had her 4 year old checkup today, and the

pediatrician just shook her head in amazement at how great her foot

looks and moves, and as she hopped and tiptoed around the room. I

think she said something like, " you'd never know.. "

Thanks again,

and Claire

[Guest guest]

Thanks, from us, too, , for your explanation and help for those

having trouble.

I really feel for those who have been put in the situation of

battling with a brace set up improperly or put onto not fully

corrected feet; it's a prescription for frustration and failure.. It

also doesn't help the perception of the method, if people think

problems are inevitable, when they are not, and should not be.

We are one of the families who had NO trouble with the brace,

anywhere along the way. Even the first night wasn't bad, and my

daughter was " older " , almost 6 months. We never had a single blister.

Was it Joanne who calculated a while ago how many times the brace

will have been put on by the time a child reaches a certain age? I've

often wondered about that, but never stopped to actually figure.. =)

it's mind boggling isn't it? It became such an ingrained part of our

routine it's like teeth brushing or anything else done every day...

like the thousands of times we have buckled the car seat straps or

changed a diaper.. =) and the results have been so worth it..

My daughter just had her 4 year old checkup today, and the

pediatrician just shook her head in amazement at how great her foot

looks and moves, and as she hopped and tiptoed around the room. I

think she said something like, " you'd never know.. "

Thanks again,

and Claire

[Guest guest]

,

I want to thank you for stating everything so clearly. I also wanted

to echo that we had absolutely no problems with Zach adjusting to

the bar (other than your normal " adjustment " period) - we were also

treated in Iowa City. My heart aches for those who have to do such

troubleshooting. How proud they must be, though, to know that their

child will finally receive proper care due to their diligence and

their acquisition of information from the internet.

Thanks again!

Holly

Zachary 7/27/02

#2 Due: 1/8/05

> As a 4 year veteran of various clubfoot support boards and the

> Ponseti method, I'm going to attempt to type some of my

> personal " OBSERVATIONS " and things I've picked up along the way

> pertaining to the foot abduction brace (also known as DBB)- please

> don't flame me or get upset with any of the text below- just take

it

> or leave it (or parts thereof) if it pertains to your child's

> situation.

>

> 1) Almost all families who have posted on the internet about major

> issues with the brace are working with doctors who are new to the

> method, who are modifying or only using parts of the method, or

> orthotists who are not setting up the brace properly. Very

rarely,

> if ever, have I heard of families who have severe or chronic

issues

> with the brace when they are treated by the U of Iowa staff and

> American Prosthetics & Orthotics in Iowa City. Bracing seems to

be a

> non-issue for the families who are in experienced hands, where

> bracing can be a nightmare for families who are not working with

> experienced staff. An exception would be children with a-typical

> clubfeet where the regular straight last shoe could cause issues

> regardless- but the new sandals seem to have helped this

> group of children also; it will just take some time for doctors to

> get experience in diagnosing these cases.

>

> 2) The child's foot **must** be completely corrected in order to

wear

> the brace comfortably. It seems that some doctors (even those

with

> good reputations and experience) can " think " the child's foot is

> corrected, when, in fact, it is not. There cannot be an attitude

> of " this is as good as this foot is going to get- let's try the

brace

> and hope that we can maintain it (or improve it) " . If your doctor

is

> new to the Ponseti method, is modifying the method, or if you're

just

> not 100% confident that the foot is corrected, you should consider

> seeking a second, third, or fourth opinion on the foot/feet. Even

> pictures or video sent to a doctor can help in diagnosing

uncorrected

> feet or problem areas, though a physical examination is really the

> best.

>

> 3) The FAB must be set up correctly for the child to be

comfortable.

> The shoe can be a straight last shoe, reverse last shoe, regular

high-

> top shoe glued to a board, or sandal........but

> the " standard " at this time is the Markell reverse last shoe. The

> inside edges of the heels of the shoes should be set at a distance

> equal to the width of the child's shoulders. The shoe for a

clubfoot

> should be set at an outward rotation of 70 degrees, but the parent

> must ensure that the last cast that was applied also rotated the

foot

> outward to this angle. If the foot wasn't casted at that angle,

then

> it won't be comfortable in the brace at that angle. A non-

clubfoot

> should be set at 25-45 degrees. There is a slight bend to

facilitate

> the front of the foot flexing upward on the clubfoot. We have

heard

> of cases of orthotists setting up the brace wrong- even when the

> doctor has given correct instructions.

>

> 4) The FAB is the preferred brace because of it's success in

> preventing relapse. The brace keeps the foot rotated outward and

the

> forefoot pointed upward to maintain the correction. The AFO and

> Wheaton brace cannot maintain the outward rotation. The KAFO is

not

> preferred due to the potential of causing muscle atrophy in the

calf

> since the knee is tied in with the foot/ankle.

>

> 5) Unfortunately, there's no " guideline " or prediction about how

well

> your child will adjust to the brace- however, some things to keep

in

> mind are: the foot/leg will most likely be sensitive to the touch

and

> muscles will be sore when the last cast is removed, the foot may

> also be swollen when the last cast is removed, red marks are okay

but

> they should fade within a half hour of the shoe being removed,

> movement between the shoe and foot is what causes blisters, you

can

> punch more holes in the strap as the leather stretches, saddlesoap

> can be used to soften the shoe leather, sometimes a custom foam

> (plastizode) insert is used to keep the heel down, the foot should

be

> flat in the shoe before strapping/lacing up, be on-guard for

blisters

> and pressure sores and deal with them immediately. Teach the

child

> how to kick their legs in unison when wearing the brace.

>

> I guess what I'm trying to stress is that if everything

is " right " ,

> the child shouldn't have any major problems with the brace, and

the

> brace should never cause pain. It's just unfortunate that many

> parents have to struggle to get things " right " and they may end up

> being more educated than the orthotists and doctors they're

working

> with. Bracing is crucial to prevent relapse, and it's in the

child's

> best interest for the parent to persevere in their attempts to get

> everything on track. We've had many families come to this board

in

> desparation, barely clinging to their sanity, but after some

> troubleshooting (addressing both minor and major issues) they got

> their bracing issues resolved and their life back to " normal " .

> To all the new families- please ask questions- and feel free to

> search the archives using key words in your search (you have to

keep

> hitting the next button to scroll through the posts one section at

a

> time), the files, photos, and links sections.....

>

> I hope this is useful to some.....I feel fortunate that my

daughter

> had zero issues with the brace, we were prepared for the worst

> (tolerance-wise) since she first wore it at the *mature* age of 5

> months old! I feel for the families who have struggled and

continue

> to struggle to get the brace right for their child- I hope this

board

> can continue to help them diagnose problems and get the support

they

> need. I know this is a major issue, because it never goes away or

> dies down as a topic on our board- it's a constant problem that we

> see with so many new families.

>

[Guest guest]

,

I want to thank you for stating everything so clearly. I also wanted

to echo that we had absolutely no problems with Zach adjusting to

the bar (other than your normal " adjustment " period) - we were also

treated in Iowa City. My heart aches for those who have to do such

troubleshooting. How proud they must be, though, to know that their

child will finally receive proper care due to their diligence and

their acquisition of information from the internet.

Thanks again!

Holly

Zachary 7/27/02

#2 Due: 1/8/05

> As a 4 year veteran of various clubfoot support boards and the

> Ponseti method, I'm going to attempt to type some of my

> personal " OBSERVATIONS " and things I've picked up along the way

> pertaining to the foot abduction brace (also known as DBB)- please

> don't flame me or get upset with any of the text below- just take

it

> or leave it (or parts thereof) if it pertains to your child's

> situation.

>

> 1) Almost all families who have posted on the internet about major

> issues with the brace are working with doctors who are new to the

> method, who are modifying or only using parts of the method, or

> orthotists who are not setting up the brace properly. Very

rarely,

> if ever, have I heard of families who have severe or chronic

issues

> with the brace when they are treated by the U of Iowa staff and

> American Prosthetics & Orthotics in Iowa City. Bracing seems to

be a

> non-issue for the families who are in experienced hands, where

> bracing can be a nightmare for families who are not working with

> experienced staff. An exception would be children with a-typical

> clubfeet where the regular straight last shoe could cause issues

> regardless- but the new sandals seem to have helped this

> group of children also; it will just take some time for doctors to

> get experience in diagnosing these cases.

>

> 2) The child's foot **must** be completely corrected in order to

wear

> the brace comfortably. It seems that some doctors (even those

with

> good reputations and experience) can " think " the child's foot is

> corrected, when, in fact, it is not. There cannot be an attitude

> of " this is as good as this foot is going to get- let's try the

brace

> and hope that we can maintain it (or improve it) " . If your doctor

is

> new to the Ponseti method, is modifying the method, or if you're

just

> not 100% confident that the foot is corrected, you should consider

> seeking a second, third, or fourth opinion on the foot/feet. Even

> pictures or video sent to a doctor can help in diagnosing

uncorrected

> feet or problem areas, though a physical examination is really the

> best.

>

> 3) The FAB must be set up correctly for the child to be

comfortable.

> The shoe can be a straight last shoe, reverse last shoe, regular

high-

> top shoe glued to a board, or sandal........but

> the " standard " at this time is the Markell reverse last shoe. The

> inside edges of the heels of the shoes should be set at a distance

> equal to the width of the child's shoulders. The shoe for a

clubfoot

> should be set at an outward rotation of 70 degrees, but the parent

> must ensure that the last cast that was applied also rotated the

foot

> outward to this angle. If the foot wasn't casted at that angle,

then

> it won't be comfortable in the brace at that angle. A non-

clubfoot

> should be set at 25-45 degrees. There is a slight bend to

facilitate

> the front of the foot flexing upward on the clubfoot. We have

heard

> of cases of orthotists setting up the brace wrong- even when the

> doctor has given correct instructions.

>

> 4) The FAB is the preferred brace because of it's success in

> preventing relapse. The brace keeps the foot rotated outward and

the

> forefoot pointed upward to maintain the correction. The AFO and

> Wheaton brace cannot maintain the outward rotation. The KAFO is

not

> preferred due to the potential of causing muscle atrophy in the

calf

> since the knee is tied in with the foot/ankle.

>

> 5) Unfortunately, there's no " guideline " or prediction about how

well

> your child will adjust to the brace- however, some things to keep

in

> mind are: the foot/leg will most likely be sensitive to the touch

and

> muscles will be sore when the last cast is removed, the foot may

> also be swollen when the last cast is removed, red marks are okay

but

> they should fade within a half hour of the shoe being removed,

> movement between the shoe and foot is what causes blisters, you

can

> punch more holes in the strap as the leather stretches, saddlesoap

> can be used to soften the shoe leather, sometimes a custom foam

> (plastizode) insert is used to keep the heel down, the foot should

be

> flat in the shoe before strapping/lacing up, be on-guard for

blisters

> and pressure sores and deal with them immediately. Teach the

child

> how to kick their legs in unison when wearing the brace.

>

> I guess what I'm trying to stress is that if everything

is " right " ,

> the child shouldn't have any major problems with the brace, and

the

> brace should never cause pain. It's just unfortunate that many

> parents have to struggle to get things " right " and they may end up

> being more educated than the orthotists and doctors they're

working

> with. Bracing is crucial to prevent relapse, and it's in the

child's

> best interest for the parent to persevere in their attempts to get

> everything on track. We've had many families come to this board

in

> desparation, barely clinging to their sanity, but after some

> troubleshooting (addressing both minor and major issues) they got

> their bracing issues resolved and their life back to " normal " .

> To all the new families- please ask questions- and feel free to

> search the archives using key words in your search (you have to

keep

> hitting the next button to scroll through the posts one section at

a

> time), the files, photos, and links sections.....

>

> I hope this is useful to some.....I feel fortunate that my

daughter

> had zero issues with the brace, we were prepared for the worst

> (tolerance-wise) since she first wore it at the *mature* age of 5

> months old! I feel for the families who have struggled and

continue

> to struggle to get the brace right for their child- I hope this

board

> can continue to help them diagnose problems and get the support

they

> need. I know this is a major issue, because it never goes away or

> dies down as a topic on our board- it's a constant problem that we

> see with so many new families.

>

[Guest guest]

Well said ! We have also had minimal trouble with the brace. Livie got

her brace in Iowa at about 6.5 months old. The frist two days were a little

rough in that she kept slipping out of the shoes, but in hindsight I realized

that it was a combination of the fact that her foot was very swelled from having

been in a cast for virtually six months (through several doctors before we went

to Iowa) and also the fact that I just wasn't tightening the strap enough.

After two days the swelling went down, I tightened the strap and we have never

had blister problems.

As you might remember, Livie stopped wearing her brace at 1.5 years old due to

the advice of another Ponseti trained physician because of loose ligaments. We

took Livie back to Iowa to be treated for a relapse about three months ago. She

had one two week cast to recorrect and then back into the FAB for 14-16 hours a

day. I was terrified how it was going to go trying to put a 2.5 year old into a

brace after she hadn't worn it for a year. Livie did fabulously though! Still

no problems with blisters. I do have to be militant about her wearing it now

though. If she gets the slightest inkling that I might not make her wear it,

she's going to fight me every time! Livie doesn't nap anymore, so the two hours

in the afternoon can be a chore, but we have stuck to our guns for the last

three months and she's doing well.

It's unfotunate that so many children are put into the brace without being fully

corrected or with it not set up properly. It really is giving the Ponseti

method a bad reputation when it should be a nonissue. For us it truly is and

always has been just one more thing that we have to do to care for our child

(like changing diapers, making bottles, rocking to sleep and all the other

thousand things that you do for a baby!)

Anyway, this has turned into a novel when all I really wanted to say was well

said!!

Jen & Livie (10-18-01 severe left clubfoot)

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

Well said ! We have also had minimal trouble with the brace. Livie got

her brace in Iowa at about 6.5 months old. The frist two days were a little

rough in that she kept slipping out of the shoes, but in hindsight I realized

that it was a combination of the fact that her foot was very swelled from having

been in a cast for virtually six months (through several doctors before we went

to Iowa) and also the fact that I just wasn't tightening the strap enough.

After two days the swelling went down, I tightened the strap and we have never

had blister problems.

As you might remember, Livie stopped wearing her brace at 1.5 years old due to

the advice of another Ponseti trained physician because of loose ligaments. We

took Livie back to Iowa to be treated for a relapse about three months ago. She

had one two week cast to recorrect and then back into the FAB for 14-16 hours a

day. I was terrified how it was going to go trying to put a 2.5 year old into a

brace after she hadn't worn it for a year. Livie did fabulously though! Still

no problems with blisters. I do have to be militant about her wearing it now

though. If she gets the slightest inkling that I might not make her wear it,

she's going to fight me every time! Livie doesn't nap anymore, so the two hours

in the afternoon can be a chore, but we have stuck to our guns for the last

three months and she's doing well.

It's unfotunate that so many children are put into the brace without being fully

corrected or with it not set up properly. It really is giving the Ponseti

method a bad reputation when it should be a nonissue. For us it truly is and

always has been just one more thing that we have to do to care for our child

(like changing diapers, making bottles, rocking to sleep and all the other

thousand things that you do for a baby!)

Anyway, this has turned into a novel when all I really wanted to say was well

said!!

Jen & Livie (10-18-01 severe left clubfoot)

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

That was a good summery, thanks. My first trouble with the DBB was that my son

was not corrected enough to wear it (and he ended up having the ATT surgery

directed by Dr. P). My second trouble with the DBB was defective shoe

construction on my 2nd born cf baby. The shoes have been a life saver

but I know hundred of children have worn the Markell just as successfully.

s.

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

I found using a Sleep Sack helped us all adjust to the bar as it kept him

swaddled up - the less he could move his legs the better he slept those first

weeks.

s.

Using the foot abduction brace

As a 4 year veteran of various clubfoot support boards and the

Ponseti method, I'm going to attempt to type some of my

personal " OBSERVATIONS " and things I've picked up along the way

pertaining to the foot abduction brace (also known as DBB)- please

don't flame me or get upset with any of the text below- just take it

or leave it (or parts thereof) if it pertains to your child's

situation.

1) Almost all families who have posted on the internet about major

issues with the brace are working with doctors who are new to the

method, who are modifying or only using parts of the method, or

orthotists who are not setting up the brace properly. Very rarely,

if ever, have I heard of families who have severe or chronic issues

with the brace when they are treated by the U of Iowa staff and

American Prosthetics & Orthotics in Iowa City. Bracing seems to be a

non-issue for the families who are in experienced hands, where

bracing can be a nightmare for families who are not working with

experienced staff. An exception would be children with a-typical

clubfeet where the regular straight last shoe could cause issues

regardless- but the new sandals seem to have helped this

group of children also; it will just take some time for doctors to

get experience in diagnosing these cases.

2) The child's foot **must** be completely corrected in order to wear

the brace comfortably. It seems that some doctors (even those with

good reputations and experience) can " think " the child's foot is

corrected, when, in fact, it is not. There cannot be an attitude

of " this is as good as this foot is going to get- let's try the brace

and hope that we can maintain it (or improve it) " . If your doctor is

new to the Ponseti method, is modifying the method, or if you're just

not 100% confident that the foot is corrected, you should consider

seeking a second, third, or fourth opinion on the foot/feet. Even

pictures or video sent to a doctor can help in diagnosing uncorrected

feet or problem areas, though a physical examination is really the

best.

3) The FAB must be set up correctly for the child to be comfortable.

The shoe can be a straight last shoe, reverse last shoe, regular high-

top shoe glued to a board, or sandal........but

the " standard " at this time is the Markell reverse last shoe. The

inside edges of the heels of the shoes should be set at a distance

equal to the width of the child's shoulders. The shoe for a clubfoot

should be set at an outward rotation of 70 degrees, but the parent

must ensure that the last cast that was applied also rotated the foot

outward to this angle. If the foot wasn't casted at that angle, then

it won't be comfortable in the brace at that angle. A non-clubfoot

should be set at 25-45 degrees. There is a slight bend to facilitate

the front of the foot flexing upward on the clubfoot. We have heard

of cases of orthotists setting up the brace wrong- even when the

doctor has given correct instructions.

4) The FAB is the preferred brace because of it's success in

preventing relapse. The brace keeps the foot rotated outward and the

forefoot pointed upward to maintain the correction. The AFO and

Wheaton brace cannot maintain the outward rotation. The KAFO is not

preferred due to the potential of causing muscle atrophy in the calf

since the knee is tied in with the foot/ankle.

5) Unfortunately, there's no " guideline " or prediction about how well

your child will adjust to the brace- however, some things to keep in

mind are: the foot/leg will most likely be sensitive to the touch and

muscles will be sore when the last cast is removed, the foot may

also be swollen when the last cast is removed, red marks are okay but

they should fade within a half hour of the shoe being removed,

movement between the shoe and foot is what causes blisters, you can

punch more holes in the strap as the leather stretches, saddlesoap

can be used to soften the shoe leather, sometimes a custom foam

(plastizode) insert is used to keep the heel down, the foot should be

flat in the shoe before strapping/lacing up, be on-guard for blisters

and pressure sores and deal with them immediately. Teach the child

how to kick their legs in unison when wearing the brace.

I guess what I'm trying to stress is that if everything is " right " ,

the child shouldn't have any major problems with the brace, and the

brace should never cause pain. It's just unfortunate that many

parents have to struggle to get things " right " and they may end up

being more educated than the orthotists and doctors they're working

with. Bracing is crucial to prevent relapse, and it's in the child's

best interest for the parent to persevere in their attempts to get

everything on track. We've had many families come to this board in

desparation, barely clinging to their sanity, but after some

troubleshooting (addressing both minor and major issues) they got

their bracing issues resolved and their life back to " normal " .

To all the new families- please ask questions- and feel free to

search the archives using key words in your search (you have to keep

hitting the next button to scroll through the posts one section at a

time), the files, photos, and links sections.....

I hope this is useful to some.....I feel fortunate that my daughter

had zero issues with the brace, we were prepared for the worst

(tolerance-wise) since she first wore it at the *mature* age of 5

months old! I feel for the families who have struggled and continue

to struggle to get the brace right for their child- I hope this board

can continue to help them diagnose problems and get the support they

need. I know this is a major issue, because it never goes away or

dies down as a topic on our board- it's a constant problem that we

see with so many new families.

[Guest guest]

Hi ,

We have reverse last shoes and I posted a question some time ago

asking why reverse lasts were no longer used. Jay Markell replied

back with an explanation. He stated that reverse last shoes give an

extra 8degrees angle which answered the question I had as to why

Zoe's angle was set at 60 degrees by our our ortho. Dr. P used to

use the reverse last when the DBB could not give proper rotation and

the shoes gave the extra angle.

Here is the link if you would like to have a read.

http://health.groups.yahoo.com/group/nosurgery4clubfoot/message/21621

I hope this helps. Thanks for the summary!

Louisa and Zoe 2-22-04 Right Uni Clubfoot

> > I just wanted to mention that our orthopedist told us that if the

> child is

> > in reverse last shoes, the rotation should be set at 45 degrees.

> The reason

> > for this is because the shoes are already bending the foot/feet

> outward and

> > a 70 degree rotation is going to really turn the foot/feet

outward

> and make

> > it really uncomfortable for the child. My understanding was that

> the

> > foot/feet actually end up being rotated more than 70 degrees if

> reverse last

> > shoes are set at 70 degrees. Straight last shoes are set to a 70

> degree

> > rotation. Not trying to start an argument or anything, just

> mentioning what

> > our doctor told us when I questioned why 's reverse

last

> shoes

> > were rotated to 45 degrees instead of the 70 degrees I had been

> hearing

> > about. Once he was able to fit into the straight last, the

doctor

> did

> > change the rotation to 70 degrees.

> >

> > I would suggest that anyone who has the reverse last shoes set at

> 45 or 70

> > and are thinking about changing the rotation or just want to make

> sure it's

> > set where it should be, email Dr. Ponseti and ask him what it

> should be, as

> > I am only stating what I was told by our doctor. I would hate to

> see a

> > child uncomfortable because reverse last shoes were rotated too

> far, but

> > also don't want to see anyone change the rotation on their

child's

> reverse

> > last shoes based only what I've posted about what our doctor told

> us.

> >

> > Now a question. We have the red adjustable bar. I've seen

mention

> about

> > the bar having a bend in it? I don't notice a bend in ours. Is

> this bend

> > only on the nonadjustable bars or should ours have one....or is

the

> bar

> > actually made with the bend and I'm just not seeing it? The area

> of the bar

> > on either side where the shoes go on are up a bit higher than the

> rest of

> > the bar....is that the bend I'm reading about?

> >

> > and

> > BCF 03/25/2004

> > DBB 23/7

> >

> >

> > Using the foot abduction brace

> >

> >

> > > 3) The FAB must be set up correctly for the child to be

> comfortable.

> > > The shoe can be a straight last shoe, reverse last shoe,

regular

> high-

> > > top shoe glued to a board, or sandal........but

> > > the " standard " at this time is the Markell reverse last shoe.

The

> > > inside edges of the heels of the shoes should be set at a

distance

> > > equal to the width of the child's shoulders. The shoe for a

> clubfoot

> > > should be set at an outward rotation of 70 degrees, but the

parent

> > > must ensure that the last cast that was applied also rotated

the

> foot

> > > outward to this angle. If the foot wasn't casted at that

angle,

> then

> > > it won't be comfortable in the brace at that angle. A non-

> clubfoot

> > > should be set at 25-45 degrees. There is a slight bend to

> facilitate

> > > the front of the foot flexing upward on the clubfoot. We have

> heard

> > > of cases of orthotists setting up the brace wrong- even when the

> > > doctor has given correct instructions.