RE: shoes/sandals for the FAB/DBB

April 19, 2004

,

Thank you, this is very informative.

It's encouraging to hear that Dr Ponseti and his colleagues are so

dedicated to continuously monitoring and improving the shoes for our

babies when necessary.

I was wondering if is still in his FAB?

and

24th Jan 2003, bilateral, FAB 14 hours per day

www.clubfoot.co.za

shoes/sandals for the

FAB/DBB

I had the opportunity to talk with Dr. Ponseti this weekend

regarding the new shoes/sandals for use as the FAB/DBB.

Dr. Ponseti said that in the 1950's when he was first developing his

method that he used regular left and right foot shoes from J.C.

Pennys for the FAB/DBB. He said that he would cut the toes out of

them and put a couple of screws through the bottom of the shoes to

attach to a bar. A picture of an older version of the shoes can be

seen at

http://www.vh.org/pediatric/provider/orthopaedics/Clubfoot/Fig26.html

Eventually, J.C. Penny's stopped making those kind of shoes and

others such as the Markell Shoe Company began making them. Over the

years there have been some changes made in the shoes including some

improvements made about a year ago. For most children in the

Ponseti method, the Markell Shoes will work just fine. Some photos'

and information on the Markell Shoes can be seen at their web site

at http://www.markellshoe.com/tarso1.html

But in attaching shoes to new babies feet, there is occasionally a

problem with sores or blisters as children feet get used to shoes.

Also, for a small percentage (less than 5%) of very difficult

clubfeet in the first year, the Markell shoes may not fit or stay on

very well.

Mr. is a small businessman in Iowa whose specialty is

molded plastic medical models. Over the past 5 plus years,

has been making clubfoot bones models, the 5 typical

Ponseti cast models and plastic clubfoot casting models for Dr.

Ponseti to help train others in the use of the Ponseti method. As

Dr. Ponseti discussed the shoe fitting problem for some children,

thought that he could create a shoe that would help

fit the 5% more difficult feet and reduce the risk of sores,

blisters and shoes coming off.

has been working on this for a number of years, making

different samples, showing them to Dr. Ponseti and seeing what did

and didn't work. Gradually, he has come up with a sandal type shoe

with I think 3 straps across it that looks a bit like a birkenstock

sandal. He has started making them in 4 to 5 smaller sizes that

would work for the first year or so of life for children for whom

the Markell Shoes are not working. After the first year or so, the

feet are usually large enough that the Markell Shoes will work

fine.

It is also possible for the shoe to have the sole custom

fit to a specific child's foot. Dr. Ponseti said that he is aware

of a Dentist whose child had clubfoot with difficult feet to fit to

the shoes. The dentist was used to doing impression castings for

models of teeth so he did an impression of his child's feet and sent

it to to make a custom fitted shoe that would fit his

child's feet exactly.

Dr. Ponseti has said that the shoes work very well and that

so far out of about 60 pairs that have been distributed, that there

have not been any sores, blisters or shoes coming off that he is

aware of. He said that these shoes are being used for the few more

difficult feet where requested from Dr. Herzenberg (Baltimore), NYU

(New York), Dr. Mosca (Seattle), Iowa and perhaps a few other

doctors and/or parents who have requested them.

One of the problems Dr. Ponseti mentioned is that this type of small

scale and specialty manufacturing of shoes makes them more expensive

per pair of shoes. Whereas the Markell shoes may cost $65 to $100

per pair, the Shoes cost about $200 to $250 per pair of

shoes (without the bars). But for those few parents whose childrens

feet won't stay in the Markell Shoes or who get blisters, sores

etc., the extra $100 to $200 per pair of shoes may mean the

difference between their child being able to keep the FAB/DBB on or

not (or the child (and parents) being able to sleep well or not).

The problem comes in that insurance companies have established

standard reimbursement rates for FAB/DBB types of shoes that fits

the $65 to $100 per pair range. Currently, they do not recognize

the value of a more expensive type shoe and so wont reimburse the

higher dollar amount for it.

For those that know what AFO's are, they are sometimes used in other

treatment methods and are usually more expensive. I believe AFO's

can be in the range of $500 to $750 per pair. Dr. Ponseti said that

because AFO's typcially cover the foot, ankle and leg; that the

insurance companies standard is to reimburse for AFO's at the higher

value.

Dr. Ponseti is trying to work on a way to get a higher insurance

reimbursement for the Shoes, but if and until that happens,

parents who want to use the Shoes will have to pay more out

of pocket to be able to get them.

In the meantime, for anyone who is interested in the Shoes,

American Prosthetics at the U of Iowa's Hospitals and Clinics will

be able to help as kind of a clearing house for availability and

information on the Shoes.

Don Shurr

American Prosthetics & Orthotics, Inc.

dshurr @ inav.net

Phone:

Hall of American Prosthetics has posted a listing of all of

the contact information for the standard Markell type FAB/DBB shoes,

bar and plastizode insert at

http://pages.ivillage.com/ponseti_links/id9.html

I have met a number of times over the past 5 years in

Iowa, at Dr. Herzenbergs in Baltimore and at the Manchester U.K.

Clubfoot training clinic last November. He is really committed to

trying to do his best to make his specialty shoes available for the

small number of children who need them. But like many things being

created for the first time, the development and startup costs of

making it all work are not easy. I hope that we can be helpful in

understanding the higher costs of these shoes and the problems that

are going to exist with reimbursements from insurance companies so

that he will be able to continue making them.

I hope that this information is helpful for those who may be

interested in the shoes/sandals for the FAB/DBB in the

Ponseti method.

A testimonial about the shoes is found in a parents message

below this.

and (3-17-99)

April 19, 2004

Welcome Morten!

Congratulations on your baby boy, it's very good news that he is already

being treated with the Ponseti Method.

We live in South Africa and our baby boy was heading for major surgery a

year ago until we found out about Dr Ponseti on the internet and took

him to Iowa when he was 10 weeks old for treatment.

His feet are beautiful now, completely straight, flexible and no scars

at all. So you don't have to worry, Dr Ponseti has a quote on his

website that assures us that our babies will have fully functional

'normal' feet with his method.

There are a few adjustments for you to make as a parent for dealing with

the casts and then the FAB (foot brace, which is two shoes attached to a

bar) which your son will be fitted with after his tenotomy (cutting of

the Achilles tendon). But your baby will not be in any pain at any time

in the Ponseti method, he may just complain a bit as he adjusts to

something new, or protests about being held down for casting.

The best thing for the Ponseti method for me is that after having

experienced the other method of casting (eight times!), when would

really cry like he was in pain and then take a long time to settle down

afterwards, his Ponseti Method casting was so gentle and relaxing that

he would fall asleep before it was over!

Also, babies are amazing at how quickly they can adapt to something, we

were always told that this process is only hard on the parents. But

that's what this list is here for. We have all had our worries and can

share our experiences with you whenever you have a question.

If you want to read a little more in the meantime, you can go to Dr

Ponseti's website:

http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html

My own website was designed at the end of last year to inform South

African parents, as we now have two Ponseti doctors in our country. But

you'll find it helpful for you too. I have compiled a lot of

information that I found through my research and also tips and

checklists that we discovered through experience. All the things I

wanted to know starting out on this journey!

www.clubfoot.co.za

Also, there is another parent website with many links to more articles

and websites to do with the Ponseti method.

So happy reading and enjoy your baby boy. We are now almost a year in

the FAB and our son is walking. No one (even medical people) can tell

that he was born with two clubfeet.

Best wishes from South Africa

and

24th Jan 2003, bilateral cf, treated by Dr Ponseti in April 2003

www.clubfoot.co.za

We are a family from Norway that got a son last week, April 6th , with

clubfoot on both feet. He is now under treatment at " Rikshospitalet "

(National hospital)in Norway through a study originally from California

(Ponseti? (We are not sure of the name, since we just now have been

dragged into this)). He was casted on both feet after 4 days and shall

change the cast on a weekly basis until he is about 4 months old.

Surprisingly for us he look fine and is acting fine despite the cast on

both feet. He is most likely having surgery when he is about 5 weeks to

cut off the akilles on both feet.

What we would like to hear from other families is what should we look

out for /make sure is done correctly. What questions should we ask, what

can we do to make sure our baby gets the best treatment and best chances

to recover. We would like to hear about the error one quickly can get

into and though this hopefully our boy will heal quickly without too

much pain and be able to grow up almost as a " normal " child.

We will be most happy for any tips. Especially if anyone from Norway has

any experience with this.

Yours

Morten Petterson

April 19, 2004

,

According to emails by parents who have the shoes, the bar used

with them is much lighter. I haven't seen the shoes except in

a photo, but did Dr Ponseti mention if this bar would also fit the

Markell shoes, or does it work differently?

Thanks,

and

April 19, 2004

,

According to emails by parents who have the shoes, the bar used

with them is much lighter. I haven't seen the shoes except in

a photo, but did Dr Ponseti mention if this bar would also fit the

Markell shoes, or does it work differently?

Thanks,

and

April 19, 2004

,

According to emails by parents who have the shoes, the bar used

with them is much lighter. I haven't seen the shoes except in

a photo, but did Dr Ponseti mention if this bar would also fit the

Markell shoes, or does it work differently?

Thanks,

and

April 19, 2004

-

Thank you for this info. This answered all of my questions regarding these

new shoes!

>

>Reply-To: nosurgery4clubfoot

>To: nosurgery4clubfoot >

>Subject: RE: shoes/sandals for the

>FAB/DBB

>Date: Mon, 19 Apr 2004 11:46:18 +0200

>

>,

>

>Thank you, this is very informative.

>It's encouraging to hear that Dr Ponseti and his colleagues are so

>dedicated to continuously monitoring and improving the shoes for our

>babies when necessary.

>I was wondering if is still in his FAB?

>

> and

>24th Jan 2003, bilateral, FAB 14 hours per day

>www.clubfoot.co.za

>

> shoes/sandals for the

>FAB/DBB

>

>I had the opportunity to talk with Dr. Ponseti this weekend

>regarding the new shoes/sandals for use as the FAB/DBB.

>

>Dr. Ponseti said that in the 1950's when he was first developing his

>method that he used regular left and right foot shoes from J.C.

>Pennys for the FAB/DBB. He said that he would cut the toes out of

>them and put a couple of screws through the bottom of the shoes to

>attach to a bar. A picture of an older version of the shoes can be

>seen at

>http://www.vh.org/pediatric/provider/orthopaedics/Clubfoot/Fig26.html

>

>Eventually, J.C. Penny's stopped making those kind of shoes and

>others such as the Markell Shoe Company began making them. Over the

>years there have been some changes made in the shoes including some

>improvements made about a year ago. For most children in the

>Ponseti method, the Markell Shoes will work just fine. Some photos'

>and information on the Markell Shoes can be seen at their web site

>at http://www.markellshoe.com/tarso1.html

>

>But in attaching shoes to new babies feet, there is occasionally a

>problem with sores or blisters as children feet get used to shoes.

>Also, for a small percentage (less than 5%) of very difficult

>clubfeet in the first year, the Markell shoes may not fit or stay on

>very well.

>

>Mr. is a small businessman in Iowa whose specialty is

>molded plastic medical models. Over the past 5 plus years,

> has been making clubfoot bones models, the 5 typical

>Ponseti cast models and plastic clubfoot casting models for Dr.

>Ponseti to help train others in the use of the Ponseti method. As

>Dr. Ponseti discussed the shoe fitting problem for some children,

> thought that he could create a shoe that would help

>fit the 5% more difficult feet and reduce the risk of sores,

>blisters and shoes coming off.

>

> has been working on this for a number of years, making

>different samples, showing them to Dr. Ponseti and seeing what did

>and didn't work. Gradually, he has come up with a sandal type shoe

>with I think 3 straps across it that looks a bit like a birkenstock

>sandal. He has started making them in 4 to 5 smaller sizes that

>would work for the first year or so of life for children for whom

>the Markell Shoes are not working. After the first year or so, the

>feet are usually large enough that the Markell Shoes will work

>fine.

>

>It is also possible for the shoe to have the sole custom

>fit to a specific child's foot. Dr. Ponseti said that he is aware

>of a Dentist whose child had clubfoot with difficult feet to fit to

>the shoes. The dentist was used to doing impression castings for

>models of teeth so he did an impression of his child's feet and sent

>it to to make a custom fitted shoe that would fit his

>child's feet exactly.

>

>Dr. Ponseti has said that the shoes work very well and that

>so far out of about 60 pairs that have been distributed, that there

>have not been any sores, blisters or shoes coming off that he is

>aware of. He said that these shoes are being used for the few more

>difficult feet where requested from Dr. Herzenberg (Baltimore), NYU

>(New York), Dr. Mosca (Seattle), Iowa and perhaps a few other

>doctors and/or parents who have requested them.

>

>One of the problems Dr. Ponseti mentioned is that this type of small

>scale and specialty manufacturing of shoes makes them more expensive

>per pair of shoes. Whereas the Markell shoes may cost $65 to $100

>per pair, the Shoes cost about $200 to $250 per pair of

>shoes (without the bars). But for those few parents whose childrens

>feet won't stay in the Markell Shoes or who get blisters, sores

>etc., the extra $100 to $200 per pair of shoes may mean the

>difference between their child being able to keep the FAB/DBB on or

>not (or the child (and parents) being able to sleep well or not).

>

>The problem comes in that insurance companies have established

>standard reimbursement rates for FAB/DBB types of shoes that fits

>the $65 to $100 per pair range. Currently, they do not recognize

>the value of a more expensive type shoe and so wont reimburse the

>higher dollar amount for it.

>

>For those that know what AFO's are, they are sometimes used in other

>treatment methods and are usually more expensive. I believe AFO's

>can be in the range of $500 to $750 per pair. Dr. Ponseti said that

>because AFO's typcially cover the foot, ankle and leg; that the

>insurance companies standard is to reimburse for AFO's at the higher

>value.

>

>Dr. Ponseti is trying to work on a way to get a higher insurance

>reimbursement for the Shoes, but if and until that happens,

>parents who want to use the Shoes will have to pay more out

>of pocket to be able to get them.

>

>In the meantime, for anyone who is interested in the Shoes,

>American Prosthetics at the U of Iowa's Hospitals and Clinics will

>be able to help as kind of a clearing house for availability and

>information on the Shoes.

>

>Don Shurr

>American Prosthetics & Orthotics, Inc.

>dshurr @ inav.net

>Phone:

>

> Hall of American Prosthetics has posted a listing of all of

>the contact information for the standard Markell type FAB/DBB shoes,

>bar and plastizode insert at

>http://pages.ivillage.com/ponseti_links/id9.html

>

>I have met a number of times over the past 5 years in

>Iowa, at Dr. Herzenbergs in Baltimore and at the Manchester U.K.

>Clubfoot training clinic last November. He is really committed to

>trying to do his best to make his specialty shoes available for the

>small number of children who need them. But like many things being

>created for the first time, the development and startup costs of

>making it all work are not easy. I hope that we can be helpful in

>understanding the higher costs of these shoes and the problems that

>are going to exist with reimbursements from insurance companies so

>that he will be able to continue making them.

>

>I hope that this information is helpful for those who may be

>interested in the shoes/sandals for the FAB/DBB in the

>Ponseti method.

>

>A testimonial about the shoes is found in a parents message

>below this.

>

> and (3-17-99)

>

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April 19, 2004