shoes/sandals for the FAB/DBB

[Guest guest]

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)

> Hi,

> Just wanted to say hi to the group and wanted to thank everyone

for

> such helpful information on this site. My son, Ian is now 7

months

> old. Ian was treated for clubfeet on both feet by Dr. Lindell in

> Naperville, IL. He did use the Ponseti method and did the

tenotomy

> under general anesthetics. Ian used the Ponseti method since

birth

> but after using the DBB with the Markell boots for 2 months, we

> noticed that his left foot was not as good as the right foot. His

> shoe would always slip off when we rotated the shoe to 35 degrees

> abduction. We then asked Dr. Lindell for advice and he mentioned

that

> Ian might have tight ligaments and they would have to do more

> extensive surgery to cut the inner ligaments. At this point, we

> decided that we needed to go visit Dr. Ponseti in Iowa. When Dr.

> Ponseti looked at Ian's left foot, he said that his heel cord was

> very tight and he suggested that we might need another tenotomy.

> When visiting Dr. Ponseti, we did bring pictures of Ian's casting

> from the previous doctor and Dr. Ponseti said that the doctor did

not

> follow thru with the last casting correctly!! At this point, Dr.

> Ponseti decided before performing the 2nd tenotomy, we would try

the

> last casting to see how Ian's foot reacts. After the last

casting,

> Ian's left foot looked great! Phewww, we were so relieved Ian

didn't

> need another tenotomy. We were so fortunate and blesssed that we

> were able to visit Dr. Ponseti. We also came at the right time to

> visit who developed the new Ponseti sandals. The

> sandals weigh 10 ounces and is made out of suede and looks like

> Birkenstock sandals! We are so thankful that God gave the

hands

> and gift to make these shoes. Ian and parents love the shoes.

They

> are light, easy to put on and very fashionable. I wish that all

kids

> switch to these sandals versus the Markell boots. The shoes also

has

> little holes near the heel which let's you see if his heel stays

down

> and does not slip!!! (With the boots, I always woke up in the

middle

> of the night thinking that his shoes slipped off) With the

sandals,

> I was assured that Ian's feet were comfortable and did not weigh a

> ton. Ian is now in his 2nd month with his new sandals and we love

> it. Please spread the word about these new sandals.

> Take care,

> Lizzy and Baby Ian