FAB/DBB installation tips - for parents newly into the DBB and those having problems

[Guest guest]

A couple of you are having problems right now. Here is some information I

have about our experiences with the DBB and pressure sores (start like a

dark/purple spot/bruise). Blisters also turn into sores - which is why it

is most important to get the shoes on right so they don't cause sores and

blisters. Most important is to get the shoes on properly and do what you

have to to stop sores from forming. So, if the pressure spots (dark) get

worse or don't go away something is wrong and it will never get better till

you stop the pressure in that area. Blisters are caused by slipping or

friction on a spot on the foot, stop the slipping with making sure the

boots are on tightly and the heel seated deep in the bottom of the shoe.

I hope there is some answers to your problems with the new babies in the

DBB. I remember this time very clearly and it was not fun at all. Most

importantly - Listen To Your Baby. S/He will tell you if there is

something wrong, and you must trust your instincts and not make things

worse by letting a sore get worse. You can get past sores, many of us have

done it but it is best to not get them in the first place.

Big Hugs to you parents dealing with this. It will get better - the moment

we fixed the problem our daughter couldn't have been happier in the

DBB. What a difference!

Kori

Darbi

3/03 Rt. CF - DBB 12hr/d

How to put Markell Open Toe Boots attached to Brace FAB/DBB (Foot Abduction

Brace/Dennis Browne Bar)

Before you put the shoes on the first time:

Take the laces out and tie a knot in the middle. Then re-lace the

shoes. Tie a knot at the very ends of each lace end so they don't come out

of the holes. This has been a lifesaver for us - we never have to re-lace

them and can pull them very loose to get the shoes on. The knot in the

middle shows us that they're even each time so I never worry about one side

being longer than the other. I love this tip!

Consider slitting the tongue keeper slit up to the top of the tongue. This

allows the tongue to sit low on the top of the foot - and allows the top of

the boot to be tightened up on the ankle enough so the fatty baby calf

doesn't pull the heel up and out. The tighter the ankle, the better seated

the foot will be.

We find it easier to have the straps and buckles on the inside rather than

the outside. Since the feet are pointed out in the first place cinching

them up on the inside is just easier in general. Straight Last shoes can

be installed on either side of the DBB - as they are not a right or left

shoe. The Ponseti Method uses straight last shoes although sometimes a

baby will get reverse last. If you got reverse last shoes ask about the

straight last shoes.

Install the strap in the lower hole on each side of the boot. Apparently

this is the best position to keep the foot in the shoes.

Medium thickness cotton socks are recommended. We like the Old Navy or

Gymboree socks with the rubber grips on the bottom. They are regularly 7

for $10 at Old Navy. I suggest you get at least 7 if not more. They seem

to get lost in the laundry... and it's not fun trying to find that perfect

sock when you need it. Plus you can make sure you've got the right colors

on hand for accessorizing :~} In the winter after the initial first few

months of getting used to the DBB and worrying about slipping I use

tights. Not only for girls - I put my non-clubfoot boys in tights (white,

black or blue of course!) in the winter too - it helps keep their legs warm

when their pants hike up while being carried outside. But tights work very

well with the DBB in our experience. The thicker the better, make sure

they're stretchy so they fit the feet nice and tight.

Remember - when you first get the DBB take it off every 2-3 hours to check

the feet for sores or red marks that don't go away. Leaving the brace on

for longer periods of time if baby seems happy is fine. If baby is showing

signs of distress take the shoes off and inspect the feet. Then use the

following instructions and re-install the brace. You should check the feet

often over the first couple of days or more if baby is showing signs of

distress. If you do not see signs that sores or blisters are forming

things are ok - keep the brace on.

Installation tips (how to put the DBB on a wiggly little baby without

causing pain or sores)

1- If you can - take the shoes off the bar. If you have a gold bar this is

simple. You may have to use a wrench or pliers to get it off the first

time as some brace shops really tighten them up. Don't loose the nut. It

is best to put the nut back on the shoe after you take it off the bar - as

it helps keep them around and getting kicked in the thighs without that nut

there really hurts! Mark on the plate where your shoes are to be set at

with a Sharpie marker. This makes it very easy to put them back in the

right spot - even in low light. If you have the red adjustable bar it is

harder to take the shoes off, maybe not possible. But if you can, try

it. I really feel it's a better way than trying to put the shoes on with

the bar.

2- Loosen the laces up all the way to the knots and pull the tongue up as

well. If you have short straps, buckle the strap into the last hole

loosely so as not to pull it out when the foot goes in. The longer straps

don't need to be buckled.

3- With the shoe off the bar insert the foot into the shoe and bend the

knee 90 degrees. Push on the top of the knee and hold the sole of the

shoe. Press the heel deeply into the back of the shoe and flex the toes

upward (dorsiflexion) as far as possible. Keep pushing on the knee and

flexing the foot and make SURE the heel is seated well into the bottom and

back of the shoe.

4- With the knee still bent and pressure applied press with your thumb or

other convenient finger on the strap where it goes through the tongue

keeper slit and hold the heel into the back of the shoe and tighten the

strap. Buckle it tightly. Dorsiflex the foot again and press again on the

knee and sole of the shoe to make sure the heel is in properly. Re-tighten

the strap very tight. If the heel is down you can't tighten it too

much. If there is any wiggle or looseness press the foot into the shoe

again push with your thumb on the strap and re-tighten the strap again. It

must be very tight - tighter than you would imagine it needs to be. So

keep going till it's really tight.

5- Pull the sock at the toes to make sure the seams aren't going to press

into baby's toes - it also helps make sure the heel is seated. It's ok if

they look all bloused out in front. This is good - gives baby room to

wiggle toes and who cares how it looks anyway!

6- Pull the tongue way down over the toes. As far as you can. I prefer it

to sit *under* the top of the boot at the ankle just a little bit. If it

sits high you may need to cut the tongue keeper slit a little more. (don't

cut it above the stitching)

7 - Tighten the laces nice and snug all the way up and tie them. The shoe

should get tighter with the laces being tightened.

8- Check to see if the foot can slip out of the boot at all. If it moves

it'll loosen up with time and slip. If it's not tight repeat the above

instructions with emphasis on the pressure on the knee and pushing the heel

into the bottom of the shoe with the foot flexed up (toes pointing toward

the baby's head) all at the same time. This isn't easy at first, but you

will get used to it and very good at it in short time.

9- Repeat the procedure with the other boot.

10- When both boots are on - take the nuts off and put the bar back on. If

your baby is bi-lateral it doesn't matter which side you do first. If baby

is unilateral it's easier to put the clubfoot side on first as the other

side set at 45 degrees is easier to put on the bar second.

Signs of trouble:

Baby cries a very unnatural (for your baby) unhappy in pain cry all the

time, kicks legs violently like she's trying to kick the shoes off, wakes

at nigh every half hour or less (other than being hungry), purple/black

marks on the heels or other parts of the foot, blisters form or sores form.

All these are typically caused by the shoes not being on properly. If

pressure sores or blisters appear - you MUST fix whatever is causing the

problem before you put the shoes back on. Sores will not heal in the shoes

once they appear (skin falls off and actual sore is resident - as opposed

to just a purple or black mark). It might mean a trip back to the Dr. for

a healing cast. Which is ok - it keeps the correction while the sore

heals. You MUST find out why the sore came - if it's slipping or pressure

or whatever - find it and fix it. When you go back to the DBB follow the

above directions and make SURE the heels are down 100% in the bottom of the

shoes. Blisters are caused by friction or rather slippage. Slippage is

often caused by the strap not being tight enough. It may seem tight

enough, but if slippage happens it very likely is not tight enough. If the

heel is rising up it seems tight but once you get the heel down you'll find

you can tighten it up another couple of holes. Dorsiflexing the foot while

you put the shoes on really helps prevent this.

After having persistent sores some parents have resorted to actually

cutting a large hole in the heels of the shoes. This helps to relieve

pressure so that baby can continue to wear the DBB while a sore heals. It

is not a long term fix. The foot must be in the shoe properly for long

term wear. However, after cutting the hole many parents have found that

they were not getting the heel down all the way and were then able to see

to make sure the heel is down. I don't recommend this - it is a short term

bandaid to the larger problem of proper fitting of the shoes. However it

is a good option to going back to casts for healing and starting again with

the 23/7 schedule for wearing the FAB. The shoes will not fall apart and

are essentially disposable as they can only be worn for a few months till

baby needs a larger size. For more information about this you can contact

me personally - frogabog@... and I can help you find a solution to

healing your child's sores. We have endured this and hope to not see any

other babies have to go through this pain and unhappiness. Remember -

there is a light at the end of the tunnel and you can find a way to keep

the FAB on so your baby can take advantage of the most effective brace to

complete the non-surgical treatment.

Other reasons why baby may be uncomfortable are:

skin sensitivity right after casts are taken off. This is unfortunate, but

will get better with time. Don't rub the legs - this hurts more. A little

lotion is ok but keep it off the feet itself as it can cause slipping.

Bar is too long or too short. The heels of the shoes (fixed on the bar in

the correct positions - 70 degrees for a clubfoot and 45 for non clubfoot)

should be shoulder width apart. Any less or more is uncomfortable for

baby. It is not the length of the bar - it is the distance between the

heels. Take the brace and place it up to baby's shoulders to check this.

Foot is at the wrong position. The clubfoot should be at 70 degrees or *AT

LEAST* as far turned out as the last cast. Parents - save your last

cast. Take that cast and put it up to a protractor with the knee pointed

to 0 degrees and see where the midline of the foot portion points to. Then

set your DBB. If it is much less than 60 degrees consider talking to your

doctor about another cast. The last cast in the Ponseti Method should be

at 70 degrees. If your cast is not there, and your doc doesn't see fit to

re-cast you can try to get there slowly over time. Set your brace to where

the cast is set at and slowly once a week increase it by 5 degrees. Do not

put the foot further out than the last cast as this causes considerable

discomfort for the baby.

Baby is irritated by not being able to move legs independently. You can

show baby how to move his legs together. They might not like this at first

but will soon learn to lift their legs up with the brace on. This is minor

irritation for the baby. They get used to this fairly quickly.

It is very important to not take baby out of the brace. Do everything you

can to make sure your baby stays in the brace. But listen to your child

and follow your heart. If you see signs of sores there is a problem you

need to tackle and rectify. Do NOT keep a brace on a child who has a

weeping sore. This is painful and you wouldn't put a tight shoe on your

own foot with a sore like that. If your child is telling you she's in pain

she likely is and you need to find out why. Do what you can to keep the

brace on - but don't make a bad situation worse by putting it on

incorrectly and causing sores. See your Dr. about healing casts or cut a

hole... but don't make sores worse.

If your baby is irritable at first consider co-sleeping so everyone gets

some sleep the first few nights. You can side lie and nurse a baby wearing

the dbb, it's a little different than a baby who doesn't wear one but is

absolutely doable. Even if you only do this for a few days while baby is

getting used to the brace - it will help everyone in your family get sleep

the first few nights. Put a pillow under baby's feet. It is easy enough

for baby to side lie in the DBB with a pillow under his feet.

Good luck and don't forget to post to the list if you need help. We're

here for you and have lots of different takes on how to make the shoes and

bar work so there's lots of different ways to work through problems.

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ok - work in progress but this may help some of you out there who need tips

right now and I need to do something else right now. I will post this in

the files section when I'm finished with it and satisfied it's complete. I

welcome any and all critiques of this as well as any additional tips I may

have forgotten. Please post to this topic for now and I will compile them

into the single file at a later date.

Kori

Mama of

Kenton - 6/98

Merek - 3/00

Darbi - 3/28/03 - Rt. CF - DBB 12hr/d

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