Using the foot abduction brace

[Guest guest]

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.