Re: FAB/DBB Tips & Tricks - For Parents

[Guest guest]

Thanks for the tips - we are still getting used to putting on the

sandals (day 4).I'm sure many of the tips posted are

relevant to us even though we are not using the markell shoes.Do you

know if anyone has posted a similar tips and tricks for the

sandals? We have not yet managed to get the heel in completely, and

do wonder whether we're doing it right - there is no-one else in

this country we can speak to about their experience. Baby

does cry when we put them on - tonight I put them on whilst he was

asleep - much easier than when he is wriggling! It seemed to work.

This is such a fantastic forum - it certainly helps knowing so many

others are goig through the same.

> FAB/DBB Tips and Tricks for Parents

>

>

> Many parents have problems using the FAB/DBB at first, you are not

> alone. 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!

>

> I have a couple of pictures inserted in this now, one of the hole

we cut

> and one of the elongated tongue keeper slit but they won't come

through on

> the list. If anyone wants a copy with the pictures I can email this

> directly to you, let me know.

>

>

> 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. If this is

still

> too short and you are *stuffing* the foot into the shoe put a hole

in the

> very end of the strap and use that to keep it buckled. These short

straps

> are very frustrating, but there should be a new/different design

on these

> soon according to the manufacturer. 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)

>

> 251cb47e.jpg

>

>

> 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 -

>

http://health.groups.yahoo.com/group/nosurgery4clubfoot/message//gro

up/nosurgery4clubfoot/post?

postID=Eep4XqJywyhHvpLRtlPjedj12RQjmX_Ornfs2hLcDbmNDJzFa0hcG4D7bK0nqk

7YjpUgAUEMXVg>frogabog@q...

> 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.

>

> 251cb4ec.jpg

>

>

> 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, gently. Don't move those

legs

> around too much, they have just come out of casts and the muscles

will be

> very sensitive. They might not like this at first

> but will soon learn to lift their legs up with the brace on. A very

> smzall baby may not really care about moving her legs much, so you

only

> need to show them this every once in a while if they seem upset

about

> it. This is actually a minor

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

the

> younger they are the less you will need to *show* them this.

>

> 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.

>

>

>

>

>

>

> Kori

> Mama of

> Kenton 6/98

> Merek 3/00

> Darbi 3/03 - Rt. CF - DBB 12hr/day

> (¨`·.·´¨)

> `·.¸(¨`·.·´¨)

> `·.¸.·´

>

>

>

>