Re: help with dbb shoes-Donna

October 4, 2004

Donna,

What size shoes does n have? Are they the 0000 Markell shoes?

I know he's a preemie, so his feet are probably very tiny. Did you

print off the shoe chart from the Markell site?

Dr. Ponseti says that the babies should always wear socks with the

shoes. He actually recommends " thin " 100% cotton socks with minimal

seams (which aren't always easy to find), not the thick, gripper

socks. I think that the socks help to prevent sores and also keep

the moisture regulated better.

The 3 months of fulltime wear is critical to prevent regression. The

foot will want to regress (regardless of the initial severity) up

until roughly age 5. The odds of regression go down with age. The

first months after the correction is obtained are the highest chance

of regression (just like when someone gets braces off their teeth,

they have to wear a retainer full-time for a while, then eventually

just at night). As the baby gets a little older, they're getting

more " therapy " when they're standing, bouncing etc. on those legs, so

that helps to work the foot in addition to being in the brace 16-18

hours/day. When the child is walking, that's when they can reduce

the time in the brace even more 12-14 hrs/day typically. We've had a

number of families here this summer who told us that their child's

feet were fine so they were let out of the brace at age 2 1/2-

3......then they had a sudden and severe relapse. So now the

protocol is to have the child wear the brace as long as they'll

tolerate it at night- hopefully up to age 4 or beyond. You might

know all of this- just re-telling it since you just joined this

particular board.

Have you considered taking a trip to Iowa City to have Dr. P examine

n's foot or sending him pictures again to see what he thinks (I

know he reviewed photos initially for you)?

It would be good to rule out the possibility that his foot is not

fully corrected so that you're sure that the problems with keeping

the shoe on are indeed related to the size of his feet only. I know

that his foot was pretty mild initially, but it could be relapsing

just the same.

I forgot, did he have a percutaneous tenotomy? Or was his

dorsiflexion enough that he didn't need it?

I'd be very concerned about him being out of the brace while he's at

daycare. Number one because of regression, number two because he's

not wearing it consistently, so he's not going to like it when it's

on (i.e. during the weekends). Did they tell you that they won't put

it back on him, or you don't think they can handle it, or something

else.....? I would think that they should be able to put it on him

if you train them, or leave them written instructions. Kori's

instructions could be adapted to be printed off so you could give

them a copy maybe?! Just an idea.

Welcome to the board- we're glad to have you here!

Regards,

& (3-16-00)

left clubfoot

>

> I too was having diffuiculty getting the shoes to stay on little

> n's feet. Over the weekend we tried a couple of things the

Doc

> suggested. The gripper socks didn't work for him..his feet are too

> small for the sock too and he screamed like a banshee. The only way

> the shoe stays on and he doesn't scream is without any socks at

all.

> I worry that this will chaffe his skin too much..but it is the only

> way right now.

>

> Now here is our other dilemma. He is supposed to be wearing the DBB

> 23 hours a day, right? but with slipping and what not we have to

> take it off and put it on several times. We both work and n

is

> in day care. There is no way they can do that...so we are unable to

> put him in the DBB during daycare. His daddy kinda worrie4s about

> not having it on all day..but...I wonder what the difference is.

Why

> exactly are they supposed to wear the brace all day for the first

> couple months then only at night? Does anyone know the answer to

> this?

>

> btw..I am new to this group, but have been on the other yahoo group

> for a few months.

>

> Donna

October 4, 2004

Hi Donna,

I just wanted to echo everything that wrote, especially to emphasize

the importance of the 23 hr per day wearing of the DBB (FAB) and to comment

that the difficulty in keeping n in the shoes may be due to regression

or improper correction. If you don't mind my asking, who is your doctor? I

would have his feet re-checked by a highly recommended Ponseti doctor and

make sure the FAB fits perfectly. He really shouldn't be able to get out of

it so often or so easily. Of course it is more difficult since he is a

preemie. How about the shoes--- we can look into if they have them

for very small feet.

HTH & keep us posted,

Emma 18-10-99. Montreal, Canada

moderately severe bilateral clubfoot

3 months unsuccessful local casting pending surgery

corrected by Dr. Ponseti with 3 casts & tenotomy

out of FAB too early, just before 2 yrs old (loose ligaments)

relapse, ATTT at 4 years old, doing great at age 5.