Clubfoot is a birth defect that makes one or both of a baby's feet point down and turn in. Surgery historically was the main treatment for clubfoot, but many physicians now prefer the Ponseti method. This is done in two phases:
The casting phase, which gradually moves the foot to the correct position.
The bracing phase, which makes sure it stays there.
Casting by an orthopedic surgeon who has been trained in the Ponseti method usually starts when a baby is a week or two old and lasts for 5 to 7 weeks. When the foot is in its final, correct position, the baby begins the bracing phase and is fitted with two AFOs, often referred to as boots and an adjustable bar. The bracing phase will last two to five years. A child will wear the brace full time initially and gradually decrease wear time as prescribed. The AFOs and adjustable bar are replaced as the child outgrows them. Often a tenotomy is part of the treatment process.
A clubfoot brace (often just called an orthotic) has two parts including an adjustable bar and special AFO’s (or boots) that attach at each end. The bar is the same length as the distance between the baby's shoulders. It slides or clicks into the bottoms of the shoes. The brace keeps the "fixed" clubfoot (or feet) in the corrected position so it doesn't twist back to where it was before the casting phase. Both feet are braced, even if the clubfoot is only on one side.
The casting phase is also called the “correction phase.” When it’s finished, a child’s feet will be in a more neutral position. When you see this, it might seem like the most important part of the Ponseti method is done, but feet grow quickly. Without the brace to keep a corrected clubfoot in the proper position or alignment, the rapid growth will likely cause the clubfoot position to return. If this occurs, the process will need to be restarted.
It's up to you to make sure your child wears the brace as the orthopedic surgeon directed. A brace may look uncomfortable, but won't hurt or bother your baby. It is new and different though, so it can take kids a little while to get used to wearing one. Most children adapt to the brace quickly. Before long, it's just another part of daily life. Putting on the brace can be a challenge at first. Your baby might squirm, cry, and kick — but then will get used to the brace after a couple of days. Don't let your baby's fussiness tempt you to "let it go" for a night or two. Removing the brace teaches your little one that crying gets results — and then it will take longer and be harder for your baby to accept wearing it.
While your baby wore casts, he or she could move the legs independently. But because both feet are in the brace, the legs can only move together. To help your child learn how to kick and swing the legs simultaneously try the following:
Move the bar gently up and down so your baby sees how the legs can move and kick together.
Push and pull the brace so your child learns how to bend his or her knees while in the brace.
While it might take them a little longer, kids wearing a brace can learn how to sit, crawl, and walk just like other kids their age. If your baby continues to be very fussy about wearing the brace, call your clubfoot care team. They can recommend other ways for you to help your child accept wearing the brace.
Some redness on the feet from the brace is normal. Serious skin problems are rare, but contact us if you see the following:
The redness doesn't go away in about 20 minutes after you take off the brace.
The skin develops blisters or sores.
These could be signs that the AFO’s are not tight enough. Don't put lotion or cream on irritated skin, as this can make the problem worse. Also contact us if your child's foot keeps coming out of the AFO or you can't get the heel to stay down in the AFO.
Babies get used to wearing a brace very quickly. To help your little one accept it as a part of daily life, try these tips:
Keep a cheerful attitude, and smile and sing to your baby.
Make putting the brace on a regular part of the day, like getting dressed.
Use a special, fun nickname, like "night-night shoes" or "magic shoes".
Give a small reward to your child for wearing the brace. You might read an extra bedtime story, give stickers, or stay a little longer at the playground.
Show your child pictures of other kids wearing a brace.
Read books written just for kids who wear a brace, like "My Clever Night-Night Shoes" (by Karen Mara Moss), "Let Us Count the Things" (by Catherine Brown), and "Wear Your Boots, Ted" (by Rebecca Jarding).
The daily bracing schedule can come with some frustrations. A baby might cry at first when the shoes and brace are put on, while an older, more active child might complain about wearing the brace to bed. So it's natural for parents to consider skipping it sometimes, or to think that 3 years with a brace is long enough, even if the orthopedic surgeon recommends 5. But even brief periods of not wearing the brace can cause problems. Besides making it harder for a child to get used to the brace as part of everyday life, skipping days can allow the foot (or feet) to very subtly move out of the corrected position. Then the brace won't fit as it should, making it uncomfortable for a child to wear. This cycle can lead to disuse of the brace and the clubfoot will likely happen again. It can help to find support from other parents who have gone through the Ponseti method with their kids. Look online for tips, advice, and support groups.
Clubfoot is a common birth defect that affects one in 1000 babies. The term clubfoot is used when a baby is born with one or both feet twisted inward and pointing down. Clubfoot is not painful and early treatment can correct almost all cases.
Working alongside the rehabilitation team from the Stollery Children's Hospital Clubfoot Clinic, we are pleased to provide follow up care once the casting and other procedures are completed.
If you would like to meet one of our orthotists and discuss the treatment plan for your son or daughter please do not hesitate to book a no charge consultation. Beside are the various Ponseti-Mitchell orthoses that we provide showing the standard adjustable bar and the Dobbs bar which promotes more active movement.
Permanent correction of a clubfoot takes time. It's important for parents to work with the clubfoot care team and follow the treatment plan to help their child get the best possible result. The Ponseti method is successful for most kids with clubfoot, and will let them walk, run, and play without pain. After a clubfoot is fully corrected, kids will often see their specialist for follow-up visits. After age 5, most only go once a year until they're done growing (around age 18) to make sure no problems develop.
Tips for parents: https://kidshealth.org/en/parents/ponseti-brace-tips.html
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