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A clubfoot shoe,brace/Foot Abduction Brace has two parts: a bar (usually metal) and special shoes (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.A Foot Abduction Brace (BNB, Denis Brown Bar or DBB) consists of an adjustable length aluminum bar with adjustable footplates onto which shoes attach. It is recommended that an adjustable bar is used instead of a fixed length bar because the child will quickly outgrow the fixed length bar. The orientation of the footplates to the bar is set by the orthotist as recommended by your doctor. Typically, the shoes are set at 60-70 degrees of external rotation on the affected boot. The non-affected boot should is typically set to 30 degrees.
The bracing phase will last 4 years. A child will wear the brace all the time (except during baths) for about 3 months, and then only during naps and at night after that.
The casting phase is also called the "correction phase." When it's finished, a child's feet will look normal and be properly positioned. So it might seem like the most important part of the Ponseti method is done. The feet grow very quickly in the first years of life. Without the brace to keep a corrected clubfoot in the proper place, that rapid growth would send the foot back into the clubfoot position.
Therefore, the brace is as important as the series of casts. The brace keeps the corrected foot growing like it should. If the brace isn't worn as directed, the clubfoot will return. Then, the child has to start all over again, beginning with another casting phase.
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. But most 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:
1. Move the bar gently up and down so your baby sees how the legs can move and kick together.
2. Push and pull the brace so your child learns how to bend his or her knees while in the brace.
3. 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.
Some redness on the feet from the brace is normal. Serious skin problems are rare, parents should consult back if the redness doesn't go away in about 20 minutes after you take off the brace.The skin sometimes develops blisters or sores. These could be signs that the shoes are not tight enough. Don't put lotion or cream on irritated skin, as this can make the problem worse. Also call your doctor if your child's foot keeps coming out of the shoe or you can't get the heel to stay down in the shoe.
If your child continues to escape from the brace try the following: (check after each step to see if the heel is down, if not proceed to the next step)
1.Tighten the strap by one more hole
2.Tighten the laces
3.Remove the tongue of the shoe (Use of the brace, without the tongue, will not harm your child)
4. Try lacing the shoes from top to bottom, so that the bow is by the toes.
Check the width of the brace and widen if necessary.
5. If you think the foot is regressing, talk to your doctor about the possibility of additional casting.
If you have a question about bracing that has not been addressed, email us at youngbonesclinic@gmail.com
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