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Clubfoot Treatment

The Maintenance Phase

After the treatment phase the final cast (which stays on for three weeks) is removed, the foot tends to go back to its clubfoot position. To prevent this clubfoot relapse, after the last plaster cast is removed, a brace must be worn about 23 hours per day for approximately three months. This holds the baby’s foot (feet) in the correct position as bones, tendons and ligaments settle into their permanent position.

Bracing, the maintenance phase, is an essential part of the Ponseti Method for clubfoot treatment and prevents relapses very effectively in 95% of patients. Use of the brace will not cause developmental delays for the child. However, if a brace is not used, the rate of clubfoot relapse is as follows: 1st year 90 percent, second year 70-80 percent, third year 30-40 percent, 4th year is 10-15 percent, subsequent years are about 6 percent.

A Foot Abduction Brace (also commonly mis-labeled a Denis Brown Bar or DBB) consists of an adjustable length aluminum bar with adjustable footplates where tiny shoes attach. The baby may feel uncomfortable at first when trying to kick his or her legs separately. However, the baby will soon learn to kick both legs simultaneously and feel comfortable.

If you lay the brace on the floor with the shoes facing upward, the child’s feet should fit snugly inside these special shoes for clubfoot correction. After three months of wearing the brace for 23 hours a day, the brace must be worn at night for 2 to 4 years. There are special bracing tips and advice that should be read by parents.

The brace can be set-up by following the recommendations of your doctor, but you may be responsible for changing the shoes and widening the bar as your child grows. Your doctor should verify that the brace is set up per his/her instructions. New shoes are needed when the baby’s toes completely curl over the edge of the shoe. Special shoes for clubfoot will typically be two sizes larger than the current shoes to allow for growth.

You may need to play with the brace settings to see what is most comfortable for your child. Mark a line for the location of the toes the first time the shoes are worn, to indicate that the heel is down. If a child was recently casted, it is normal for the foot to have some swelling, so the line may not be accurate just a few days later.

If the brace is not worn as directed by the doctor, then the baby’s corrected foot can return to its clubfoot position. Likewise, if the nighttime brace is not worn correctly, then the corrected foot can move back to its clubfoot position. That’s why it is very important for parents or caregivers to remember to keep the brace on exactly as the doctor recommends.

In rare cases where the foot returns to the clubfoot position, in spite of proper braces for clubfoot, then surgery may be needed when the child is over two years of age. That said, clubfoot surgery should always be the last choice as it can cause scarring and is not a "cure" for clubfoot, although it may lead to some improvement.

» Clubfoot Treatment Overview
» Clubfoot Treatment Phase I
» Clubfoot Treatment Phase II
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