Clubfoot bracing
Fetal clubfoot, also known as talipes equinovarus, is a congenital foot deformity in which the foot is curved toward the middle of the body and the toes point downward. Treatment with casting is usually very successful, but the use of a brace after casting is highly recommended to prevent the deformity from coming back. In fact, recurrence is five times as likely in children who don't consistently wear the brace as recommended. Learn more about clubfoot.
Clubfoot recurrence can be difficult to treat in toddlers and young children. As children get older, they are more likely to be upset by the casting procedure and more likely to be bothered by the casts. Also, the feet get less flexible with age and getting a good correction can be more challenging. For these reasons, we stress the importance of using the brace as prescribed. If your child has problems keeping the brace on, call your doctor or the Orthotics Department right away so we can have the brace adjusted or consider switching to a different type of bar-and-shoe brace.
The clubfoot braces
Several clubfoot braces are available. They consist of two shoes connected by a bar. Both feet are braced, even if the clubfoot is only on one side. Generally, the clubfoot is turned to the outside more than the unaffected foot.
For young infants, the brace is used full time (except for bath time) for 3 to 4 months, then with naps and at night for up to 4 years. Research has shown that children who wear the brace as prescribed do better in the long run and are less likely to need additional treatment. If your child has difficulty tolerating the brace, or pulls out of the brace frequently, notify your physician and orthotist (brace fitter) right away so they can provide tips, make necessary adjustments or change the brace type as needed.
How the brace is worn
The clubfoot brace should be worn with thin cotton socks. Thicker socks make the brace easier to slide out of. If your child pulls out of the brace easily, try wearing the brace with no socks. You can also remove the tongue from the Markell shoe and just use the laces. The ankle strap should be very snug. Make sure your child's toes are showing out the end of the brace. It may be easier to put the brace on the more severely deformed foot first (or the clubfoot — if only one foot is affected). Make sure the heel settles down into the shoe. Don't use any lotions, powders or creams on the foot; this can make the foot slide around in the brace and cause a blister.
When fussiness occurs
Children are often very fussy when they are first getting use to the brace. During the first week of brace wear, check your child's feet every three hours or so to look for red spots or other skin irritation. If you notice skin changes, let your doctor or orthotist know right away. Check your child's toes frequently to make sure they are all showing. If possible, try to remove the brace for skin checks at times when your child is content. That way, your child won't get the idea that crying will lead to brace removal. If your child can't be consoled and there's no other explanation, you take off the brace briefly to make sure there are no skin changes.
Tips for success
- Have a consistent routine
Once your child is done with full-time wear, make sure the brace always goes on before naps and at bedtime. This way your child understands that when it's time to sleep, it's time for the brace, too. - Show your child how to move
Show your child how to move his legs by gently moving the bar up and down. This shows him that he is free to bend at the knees and hips, now that the casts are off. - Put padding over the bar
Many baby stores carry car seat strap covers designed to pad car seat straps. These can be used to pad the metal bar of the brace so you child doesn't hit the bar on furniture, himself or others.