FAB/DBB Tips & Tricks - For Parents

October 13, 2004

Hi Kori,

I am SO sorry that you lost most all of your pictures. I know that you must

be devastated as they are priceless. That must suck. I can kinda relate. My

hd crashed a few weeks ago. I had to reformat it and I still have a lot left

to reinstall. My heart goes out and I hope that someone on the boards has

copies of your pics. once again, I am sorry.

Freeman

October 13, 2004

Hi everyone!

First I want to say sorry this hasn't been around the past few weeks and

I'd like to also welcome any new parents who have ventured in

recently. You won't be disappointed in the wonderful parents who are here

on this list. Make sure to ask your questions and never give up, your

baby will have perfect feet in no time!

I usually send this once every two weeks or whenever I notice parents

coming here asking about problems they're having with baby who is newly

into the FAB. Unfortunately, the past few weeks have been a little strange

for us plus my last hard drive with all my backed up data (after loosing

two hd's in another machine earlier this summer) got sick and died so I

haven't even had a copy of this *to* send. I apologize. But made it

easy for me to find it tonight (with very little pain - thank you!) and I'm

back in business!!

The only thing, is I had just recently added a few pictures and noted as

such in this version but along with the cascade of failed hard drives

recently all my pictures went too, one hd after another... in a matter of a

few months... I think I have lost forever the pictures I had of Darbi's

casts, her feet with the sores and the pictures of her holed shoes amongst

other valuable pictures of my children from the past couple years. My

last place to look is on the CFPics photo section and perhaps the other

groups. I think I might have pictures of a few of these things in there

but I've lost a LOT of my favorite pictures of my children and I have no

others from that time frame. I'm just sick about it... At any rate, I

don't have the pics anymore to go with this. I will try to find them, but

there's no guarantee I will ever see them again. :~{ Maybe someday I'll

have 2 or 3 thousand dollars to try to get the data off these broken

drives, but even then who knows if I can actually get them.

If anyone has a copy of this with the pics inserted (might be one or two

people out there max) let me know, I would love copies of those pics. If

anyone has copies of pictures I've sent to the CFPics list of my children

or anything I've sent, please let me know. I really have nothing but the

past few months which are on CD's that come right out of the camera,

otherwise I'd have lost everything through most of this year

too. Anything would be good at this point, thanks for anything you can

send me.

As always, if you would like me to add something to this that you found

helpful let me know and I'll be happy to include it. I figure, the more

tips the better right?

Kori & Darbi

At 09:09 PM 10/13/2004, frogabog wrote:

>FAB/DBB Tips and Tricks for Parents

>

>Many parents have problems using the FAB/DBB at first, you are not

>alone. Here is some information I have about our experiences with the DBB

>and pressure sores (start like a

>dark/purple spot/bruise). Blisters also turn into sores - which is why it

>is most important to get the shoes on right so they don't cause sores and

>blisters. Most important is to get the shoes on properly and do what you

>have to to stop sores from forming. So, if the pressure spots (dark) get

>worse or don't go away something is wrong and it will never get better till

>you stop the pressure in that area. Blisters are caused by slipping or

>friction on a spot on the foot, stop the slipping with making sure the

>boots are on tightly and the heel seated deep in the bottom of the shoe.

>

>I hope there is some answers to your problems with the new babies in the

>DBB. I remember this time very clearly and it was not fun at all. Most

>importantly - Listen To Your Baby. S/He will tell you if there is

>something wrong, and you must trust your instincts and not make things

>worse by letting a sore get worse. You can get past sores, many of us have

>done it but it is best to not get them in the first place.

>

>Big Hugs to you parents dealing with this. It will get better - the moment

>we fixed the problem our daughter couldn't have been happier in the

>DBB. What a difference!

>

>I have a couple of pictures inserted in this now, one of the hole we cut

>and one of the elongated tongue keeper slit but they won't come through on

>the list. If anyone wants a copy with the pictures I can email this

>directly to you, let me know.

>

>Kori

>Darbi

>3/03 Rt. CF - DBB 12hr/d

>

>*********************************************************

>

>How to put Markell Open Toe Boots attached to Brace FAB/DBB (Foot Abduction

>Brace/Dennis Browne Bar)

>

>Before you put the shoes on the first time:

>

>Take the laces out and tie a knot in the middle. Then re-lace the

>shoes. Tie a knot at the very ends of each lace end so they don't come out

>of the holes. This has been a lifesaver for us - we never have to re-lace

>them and can pull them very loose to get the shoes on. The knot in the

>middle shows us that they're even each time so I never worry about one side

>being longer than the other. I love this tip!

>

>Consider slitting the tongue keeper slit up to the top of the tongue. This

>allows the tongue to sit low on the top of the foot - and allows the top of

>the boot to be tightened up on the ankle enough so the fatty baby calf

>doesn't pull the heel up and out. The tighter the ankle, the better seated

>the foot will be.

>

>We find it easier to have the straps and buckles on the inside rather than

>the outside. Since the feet are pointed out in the first place cinching

>them up on the inside is just easier in general. Straight Last shoes can

>be installed on either side of the DBB - as they are not a right or left

>shoe. The Ponseti Method uses straight last shoes although sometimes a

>baby will get reverse last. If you got reverse last shoes ask about the

>straight last shoes.

>

>Install the strap in the lower hole on each side of the boot. Apparently

>this is the best position to keep the foot in the shoes.

>

>Medium thickness cotton socks are recommended. We like the Old Navy or

>Gymboree socks with the rubber grips on the bottom. They are regularly 7

>for $10 at Old Navy. I suggest you get at least 7 if not more. They seem

>to get lost in the laundry... and it's not fun trying to find that perfect

>sock when you need it. Plus you can make sure you've got the right colors

>on hand for accessorizing :~} In the winter after the initial first few

>months of getting used to the DBB and worrying about slipping I use

>tights. Not only for girls - I put my non-clubfoot boys in tights (white,

>black or blue of course!) in the winter too - it helps keep their legs warm

>when their pants hike up while being carried outside. But tights work very

>well with the DBB in our experience. The thicker the better, make sure

>they're stretchy so they fit the feet nice and tight.

>

>Remember - when you first get the DBB take it off every 2-3 hours to check

>the feet for sores or red marks that don't go away. Leaving the brace on

>for longer periods of time if baby seems happy is fine. If baby is showing

>signs of distress take the shoes off and inspect the feet. Then use the

>following instructions and re-install the brace. You should check the feet

>often over the first couple of days or more if baby is showing signs of

>distress. If you do not see signs that sores or blisters are forming

>things are ok - keep the brace on.

>

>Installation tips (how to put the DBB on a wiggly little baby without

>causing pain or sores)

>

>1- If you can - take the shoes off the bar. If you have a gold bar this is

>simple. You may have to use a wrench or pliers to get it off the first

>time as some brace shops really tighten them up. Don't loose the nut. It

>is best to put the nut back on the shoe after you take it off the bar - as

>it helps keep them around and getting kicked in the thighs without that nut

>there really hurts! Mark on the plate where your shoes are to be set at

>with a Sharpie marker. This makes it very easy to put them back in the

>right spot - even in low light. If you have the red adjustable bar it is

>harder to take the shoes off, maybe not possible. But if you can, try

>it. I really feel it's a better way than trying to put the shoes on with

>the bar.

>

>2- Loosen the laces up all the way to the knots and pull the tongue up as

>well. If you have short straps, buckle the strap into the last hole

>loosely so as not to pull it out when the foot goes in. If this is still

>too short and you are *stuffing* the foot into the shoe put a hole in the

>very end of the strap and use that to keep it buckled. These short straps

>are very frustrating, but there should be a new/different design on these

>soon according to the manufacturer. The longer straps

>don't need to be buckled.

>

>3- With the shoe off the bar insert the foot into the shoe and bend the

>knee 90 degrees. Push on the top of the knee and hold the sole of the

>shoe. Press the heel deeply into the back of the shoe and flex the toes

>upward (dorsiflexion) as far as possible. Keep pushing on the knee and

>flexing the foot and make SURE the heel is seated well into the bottom and

>back of the shoe.

>

>4- With the knee still bent and pressure applied press with your thumb or

>other convenient finger on the strap where it goes through the tongue

>keeper slit and hold the heel into the back of the shoe and tighten the

>strap. Buckle it tightly. Dorsiflex the foot again and press again on the

>knee and sole of the shoe to make sure the heel is in properly. Re-tighten

>the strap very tight. If the heel is down you can't tighten it too

>much. If there is any wiggle or looseness press the foot into the shoe

>again push with your thumb on the strap and re-tighten the strap again. It

>must be very tight - tighter than you would imagine it needs to be. So

>keep going till it's really tight.

>

>5- Pull the sock at the toes to make sure the seams aren't going to press

>into baby's toes - it also helps make sure the heel is seated. It's ok if

>they look all bloused out in front. This is good - gives baby room to

>wiggle toes and who cares how it looks anyway!

>

>6- Pull the tongue way down over the toes. As far as you can. I prefer it

>to sit *under* the top of the boot at the ankle just a little bit. If it

>sits high you may need to cut the tongue keeper slit a little more. (don't

>cut it above the stitching)

>

>251cb47e.jpg

>

>7 - Tighten the laces nice and snug all the way up and tie them. The shoe

>should get tighter with the laces being tightened.

>

>8- Check to see if the foot can slip out of the boot at all. If it moves

>it'll loosen up with time and slip. If it's not tight repeat the above

>instructions with emphasis on the pressure on the knee and pushing the heel

>into the bottom of the shoe with the foot flexed up (toes pointing toward

>the baby's head) all at the same time. This isn't easy at first, but you

>will get used to it and very good at it in short time.

>

>9- Repeat the procedure with the other boot.

>

>10- When both boots are on - take the nuts off and put the bar back on. If

>your baby is bi-lateral it doesn't matter which side you do first. If baby

>is unilateral it's easier to put the clubfoot side on first as the other

>side set at 45 degrees is easier to put on the bar second.

>

>Signs of trouble:

>

>Baby cries a very unnatural (for your baby) unhappy in pain cry all the

>time, kicks legs violently like she's trying to kick the shoes off, wakes

>at nigh every half hour or less (other than being hungry), purple/black

>marks on the heels or other parts of the foot, blisters form or sores form.

>

>All these are typically caused by the shoes not being on properly. If

>pressure sores or blisters appear - you MUST fix whatever is causing the

>problem before you put the shoes back on. Sores will not heal in the shoes

>once they appear (skin falls off and actual sore is resident - as opposed

>to just a purple or black mark). It might mean a trip back to the Dr. for

>a healing cast. Which is ok - it keeps the correction while the sore

>heals. You MUST find out why the sore came - if it's slipping or pressure

>or whatever - find it and fix it. When you go back to the DBB follow the

>above directions and make SURE the heels are down 100% in the bottom of the

>shoes. Blisters are caused by friction, or rather slippage. Slippage is

>often caused by the strap not being tight enough. It may seem tight

>enough, but if slippage happens it very likely is not tight enough. If the

>heel is rising up it seems tight but once you get the heel down you'll find

>you can tighten it up another couple of holes. Dorsiflexing the foot while

>you put the shoes on really helps prevent this.

>

>After having persistent sores some parents have resorted to actually

>cutting a large hole in the heels of the shoes. This helps to relieve

>pressure so that baby can continue to wear the DBB while a sore heals. It

>is not a long term fix. The foot must be in the shoe properly for long

>term wear. However, after cutting the hole many parents have found that

>they were not getting the heel down all the way and were then able to see

>to make sure the heel is down. I don't recommend this - it is a short term

>bandaid to the larger problem of proper fitting of the shoes. However it

>is a good option to going back to casts for healing and starting again with

>the 23/7 schedule for wearing the FAB. The shoes will not fall apart and

>are essentially disposable as they can only be worn for a few months till

>baby needs a larger size. For more information about this you can contact

>me personally -

>http://health.groups.yahoo.com/group/nosurgery4clubfoot/message//group/nosurge\

ry4clubfoot/post?postID=Eep4XqJywyhHvpLRtlPjedj12RQjmX_Ornfs2hLcDbmNDJzFa0hcG4D7\

bK0nqk7YjpUgAUEMXVg>frogabog@q...

>

>and I can help you find a solution to

>healing your child's sores. We have endured this and hope to not see any

>other babies have to go through this pain and unhappiness. Remember -

>there is a light at the end of the tunnel and you can find a way to keep

>the FAB on so your baby can take advantage of the most effective brace to

>complete the non-surgical treatment.

>

>251cb4ec.jpg

>

>Other reasons why baby may be uncomfortable are:

>

>skin sensitivity right after casts are taken off. This is unfortunate, but

>will get better with time. Don't rub the legs - this hurts more. A little

>lotion is ok but keep it off the feet itself as it can cause slipping.

>

>Bar is too long or too short. The heels of the shoes (fixed on the bar in

>the correct positions - 70 degrees for a clubfoot and 45 for non clubfoot)

>should be shoulder width apart. Any less or more is uncomfortable for

>baby. It is not the length of the bar - it is the distance between the

>heels. Take the brace and place it up to baby's shoulders to check this.

>

>Foot is at the wrong position. The clubfoot should be at 70 degrees or *AT

>LEAST* as far turned out as the last cast. Parents - save your last

>cast. Take that cast and put it up to a protractor with the knee pointed

>to 0 degrees and see where the midline of the foot portion points to. Then

>set your DBB. If it is much less than 60 degrees consider talking to your

>doctor about another cast. The last cast in the Ponseti Method should be

>at 70 degrees. If your cast is not there, and your doc doesn't see fit to

>re-cast you can try to get there slowly over time. Set your brace to where

>the cast is set at and slowly once a week increase it by 5 degrees. Do not

>put the foot further out than the last cast as this causes considerable

>discomfort for the baby.

>

>Baby is irritated by not being able to move legs independently. You can

>show baby how to move his legs together, gently. Don't move those legs

>around too much, they have just come out of casts and the muscles will be

>very sensitive. They might not like this at first

>but will soon learn to lift their legs up with the brace on. A very

>smzall baby may not really care about moving her legs much, so you only

>need to show them this every once in a while if they seem upset about

>it. This is actually a minor

>irritation for the baby. They get used to this fairly quickly and the

>younger they are the less you will need to *show* them this.

>

>It is very important to not take baby out of the brace. Do everything you

>can to make sure your baby stays in the brace. But listen to your child

>and follow your heart. If you see signs of sores there is a problem you

>need to tackle and rectify. Do NOT keep a brace on a child who has a

>weeping sore. This is painful and you wouldn't put a tight shoe on your

>own foot with a sore like that. If your child is telling you she's in pain

>she likely is and you need to find out why. Do what you can to keep the

>brace on - but don't make a bad situation worse by putting it on

>incorrectly and causing sores. See your Dr. about healing casts or cut a

>hole... but don't make sores worse.

>

>If your baby is irritable at first consider co-sleeping so everyone gets

>some sleep the first few nights. You can side lie and nurse a baby wearing

>the dbb, it's a little different than a baby who doesn't wear one but is

>absolutely doable. Even if you only do this for a few days while baby is

>getting used to the brace - it will help everyone in your family get sleep

>the first few nights. Put a pillow under baby's feet. It is easy enough

>for baby to side lie in the DBB with a pillow under his feet.

>

>Good luck and don't forget to post to the list if you need help. We're

>here for you and have lots of different takes on how to make the shoes and

>bar work so there's lots of different ways to work through problems.

>

>Kori

>Mama of

>Kenton 6/98

>Merek 3/00

>Darbi 3/03 - Rt. CF - DBB 12hr/day

>(¨`·.·´¨)

>`·.¸(¨`·.·´¨)

>`·.¸.·´

>

October 13, 2004

Thank you so much Kori! I have met a mom that is having

problems with the FAB on her 2 mo. old. I am sure that this info

will help her out!!

Thanks again!

and Becky 11/12/01, bilateral clubfoot

October 15, 2004

I would like to see those pictures. We are still having issues I

think he is too smart for his own good. So far I have tried nearly

every suggestions laid before me, and he STILL pulls his foot out.

> FAB/DBB Tips and Tricks for Parents

>

> Many parents have problems using the FAB/DBB at first, you are not

> alone. Here is some information I have about our experiences with

the DBB

> and pressure sores (start like a

> dark/purple spot/bruise). Blisters also turn into sores - which is

why it

> is most important to get the shoes on right so they don't cause

sores and

> blisters. Most important is to get the shoes on properly and do

what you

> have to to stop sores from forming. So, if the pressure spots

(dark) get

> worse or don't go away something is wrong and it will never get

better till

> you stop the pressure in that area. Blisters are caused by

slipping or

> friction on a spot on the foot, stop the slipping with making sure

the

> boots are on tightly and the heel seated deep in the bottom of the

shoe.

>

> I hope there is some answers to your problems with the new babies

in the

> DBB. I remember this time very clearly and it was not fun at all.

Most

> importantly - Listen To Your Baby. S/He will tell you if there is

> something wrong, and you must trust your instincts and not make

things

> worse by letting a sore get worse. You can get past sores, many of

us have

> done it but it is best to not get them in the first place.

>

> Big Hugs to you parents dealing with this. It will get better -

the moment

> we fixed the problem our daughter couldn't have been happier in the

> DBB. What a difference!

>

> I have a couple of pictures inserted in this now, one of the hole

we cut

> and one of the elongated tongue keeper slit but they won't come

through on

> the list. If anyone wants a copy with the pictures I can email this

> directly to you, let me know.

>

> Kori

> Darbi

> 3/03 Rt. CF - DBB 12hr/d

>

> *********************************************************

>

November 5, 2004

Thanks for the tips for the dbb. Jordan started off with a blister that got

progressively worse. Now it is an open sore. I was using the advanced healing

bandaids from johnson and johnson but it further irritated his skin so the sore

got worse not better. Anyhow, on the inside of his Markell shoe there is a

ridge on the upper part of the heel to help prevent the foot from slipping out.

Jordan's upper heel rubs against the lower part of the ridge causing the

blister. His feet are in the shoes properly so the tech tells me. I am taking

the shoes to the Orthotist today to see if he can alter the shoe so that it

doesn't cause this irritation. I plan on putting the shoe back on ASAP. I don't

want to have to go through any of this again so that shoe is going on!

thanks again.

Keri

FAB/DBB Tips & Tricks - For Parents

Apparently it's time to send this to the lists again. Hope it helps some

of you newly into the DBB/FAB.

Kori

******************************************************************************

FAB/DBB Tips and Tricks for Parents

Many parents have problems using the FAB/DBB at first, you are not

alone. Here is some information I have about our experiences with the DBB

and pressure sores (start like a

dark/purple spot/bruise). Blisters also turn into sores - which is why it

is most important to get the shoes on right so they don't cause sores and

blisters. Most important is to get the shoes on properly and do what you

have to to stop sores from forming. So, if the pressure spots (dark) get

worse or don't go away something is wrong and it will never get better till

you stop the pressure in that area. Blisters are caused by slipping or

friction on a spot on the foot, stop the slipping with making sure the

boots are on tightly and the heel seated deep in the bottom of the shoe.

I hope there is some answers to your problems with the new babies in the

DBB. I remember this time very clearly and it was not fun at all. Most

importantly - Listen To Your Baby. S/He will tell you if there is

something wrong, and you must trust your instincts and not make things

worse by letting a sore get worse. You can get past sores, many of us have

done it but it is best to not get them in the first place.

Big Hugs to you parents dealing with this. It will get better - the moment

we fixed the problem our daughter couldn't have been happier in the

DBB. What a difference!

Kori

Darbi

3/03 Rt. CF - DBB 12hr/d

*********************************************************

How to put Markell Open Toe Boots attached to Brace FAB/DBB (Foot Abduction

Brace/Dennis Browne Bar)

Before you put the shoes on the first time:

Take the laces out and tie a knot in the middle. Then re-lace the

shoes. Tie a knot at the very ends of each lace end so they don't come out

of the holes. This has been a lifesaver for us - we never have to re-lace

them and can pull them very loose to get the shoes on. The knot in the

middle shows us that they're even each time so I never worry about one side

being longer than the other. I love this tip!

Consider slitting the tongue keeper slit up to the top of the tongue. This

allows the tongue to sit low on the top of the foot - and allows the top of

the boot to be tightened up on the ankle enough so the fatty baby calf

doesn't pull the heel up and out. The tighter the ankle, the better seated

the foot will be.

We find it easier to have the straps and buckles on the inside rather than

the outside. Since the feet are pointed out in the first place cinching

them up on the inside is just easier in general. Straight Last shoes can

be installed on either side of the DBB - as they are not a right or left

shoe. The Ponseti Method uses straight last shoes although sometimes a

baby will get reverse last. If you got reverse last shoes ask about the

straight last shoes.

Install the strap in the lower hole on each side of the boot. Apparently

this is the best position to keep the foot in the shoes.

Medium thickness cotton socks are recommended. We like the Old Navy or

Gymboree socks with the rubber grips on the bottom. They are regularly 7

for $10 at Old Navy. I suggest you get at least 7 if not more. They seem

to get lost in the laundry... and it's not fun trying to find that perfect

sock when you need it. Plus you can make sure you've got the right colors

on hand for accessorizing :~} In the winter after the initial first few

months of getting used to the DBB and worrying about slipping I use

tights. Not only for girls - I put my non-clubfoot boys in tights (white,

black or blue of course!) in the winter too - it helps keep their legs warm

when their pants hike up while being carried outside. But tights work very

well with the DBB in our experience. The thicker the better, make sure

they're stretchy so they fit the feet nice and tight.

Remember - when you first get the DBB take it off every 2-3 hours to check

the feet for sores or red marks that don't go away. Leaving the brace on

for longer periods of time if baby seems happy is fine. If baby is showing

signs of distress take the shoes off and inspect the feet. Then use the

following instructions and re-install the brace. You should check the feet

often over the first couple of days or more if baby is showing signs of

distress. If you do not see signs that sores or blisters are forming

things are ok - keep the brace on.

Installation tips (how to put the DBB on a wiggly little baby without

causing pain or sores)

1- If you can - take the shoes off the bar. If you have a gold bar this is

simple. You may have to use a wrench or pliers to get it off the first

time as some brace shops really tighten them up. Don't loose the nut. It

is best to put the nut back on the shoe after you take it off the bar - as

it helps keep them around and getting kicked in the thighs without that nut

there really hurts! Mark on the plate where your shoes are to be set at

with a Sharpie marker. This makes it very easy to put them back in the

right spot - even in low light. If you have the red adjustable bar it is

harder to take the shoes off, maybe not possible. But if you can, try

it. I really feel it's a better way than trying to put the shoes on with

the bar.

2- Loosen the laces up all the way to the knots and pull the tongue up as

well. If you have short straps, buckle the strap into the last hole

loosely so as not to pull it out when the foot goes in. If this is still

too short and you are *stuffing* the foot into the shoe put a hole in the

very end of the strap and use that to keep it buckled. These short straps

are very frustrating, but there should be a new/different design on these

soon according to the manufacturer. The longer straps

don't need to be buckled.

3- With the shoe off the bar insert the foot into the shoe and bend the

knee 90 degrees. Push on the top of the knee and hold the sole of the

shoe. Press the heel deeply into the back of the shoe and flex the toes

upward (dorsiflexion) as far as possible. Keep pushing on the knee and

flexing the foot and make SURE the heel is seated well into the bottom and

back of the shoe.

4- With the knee still bent and pressure applied press with your thumb or

other convenient finger on the strap where it goes through the tongue

keeper slit and hold the heel into the back of the shoe and tighten the

strap. Buckle it tightly. Dorsiflex the foot again and press again on the

knee and sole of the shoe to make sure the heel is in properly. Re-tighten

the strap very tight. If the heel is down you can't tighten it too

much. If there is any wiggle or looseness press the foot into the shoe

again push with your thumb on the strap and re-tighten the strap again. It

must be very tight - tighter than you would imagine it needs to be. So

keep going till it's really tight.

5- Pull the sock at the toes to make sure the seams aren't going to press

into baby's toes - it also helps make sure the heel is seated. It's ok if

they look all bloused out in front. This is good - gives baby room to

wiggle toes and who cares how it looks anyway!

6- Pull the tongue way down over the toes. As far as you can. I prefer it

to sit *under* the top of the boot at the ankle just a little bit. If it

sits high you may need to cut the tongue keeper slit a little more. (don't

cut it above the stitching)

251cb47e.jpg

7 - Tighten the laces nice and snug all the way up and tie them. The shoe

should get tighter with the laces being tightened.

8- Check to see if the foot can slip out of the boot at all. If it moves

it'll loosen up with time and slip. If it's not tight repeat the above

instructions with emphasis on the pressure on the knee and pushing the heel

into the bottom of the shoe with the foot flexed up (toes pointing toward

the baby's head) all at the same time. This isn't easy at first, but you

will get used to it and very good at it in short time.

9- Repeat the procedure with the other boot.

10- When both boots are on - take the nuts off and put the bar back on. If

your baby is bi-lateral it doesn't matter which side you do first. If baby

is unilateral it's easier to put the clubfoot side on first as the other

side set at 45 degrees is easier to put on the bar second.

Signs of trouble:

Baby cries a very unnatural (for your baby) unhappy in pain cry all the

time, kicks legs violently like she's trying to kick the shoes off, wakes

at nigh every half hour or less (other than being hungry), purple/black

marks on the heels or other parts of the foot, blisters form or sores form.

All these are typically caused by the shoes not being on properly. If

pressure sores or blisters appear - you MUST fix whatever is causing the

problem before you put the shoes back on. Sores will not heal in the shoes

once they appear (skin falls off and actual sore is resident - as opposed

to just a purple or black mark). It might mean a trip back to the Dr. for

a healing cast. Which is ok - it keeps the correction while the sore

heals. You MUST find out why the sore came - if it's slipping or pressure

or whatever - find it and fix it. When you go back to the DBB follow the

above directions and make SURE the heels are down 100% in the bottom of the

shoes. Blisters are caused by friction, or rather slippage. Slippage is

often caused by the strap not being tight enough. It may seem tight

enough, but if slippage happens it very likely is not tight enough. If the

heel is rising up it seems tight but once you get the heel down you'll find

you can tighten it up another couple of holes. Dorsiflexing the foot while

you put the shoes on really helps prevent this.

After having persistent sores some parents have resorted to actually

cutting a large hole in the heels of the shoes. This helps to relieve

pressure so that baby can continue to wear the DBB while a sore heals. It

is not a long term fix. The foot must be in the shoe properly for long

term wear. However, after cutting the hole many parents have found that

they were not getting the heel down all the way and were then able to see

to make sure the heel is down. I don't recommend this - it is a short term

bandaid to the larger problem of proper fitting of the shoes. However it

is a good option to going back to casts for healing and starting again with

the 23/7 schedule for wearing the FAB. The shoes will not fall apart and

are essentially disposable as they can only be worn for a few months till

baby needs a larger size. For more information about this you can contact

me personally -

http://health.groups.yahoo.com/group/nosurgery4clubfoot/message//group/nosurger\

y4clubfoot/post?postID=Eep4XqJywyhHvpLRtlPjedj12RQjmX_Ornfs2hLcDbmNDJzFa0hcG4D7b\

K0nqk7YjpUgAUEMXVg>frogabog@q...

and I can help you find a solution to

healing your child's sores. We have endured this and hope to not see any

other babies have to go through this pain and unhappiness. Remember -

there is a light at the end of the tunnel and you can find a way to keep

the FAB on so your baby can take advantage of the most effective brace to

complete the non-surgical treatment.

251cb4ec.jpg

Other reasons why baby may be uncomfortable are:

skin sensitivity right after casts are taken off. This is unfortunate, but

will get better with time. Don't rub the legs - this hurts more. A little

lotion is ok but keep it off the feet itself as it can cause slipping.

Bar is too long or too short. The heels of the shoes (fixed on the bar in

the correct positions - 70 degrees for a clubfoot and 45 for non clubfoot)

should be shoulder width apart. Any less or more is uncomfortable for

baby. It is not the length of the bar - it is the distance between the

heels. Take the brace and place it up to baby's shoulders to check this.

Foot is at the wrong position. The clubfoot should be at 70 degrees or *AT

LEAST* as far turned out as the last cast. Parents - save your last

cast. Take that cast and put it up to a protractor with the knee pointed

to 0 degrees and see where the midline of the foot portion points to. Then

set your DBB. If it is much less than 60 degrees consider talking to your

doctor about another cast. The last cast in the Ponseti Method should be

at 70 degrees. If your cast is not there, and your doc doesn't see fit to

re-cast you can try to get there slowly over time. Set your brace to where

the cast is set at and slowly once a week increase it by 5 degrees. Do not

put the foot further out than the last cast as this causes considerable

discomfort for the baby.

Baby is irritated by not being able to move legs independently. You can

show baby how to move his legs together, gently. Don't move those legs

around too much, they have just come out of casts and the muscles will be

very sensitive. They might not like this at first

but will soon learn to lift their legs up with the brace on. A very

smzall baby may not really care about moving her legs much, so you only

need to show them this every once in a while if they seem upset about

it. This is actually a minor

irritation for the baby. They get used to this fairly quickly and the

younger they are the less you will need to *show* them this.

It is very important to not take baby out of the brace. Do everything you

can to make sure your baby stays in the brace. But listen to your child

and follow your heart. If you see signs of sores there is a problem you

need to tackle and rectify. Do NOT keep a brace on a child who has a

weeping sore. This is painful and you wouldn't put a tight shoe on your

own foot with a sore like that. If your child is telling you she's in pain

she likely is and you need to find out why. Do what you can to keep the

brace on - but don't make a bad situation worse by putting it on

incorrectly and causing sores. See your Dr. about healing casts or cut a

hole... but don't make sores worse.

If your baby is irritable at first consider co-sleeping so everyone gets

some sleep the first few nights. You can side lie and nurse a baby wearing

the dbb, it's a little different than a baby who doesn't wear one but is

absolutely doable. Even if you only do this for a few days while baby is

getting used to the brace - it will help everyone in your family get sleep

the first few nights. Put a pillow under baby's feet. It is easy enough

for baby to side lie in the DBB with a pillow under his feet.

Good luck and don't forget to post to the list if you need help. We're

here for you and have lots of different takes on how to make the shoes and

bar work so there's lots of different ways to work through problems.

Kori

Mama of

Kenton 6/98

Merek 3/00

Darbi 3/03 - Rt. CF - DBB 12hr/day

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November 5, 2004