Re: Kicking off DBB shoes

March 15, 2005

This is long but worth printing and keeping to help with your shoes:

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//grou

p/nosurgery4clubfoot/post?

postID=Eep4XqJywyhHvpLRtlPjedj12RQjmX_Ornfs2hLcDbmNDJzFa0hcG4D7bK0nqk7

YjpUgAUEMXVg>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

Kicking off DBB shoes

Hi, I am a new member to the group and was wondering if anyone had

any advice on how to keep the shoes on. I have tried non-slip

socks, tying the shoes backwards (from top to bottom), duck tape,

and many more. If anyone has been at this stage and can help me in

any way it would be greatly appreciated. She is 2 years old, and

constantly kicks her shoes off at bedtime. I can only get her to

wear them 3 to 5 hours per night. She is suppose to wear them 10 to

12 hours per night. Thanks again.

Louise

March 15, 2005

Hi Louise,

Welcome!!

Attached is a file that may help you (sent only to Louise - if anyone else

wants a copy email me privately - the list doesn't accept

attachments) Since she's older, her feet are better formed and should stay

in the shoes better in general. But there may be something in there that

you can use. Also, check some things that could be part of the problem...

*bar length - if it's too long or too small it could contribute to the

feet not getting fully in when you're tightening them up, and also

contribute to the pulling out. It should be about shoulder width heel to

heel or bolt to bolt, whichever is more comfortable for your little one.

*shoe width - are her feet extra narrow? They make a narrow shoe, so maybe

that'll help.

*strap slot - are you using the upper slot? Try the bottom one (where the

strap goes through the sides of the shoes)

I'm sure others will offer some other possibilities. This one, isn't going

to go over well but it should be considered...

*correction loss - if the foot isn't perfectly corrected, this could cause

the slipping. Something to consider of course.

If you're unsure, there are parents here who are adept at spotting

relapsing feet and we have a separate list where we can send attachments

such as pictures so come on over there and show us what you're

seeing.

http://groups.yahoo.com/group/CFPics/http://groups.yahoo.com/group/CFPics/

If you think her feet aren't 100% still, have her stand flat and take pics

from front and back, then the soles of her feet, and a profile pic while

you dorsiflex her foot as far as possible. That's just FYI - in case you

ever need to take pics for Dr. Ponseti or anyone who is looking to check

her correction. I'm not saying she has relapsed, just offering the info in

case you need it.

Glad to have you!

Kori

Darbi Ruth - 3/28/03

Rt. CF - FAB 12-14hr/d

At 08:06 AM 3/15/2005, you wrote:

>Hi, I am a new member to the group and was wondering if anyone had

>any advice on how to keep the shoes on. I have tried non-slip

>socks, tying the shoes backwards (from top to bottom), duck tape,

>and many more. If anyone has been at this stage and can help me in

>any way it would be greatly appreciated. She is 2 years old, and

>constantly kicks her shoes off at bedtime. I can only get her to

>wear them 3 to 5 hours per night. She is suppose to wear them 10 to

>12 hours per night. Thanks again.

>

>Louise

>

March 15, 2005

Louise,

I see lots of helpful tips for you, I was wondering if you have tried

just teaching her that she needs to keep them on? Do you think she is

intentionally doing it, or unconsciously kicking her feet in her

sleep? I know she is a bit young for all that reasoning stuff, but if

you can start working on it, it may help in the long run because she

will understand the purpose of the shoes and how they are helping her.

I know some of the kids have dolls or stuffed animals who also wear

the DBB, this might make it more fun for her and she wouldn't want to

kick it off. I know my mom said I used to kick mine off when I was

little (she tried all the same tricks you mentioned), and the only

thing that seemed to work was actually making the bar " fun " , at least

as much as possible.

>

> >Hi, I am a new member to the group and was wondering if anyone had

> >any advice on how to keep the shoes on. I have tried non-slip

> >socks, tying the shoes backwards (from top to bottom), duck tape,

> >and many more. If anyone has been at this stage and can help me in

> >any way it would be greatly appreciated. She is 2 years old, and

> >constantly kicks her shoes off at bedtime. I can only get her to

> >wear them 3 to 5 hours per night. She is suppose to wear them 10 to

> >12 hours per night. Thanks again.

> >

> >Louise

> >

March 15, 2005

I think I'm going to dig out one of my old stuffed bears and put her old

shoes on it (the only pair I've got left lol). That's an excellent idea

! Thanks!

Kori

At 10:49 AM 3/15/2005, you wrote:

>Louise,

>I see lots of helpful tips for you, I was wondering if you have tried

>just teaching her that she needs to keep them on? Do you think she is

>intentionally doing it, or unconsciously kicking her feet in her

>sleep? I know she is a bit young for all that reasoning stuff, but if

>you can start working on it, it may help in the long run because she

>will understand the purpose of the shoes and how they are helping her.

> I know some of the kids have dolls or stuffed animals who also wear

>the DBB, this might make it more fun for her and she wouldn't want to

>kick it off. I know my mom said I used to kick mine off when I was

>little (she tried all the same tricks you mentioned), and the only

>thing that seemed to work was actually making the bar " fun " , at least

>as much as possible.

>

> >

> > >Hi, I am a new member to the group and was wondering if anyone had

> > >any advice on how to keep the shoes on. I have tried non-slip

> > >socks, tying the shoes backwards (from top to bottom), duck tape,

> > >and many more. If anyone has been at this stage and can help me in

> > >any way it would be greatly appreciated. She is 2 years old, and

> > >constantly kicks her shoes off at bedtime. I can only get her to

> > >wear them 3 to 5 hours per night. She is suppose to wear them 10 to

> > >12 hours per night. Thanks again.

> > >

> > >Louise

> > >

March 16, 2005

Thankyou kindly for writing back to me with all that great advice. I have her

slots in the bottom one, and had heal guards put into the back of her shoes. I

had taken her up to London, Ont to the place that makes the DBB shoes and he

watched me and also put the shoes on himself and she got out of them in less

than 1 minute after putting them on. He said " Good luck! " He said maybe

putting a sack on her feet so she doesn't think about them.

She doesn't get those red marks on the top of her feet from the straps as I can

see. Maybe they are not on tight enough? She doesn't get blisters either and

her feet are not narrow, quite chubby looking but not fat feet.

I will definetly get some pics of her feet for help, that would be great for

some advice.

Dr. Carey in London (Canada) says her feet look really good other than her right

foot was tightening up again ( because she didn't have them on for almost 3

months due to teething and no one in the house was getting any sleep) I finally

go her back in them and in Nov/04 I was told I had until April 28 to get her

right foot better or he would start castings, or minor tenotomy again on her

tendon. So I am a little worried about going back in April . I have stayed up

at night to make sure she wears them everynight for atleast 3 hours. Its

catching up on me in the lack of sleep department. However I don't want her to

ask why I never tried harder for her to keep them on.

Her foot on the outside where the pinky toes are the tendon or muscle isn't

tight enough either so they bend down slightly, he said that was more cosmetic

surgery, nothing that will stop her from doing anything she wanted.

Sorry about going on like this I guess its extremely nice to talk to someone who

knows what I am going through. Thanks again for your help.

Take care.

Louise

frogabog frogabog@...> wrote: