Denis Browne method, graphic description

[Guest guest]

I have been reading the book on clubfoot treatment by J.H. Kite, written in

1964. It has a fair amount of historical discussion on the treatment of

clubfoot. I thought some of you might be interested in this, from the section

entitled " Denis Browne Splint " . At least because it explains why Dr Ponseti

objects to using the term DBB.

Non-operative, not always so wonderful.

Denis Browne, surgeon to the Hospital for Sick Children in London, has written

many articles to prove his theory that most congenital deformities are due to

intrauterine pressure. Browne recommends the method of treatment which he

described in 1934. He says that function is more important than structure. “The

talipes foot is not corrected until it will go up with the slightest pressure

into a full calcaneo-valgus—that is to say, till the back of the little toe

touches the outer side of the leg. Anything less means imperfect reduction of

the deformity. Full correction must be obtained at the first manipulation.

When the foot is slowly pulled around it gives at its weakest point, the

junction of the tarsus and metatarsus, leaving almost unaffected the center of

the deformity.”

He says he uses a “wood worker’s vice” and a “nutcracker” which is an

instrument with two long levers, in which he can place the foot and exert

tremendous force on the foot when the “resistance is beyond the strength of the

hands.” He then applies his splint. “If, however, great violence has been used

it is probably best to put up the feet in plaster of Paris for a week or so.”

The feet are strapped with adhesive each to a metal foot piece and these

fastened to a bar which can be bent, and the foot plates can be turned outward

as desired on the bar. He says, “I have never seen it applied in my way by

anyone else. Do not be alarmed by a fair amount of swelling after the first

violent manipulations. I have never seen any trouble from it. Never cease the

splinting because of pressure sores or skin irritation. Both are rare, neither

is important.”

Naomi

The Family

Naomi Hannah(02/21/01) Jonah(06/20/03, bilateral clubfoot, FAB 14/7)

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