FAB/DBB Tips & Tricks - For Parents (Re: To Everyone)

[Guest guest]

Just moving this up for new members.

> 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//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

> Mama of

> Kenton 6/98

> Merek 3/00

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

> (?`?.???)

> `?.?(?`?.???)

> `?.?.??

>

>

>

>