Info on bracing, from Global Health

[Guest guest]

I was looking at the section on brace wear in the Global Health

booklet recently, and thought perhaps some parents weren't aware of

it. It's tucked at the very end of the booklet.

here it is for those who might be interested, on pages 29,30.

http://www.global-help.org/publications/cf-english.pdf

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Instructions for Brace Use

The foot abduction brace is used only after the clubfoot has been

completely corrected by manipulation and serial casting. Even when

well corrected, the clubfoot has a tendency to relapse until the age

of approximately 4 years. The foot abduction brace, which is the only

successful method of preventing a relapse when used consistently as

described herein, is effective in 90% of the patients. Use of the

brace will not delay your child & #700;s sitting, crawling, or walking.

Foot abduction brace

The brace consists of an adjustable aluminum bar with adjustable

footplates to which straight last shoes attach. The orientation of

the footplates to the bar is set by the orthotist. The shoes are

straight last, meaning they can go on either foot, but the shoes are

set up with the buckles on the inside, so that you do not have to

turn the baby over to tighten the straps and laces. The foot strap is

the key to this device; it does not matter if the strap goes through

the top or bottom holes on the sides of the shoe. On the inside of

the shoe, above the heel, there is a pink pad that creates an area

for a normal heel to develop and grow into; it also helps to prevent

the heel from coming out of the shoe.

Wearing schedule

Use the brace once the last set of casts is removed. The infant wears

the brace for 23 hours a day for the first 3 months after cast

removal. The brace is removed only for baths. For the next 3 to 4

years, the brace is used at night and nap time only. Your physician

will decide on the duration of bracing depending upon the clubfoot

severity. However, do not end treatment early. If you are unsure, ask

your doctor.

Wearing instructions

1. Always use cotton socks that cover the foot everywhere

the shoe touches the baby & #700;s foot and leg. Your baby & #700;s skin may be

sensitive after the last casting, so you may want to use two pairs of

socks for the first 2 days only. After the second day, use only one

pair of socks.

2. If your child does not fuss when you put the brace on, you may

want to focus on getting the worst foot in first and the better one

in second. However, if your baby tends to kick a lot when

putting on the brace, focus on the better foot first, because the

baby will tend to kick into the second shoe.

3. Hold the foot into the shoe and tighten the strap first. The strap

helps keep the heel firmly down into the shoe. Do not mark the hole

on the strap that you use, because with use, the leather strap will

stretch and your mark will become meaningless.

4. Check that the child & #700;s heel is down in the shoe by pulling up and

down on the lower leg. If the toes move backward and forward, the

heel is not down, so you must retighten the strap. A line should be

on the insole of the shoe, indicating the location of the child & #700;s

toes; the toes will be at or beyond this line if the heel is down.

5. Lace the shoes tightly, but do not cut off circulation.

Remember: the strap is the most important part. The laces are used to

help hold the foot in the shoe.

6. Be sure all the baby & #700;s toes are out straight and that none of them

are bent under. Until you are certain

of this, you may want to cut the toe portion out of a pair of socks

so you can clearly see all the toes.

Set up brace

The brace will be set up for you by your orthotist, but you may be

responsible for changing the shoes and widening the bar as your child

grows. Change the shoes only when the baby & #700;s toes completely curl

over the edge of the shoe. The forefoot adduction (inward curving)

usually does not recur, so waiting will not affect the correction but

will save you money. If you do not know what size shoes were used on

the bar, measure the length of the shoe and contact your orthotist.

New shoes will be two sizes larger than the current shoes. You may

contact your local orthotist to order new straight last shoes for the

foot abduction brace. Screws are used on the bottoms of the shoes to

attach the shoes to the footplate on the bar. Mark the joints on the

bar before changing the shoes to ensure a return to the proper

alignment. Attach the shoes with the buckles toward the inside.

You should adjust the width of the bar at this time. Measure the

distance between the outside of the shoulders, this will be equal to

the distance between the center heel screws in the shoe; lengthen the

bar to match your measurements. Mark a line for the location of the

toes the first time the shoes are worn to indicate that the heel is

down.

Helpful tips

1. Expect your child to fuss in the brace for the first 2 days. This

is not because the brace is painful but because it is something new

and different.

2. Play with your child in the brace. This is key to getting over the

irritability quickly. The child is unable to move his/her legs

independently of each other. You must teach your child that he/she

can kick and swing the legs simultaneously with the brace on. You can

do this by gently flexing and extending the knees by pushing and

pulling on the bar of the brace.

3. Make it routine. Children do better if you make this treatment a

routine in your life. During the 3 to 4 years of night and nap time

wear, put the brace on any time your child goes to the " sleeping

spot. " The child will know that when it is that time of day, the

brace needs to be worn. Your child is less likely to fuss if you make

the use of this brace a part of the daily routine.

4. Pad the bar. A bicycle handlebar pad works well for this. By

padding the bar, you will protect your child, yourself, and your

furniture from being hit by the bar when the child is wearing it.

5. Never use lotion on any red spots on the skin. Lotion makes the

problem worse. Some redness is normal with use. Bright red spots or

blisters, especially on the back of the heel, usually indicate that

the shoe was not worn tightly enough. Make sure that the heel stays

down in the shoe. If you notice any bright red spots or blistering,

contact your physician.

6. If your child continues to escape from the brace, and the heel is

not down in the shoe, try the following.

a. Tighten the strap by one more hole.

b. Tighten the laces.

c. Remove the tongue of the shoe (use of the brace without the tongue

will not harm your child).

d. Try lacing the shoes from top to bottom, so that the bow is by the

toes.

7. Periodically tighten the screws on the bar. Tools have been

provided.

http://www.global-help.org/publications/cf-english.pdf