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New Clubfoot Bracing System May Be Easier for Parents and Child

Posted on: 07/12/2007
Children born with a clubfoot must wear special casts and braces for 23 hours a day for three months, and then every night for three to four years. While this traditional bracing system, called the Ponseti method is effective, many children whose parents are not vigilant about the amount of time the brace is worn do not get a full correction of the clubfoot.

When a patient or family doesn't participate fully in a treatment, this is called non-compliance. Researchers have found that parents who are non-compliant usually are so because the braces are too awkward to put on, the child gets upset and is uncomfortable, or the child develops blisters on the feet.

The researchers in this study wanted to see if a newer style of bracing would increase parent compliance, increase the chances of preventing clubfoot relapse after it was corrected using the Ponseti method, and decrease any complications. While the Ponseti method uses stiff boots/shoes attached to a wide metal rod, to hold the feet in place, the new dynamic method allows for some movement of the child's legs, so there can be some muscle movement, and the shoe/boot part is replaced by a softer molded section that is put inside the part that holds the foot.

Twenty-eight patients were studied; they had been treated with the Ponseti method and then the new dynamic method to keep the clubfoot from returning. Eighteen patients had originally used the Ponseti method but the parents had stopped because of blisters or difficulty applying the braces. The rest of the patients had completed their treatment with the Ponseti method.

At the start of treatment with the Ponseti method, all parents were taught how to care for the braces and how to apply them properly. They received support from a special "clubfoot" nurse. The parents were taught how to exercise their child's legs in order to keep the muscles from wasting. The children received their casts/braces between the ages of one week and 77 weeks, but the usual age was around 16 weeks. Follow-up was about 29 months, but ranged from 24 to 36 months.

In this study, the researchers found that non-compliance with the new braces only happened in two cases (7.1 percent) of the patients. Of these two, one child's braces were not being applied properly and caused skin breakdown. With the other child, family scheduling and lack of family support didn't allow for proper bracing. This rate of 7.1 percent compares with a non-compliance rate of 41 percent reported earlier for the Ponseti method. Only 7 percent of patients developed skin blisters with the new system, compared with 23.5 percent with the older system.

The researchers concluded that the new system was well tolerated by both patients and their parents.

References:
Ryan C. Chen, MD, et al. A New Dynamic Foot Abduction Orthosis for Clubfoot Treatment. In Journal of Pediatric Orthopaedics. July/August 2007. Vol. 27. No. 4. Pp.522-528.

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