30/11/2019
Clubfoot – boots and bar
Clubfoot, otherwise known as Congenital Talipes Equino Varus (CTEV), is a common condition that affects one or both feet of a newborn baby.
A baby with clubfoot has a foot that turns in at the ankle and points upwards.
Treatment has been shown to be overwhelmingly effective in preventing a relapse when correctly followed.
Treatment
A technique called the Ponseti method is the standard treatment for clubfoot. Your child will have their foot/feet gently stretched, and a series of casts applied to correct the foot. If needed, this is followed by a small procedure to lengthen the Achilles' tendon.
A foot brace, also known as the Dennis Browne bar, is then used to overcorrect the feet and hold them in dorsiflexion (foot pointing up), external rotation (foot pointing out) and valgus (flattened arch). It is essential that bracing only starts once the foot has been fully corrected following plaster casts.
The brace is made up of two shoes attached to an aluminium bar. The distance between the heels of the shoes is about the width of your child’s shoulders.
If both feet are affected, the shoes are set at 60–70 degrees of external (outward) rotation on each side. If only one foot is affected, the unaffected foot is set at 30-40 degrees of external rotation. In both cases, the bar should bend upwards about 10 degrees.
Clubfoot has a tendency to return to its original position (relapse) even after correction. To prevent a relapse, your child’s foot/feet must stay in the overcorrected position for the correct length of time.
How long will my child need the brace?
After the final plaster cast is taken off and the foot is fully corrected, your child will wear the brace:
twenty-three hours a day for the first three months
sixteen hours a day after initial three months
fourteen hours a day once your child is pulling to stand
twelve hours a day once your child is walking
Once your child is wearing the brace for 12 hours a day (overnight and naps), they will continue wearing the brace until they are four years old.
Putting the brace on your child
Dress your child in light cotton socks that are long enough to cover their foot and leg. Change to clean socks daily.
Loosen the strap and laces of the boots. Place the most difficult/affected foot into the boot first.
Bend your child’s knee as you push the heel down into the boot. Hold the foot and heel down as you tighten the ankle strap. (Figure 3)
Lace the shoe tightly. Check heel is down by feeling with your finger. (Figure 4)
Tighten strap one more hole if possible and tighten laces again. Check heel is down again.
Repeat with other boot.
Apply bar to correct angles, as marked on the bottom of the boots.
Follow-up
Further reviews with an orthotist (brace specialist) and physiotherapist will happen every three months until your child is walking. Once their feet are stable, your child will be reviewed every six months. If your child outgrows the boots (toes hanging over the edge), contact your orthotist.
Key points to remember
Clubfoot is a common condition in newborn babies.
Treatment is very effective in correcting and preventing a relapse.
Your child will wear the brace until they are four years old.
