Ponseti-AFO - tips on using the Mitchell Foot Abduction Brace

There are two main types of clubfoot braces used today: The Markell, and the Mitchell. To
identify which shoe you have, you can look on my clubfoot braces page.

If you have the Mitchell brace, also known as the Ponseti AFO, the following is a list of tips
and tricks offered by other parents who use this style of brace. If you are still having trouble
with using your Mitchell shoes after reading this document, I strongly suggest you join the
Nosurgery 4 Clubfoot Group where hundreds of other parents come together to help each
other navigate their clubfoot treatment process.

The AFOs come preset at 60 degrees which is the same as 70 degrees in the Markells.
Your consultant will advise as necessary whether the angles can be adjusted.

When you first get the sandals, try and treat them with a suede protector – helps with
spills!
You may find it helpful to dip the ends of the straps in varnish – it hardens the suede
and makes it easier to thread them through the buckle.
Children should always wear socks – ideally with rubber wording underneath as this
helps with grip, such as the socks from GAP or the M & S Petit Babe range
For younger children who sleep a lot, it may be helpful when first using the AFO, to put
it on whilst the child is asleep – this helps you to get used to how they fit, and get the
‘knack’ of fitting them when the legs are still!
When fitting, lay the child on their back, or sitting with the feet towards you. For
children under a year, some parents have found sitting them in a ‘bumbo’ chair, makes
fitting easier.
If the feet have different levels of correction, fit the least corrected one first
It can be difficult to ‘slide’ the feet into the shoes. So hold the foot on either side of the
ankle, and place in to the back of the shoe – as far back and down as you can get it.
Hold the foot in this position whilst doing the buckles up. If the foot moves, then refit.
Do the middle buckle first, followed by the top and bottom buckles
Make sure there are no kinks in the leather.
The middle strap is the most important strap – ensure this is nice and tight
Don’t expect the heel to always ‘come down’ right from the start – in some cases it can
take a number of weeks
Ensure the length of the AFO (from middle screw to middle screw) is the same width or
slightly longer than the width of the shoulders
If the degrees need to be adjusted, you need to remove the outer screw, then the
screw in the middle just needs to be loosened to turn the dial, then depending on the
angle you want, the screw needs to go back into a hole which aligns with the angle
(you'll see when you do it for yourselves!)
When putting the shoes on at bedtime, try and allow time for the child to wear the
shoes for a while before going to bed. This seems to help children settle better than if
the shoes are put on immediately before getting into bed.