In these two photos, you see Garrison wearing Brian's old pair of AFO clubfoot braces. The feet are obviously free to move in any direction they want, so no correction is being held at all, allowing the feet to begin the process of relapsing to their previously clubbed state. |
The series of photos above show you that clubfoot and wearing the foot abduction brace does not interfer with my son's fun or play. Two previously clubfooted boys climbing a tree (Brian, and Everett who still wears his FAB 12 hours a night). Everett wearing his FAB building some weird thing to climb up on for sport. Everett up on a playground with our friend. |
Wearing a foot abduction brace doesn't have to cramp your family's life style, nor your child's ability to play, develop and enjoy life. Above, 2 month old Garrison went on a bow-fishing tournament with his father and I, spending six hours out on a boat - we still managed to win 3rd place! Below, all three of our previously clubfooted boys are going out fishing with Dad; Everett only wears his FAB at night so it's not on him here, but Garrison was still in his period of 22 hours a day of FAB wear so there he is, wearing it along with his life jacket. Both items are non-negotiable although I'm willing to bet he'd rather take both off! Photos on this page are thumbnails, click to enlarge. |
| When Kids Say "No." or, "My Kid Hates His Brace! Help!" |
clubfoot braces) has been coming up a lot lately so I have built this page to help iron out the facts about the importance of your kid wearing his or her foot abduction brace. I have heard parents say many times over the years, "My child hates the bar (so we stopped using it)." Tragically, even most doctors warn parents that their child probably won't tolerate the brace, giving instructions such as, "Leave the brace on as much as you can for as long as you can." Those are pretty vague instructions with a loud message spoken between the lines that the parent should not expect much, nor do much, nor is there much to be done even if they wanted to.
non-surgical treatment process end up having surgery anyway. There's a few key points to address right off the top here. First, to wear or not to wear the clubfoot brace is not an option. This is a necessary medical device designed to prevent the relapse of the talipes condition in a child whose foot, or feet, have been corrected by a serial casting method. If your child had to take a prescription medication ten times a day to prevent some mentally crippling brain disease, you'd shove those pills down his throat no matter how bad they tasted, right? Yet, being a foot abduction brace, a piece of hardware strapped on to the kid, a lot of parents don't take the treatment near as seriously as they should. "But my kid hates his clubfoot brace!" they say. He probably hates having to hold hands to cross a busy street, too, but would you just let him run in traffic unsupervised? Doubtful. If he said, "But Mommy I love the taste of rat poison!" would you feed it to him? Hardly! If your child hates his brace, it could be an issue with poor fitting, we'll address that later.
wish to believe in mapped out a plan that babies need parents because babies do not know how to take care of themselves, nor do they have the mental capacity to make their own wise decisions in life. Babies, and I use that term to include children up to four and even five years old, will drink gasoline; they will climb a ladder to the top of the roof and fall off; they will walk in front of a speeding truck; they will put their hand in the mouth of a lion; they will step off a cliff; they will eat all the candy in the world and skip all nutritious food. Babies have no real common sense. They have no concept of pain, disaster, illness, injury, tragedy or regret. Kids just want to do what feels good to them at any given moment, plain and simple. This is why they have parents to keep them safe and to make all those hard, but smart decisions regarding their health and safety - which includes wearing their clubfoot brace. Wearing it is not an option; keeping it on is not a choice that child should be given to make, because any child in his right mind would choose to throw it away. But my kid only has one clubfoot, why should he suffer having both feet braced? Why can't he just wear a brace on the affected foot? Because this is how the foot abduction brace works. By bracing one foot against the other, clubbed or not, the feet are held in the position they need to stay in for optimum long term results. A unilateral clubfoot cannot be held unless it is held against the other foot, even if that other foot is not clubbed. The so called boots on a bar are designed (quite successfully) to hold the feet at a 70 degree angle of outward rotation (60 degrees in the Mitchell brand), with the toes kicked up to 10 degrees of dorsiflexion. In a Bilateral clubfoot case, both feet will be rotated to the 60 or 70 degree mark. In Unilateral clubfoot cases, only the affected foot will be set at this extreme while the non- clubbed foot will be set at approximately 45 degrees. Rotation is the foot's ability to move from left to right; dorsiflex is the ability to move the foot up and down at the ankle. (Clubfoot Glossary) If you are wearing shoes right now as you read this, we can easily demonstrate the reason a clubfoot brace with no bar is ineffective. Try pointing your toes down, as if you were going to stand on them like a ballerina. Now bring them back up. You can move your feet up and down. Next, point the toes of your left foot towards the toes of your right foot. Now swing your feet out to point away from each other. You notice, even with shoes on, and even with heavy lace up boots on, you can do these movements with your feet. A clubfooted child wearing a brace with no bar is wearing nothing more than a fancy shoe, and he too can move his feet up and down, back and forth. So why is this a problem? Because the genetic impulse of a clubbed foot is to turn in and point down. With out the bar stabilizing the feet against each other, the clubbed foot/feet are going to gravitate back to their clubbed position (i.e. in and down). The muscles and tendons that were so carefully stretched and the bones that were so delicately put back in proper position during casting are going to begin their migration back home, the place of their birth. Another example for you to try: Either barefooted or with shoes on, relax your feet. What position do they naturally fall in to? Toes pointed together, and pointed down. Any clubfoot brace with out a bar in use is going to allow the feet to fall in to this down and in position, letting the tendons shrink back up and letting the foot relapse back to it's previously clubbed condition. Next Example: spread you feet apart to shoulder width. Point your toes out to approximately 60 or 70 degrees of outward rotation. Now kick your ankles up just a little to about 10 degrees of dorsiflexion. Hold them there. Do you feel the amount of stretch that is happening in your heel? Do you feel how impossible it would be to let the foot curl in to a clubbed position from this place? That is the magic of the foot abduction brace, aka, boots on a bar. My kid's feet look fine, the doctor said so! Why do we need to keep wearing this thing? Your child's feet look fine because he HAS been wearing his foot abduction brace. Age 2 years is the most common time for parents and doctors to stop use of the FAB, due to common belief that the feet look fine so they will continue to be fine. Wrong! According to research at the Ponseti Clubfoot Clinic in Iowa City, Iowa, (the world wide mecca of clubfoot research and treatment development) children still have an 80 to 90% chance of suffering a relapse in their 2nd year after serial casting. There is still very strong 50 to 60% chance of relapse in the third year. During the fourth year there is still a one-in-five chance the child's feet will relapse with a decline to 10 percent or less in the fifth year and beyond. Just because the feet look good at two years old doesn't mean the feet will stay good! Remember, at age two, there is still an 85% chance they will relapse, meaning only about a 15% chance they'll stay good! chance your child will have to return to serial casting if not even surgery to fix something you could have prevented? Long term parental compliance of the kids clubfoot brace is 80% of the treatment. Serial casting does 20% in fixing the feet, but the long term use of the foot abduction brace does the other 80% bringing your child up to a a 100% correction in 95% of the cases this method is used in. Reasons your kid might hate his clubfoot brace: A toddler age child who objects strongly to anything is a rather unpleasant animal to live with as any parent of toddlers can testify! "NO!" and "I don't want to!" become some of their favorite phrases as he learns he actually has some power in the house. You may notice your child exercising his power in many areas - not wanting dressed, not wanting his car seat buckled, not wanting to eat his favorite food - objecting to things simply because he has learned that he can and it's like a new toy that must be played with! If or when your toddler decides to tell you 'NO I don't want to wear my brace!", this is the time when parents have to buck up and do it anyway. It's not an option. Would you forego the car seat? No, so do not forego the brace either. Explain to your child why he needs to wear it. Show him photographs of his feet at birth, and of the casts he had to wear. Explain in simple terms the brace keeps his feet from curling up again. Then put it on. If the child fights and screams and cries, put it on anyway. He'll quickly learn that his fits are not winning and he'll give up. In some situations, the child begins to object because he has been given the option to wear or not wear up to this point, so now he's going to put his foot down (no pun intended!) and tell you no more brace. This is what we call Parental Inconsistency, or Parental Non-Compliance. The parent has not been consistent with it's use, therefore the child has learned the brace is more of an optional item than a mandatory item. This can happen for a couple of reasons and only you can decide if any of these apply to you and your situation or not: Parent is ashamed of the public seeing the brace and knowing the child has a birth defect so parent doesn't use it, or fails to use it as much as prescribed. Parent pities the child having to wear the brace so it's taken off. Parent is not properly educated to the importance of using the brace. Parent is not educated to the proper way to apply the brace so it's hard and clumsy to use. (Read the section FAB Wear Tips) Brace is not set up properly so the child is uncomfortable and cries a lot (so the parent takes it off). Again, refer to FAB Wear Tips linked above. I can't help with any mental hangups you might suffer, but the other things, I can. There are a few physical reasons the child might hate his clubfoot brace - consider these, make changes if necessary, then put the brace on anyway. It's not an option. The child has no choice in this matter. Reason #1: He has outgrown his bar. You can easily demonstrate on yourself again the discomfort a child would feel if their bar was too narrow. Put your feet in to the 70 degrees of rotation and 10 degrees of dorsiflexion again, but now instead of placing your heels shoulder width apart, bring them in closer together. Discomfort can be felt in the legs and hips and feet. Adjust his bar as necessary; if you do not have an adjustable bar, insist on getting one, they are available. If your doctor says no, demand you get one and keep demanding until he decides to humor the lunatic woman to get her out of his office. If possible, educate your doctor, yes, it is possible. There is a lot of mixed information regarding how to adjust the bar. Some say measure the distance between the bolts on the bottom; other say measure the distance between the heels of the shoes. That's all well and good except almost no two pair of shoes are the same. Bolts on a newborn size are placed differently than the bolts on a toddler size. The screw on a Mitchell FAB is not in the same place as a bolt on the Markell style. A good general rule of thumb to check bar width correctly is to simply eye-ball it. Does it appear the child's heels are shoulder width apart? Another more accurate way is to lay the brace on a hard flat surface (table or floor), then lay your child down between the shoes. If his shoulders fit neatly between the shoes with out scrunching up, nor with out gobs of room on either side, then it's OK. If in doubt, it is better to err on the side of a little too wide than a little too narrow. Children who have been wearing their FAB with out issue who suddenly have sleep disturbances have most likely outgrown their bar! Reason #2: The child's feet are not in shape for the clubfoot brace. Either the doctor did not achieve full correction prior to prescribing the brace, or, due to Parental Non- Compliance, the feet have been allowed to relapse to some degree. In either event, a non-corrected clubfoot in a foot abduction brace is going to HURT. The child will suffer pain, blisters, pressure sores, loss of appetite, lack of sleep, mental unrest, physical decline.... It is at this point a bad doctor will tell a parent, "Well there's nothing more we can do." but a good doctor is going to say, "Lets give him one or two more casts to get the feet back in shape and try it again." This doctor is going to help you discover why the FAB is hurting, and help you correct the issue. If you don't have this doctor, you have to become your own specialist. Look at the brace first: Is it set to the proper degree of rotation? Is the bar bent to provide the 10 degrees of upward dorsiflexion? Are the child's heels shoulder width apart as he wears the brace? Can you notice any defect in the brace such as a bulky seam that might be hurting? Are there seams in the socks you use that are pressing in to the foot? If these things are good, it's time to consider his actual feet. Even though they may "look" good, there's that popular chance they have regressed internally in a way that is not noticeable externally (yet). If your current doctor is not willing to examine and potentially re-cast the foot, it's time to find a new doctor. If the doctor is quite confident the foot is OK and you as a parent believe him, then consider changing FAB's. If you are using the Markell, ask for the Mitchell. It may take a few weeks to get the new brace, so consider with your doctor putting the child in to a "holding cast" to prevent any relapse until the brace arrives to you. If the Mitchell's don't solve your brace wearing nightmares, go back to considering your child's feet need further casting treatment and seek out a qualified Ponseti Method second-opinion. A kid's clubfoot brace shouldn't be difficult to use, nor should it cause the child pain or discomfort in any way. When used from infancy in a constant and consistent manner as prescribed in the Ponseti Method, by the time your child is old enough to verbalize or express any objections, the FAB should be such a normal part of his life that he will have very few (if any) objections. Used correctly, it is very common for older kids to literally freak out when it comes time to stop using the FAB; many parents find they have to "wean" their child off of it because wearing it has become so ingrained on this child's brain. Remember: Kids only fight over their FAB for two valid reasons: One, the FAB is hurting (it shouldn't so something is wrong) and Two, the parents haven't taught the child from infancy that the brace is non-negotiable. |
Contrary to the photo to your right of a bar being too narrow, this photo shows Garrison at 4 months old, his bar correctly set to fix his heels at shoulder width. |
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| Kid's Clubfoot Braces Wearing the FAB should be as mandatory as a seat belt. |
| Return to Kid's Clubfoot Braces Top of Page Learn More About Various Clubfoot Braces Read tips to help make FAB Wear a success Six-Feet.com |
The Mitchell Clubfoot Brace with an adjustable bar. |
| This photo shoes an infant wearing a Markell foot abduction brace, (commonly called the Dennis Brown Brace or DBB). Notice this bar is not adjustable. Also notice that while the bar may be as wide as the child's shoulders, the heels are most definitely not shoulder-width apart. Being this narrow is going to be painful and thus counter-productive to the treatment process. . This child's FAB is set up for disaster! |
| This photo shows my oldest son, Brian, at about 16 months old, wearing a style of clubfoot brace called an AFO. AFO's are not a good choice for clubfoot treatment because they do NOT hold either the rotation or the dorsiflexion necessary for successful, permanent correction (see photos below) Notice that his feet still curl inwards, even with the braces on. After six months of non-Ponseti casting and 18 months of full time AFO wear coupled with weekly physical therapy, Brian's feet were now worse than they were at birth. Read Brian's clubfoot story here. |
| In these final two photos you see the Adjustable bar on Brian's old Markell style FAB or DBB. Not real evident in the photo, the two black bands in the center of the bar allow for widening. (click all photos on this page to enlarge them) The other photo shows the heel cut out of the Markell FAB. This is becoming a popular modification to this particular shoe because it lets a parent see if the child's heel is seated completely in the shoe, or not. Also, when a child develops blisters, sores and / or pressure sores from this shoe (usually because the heel is not seated properly), cutting out the heel lets the wound mend as the child continues to wear the brace so correction is not lost |
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