June 26, 2007 -- A new brace that maintains correction for
clubfoot, a birth defect in which the foot is turned in toward the
body, has shown better compliance and fewer complications than
the traditional brace used to treat the condition.
Orthopedic surgeon Matthew Dobbs describes the differences
between a traditional brace for clubfoot and the new version he
designed. Dobbs' brace allows for more mobility, which helps
preserve muscles in the foot.
Matthew B. Dobbs, M.D., associate professor of orthopedic
surgery at the School of Medicine, designed the new dynamic
brace, called the Dobbs brace, to allow active movement, preserve
muscle strength in the foot and ankle and be less restrictive to the
child than the traditional brace.
Dobbs tested the brace on 28 patients who had already received
non-surgical treatment for their clubfeet at St. Louis Children's
Hospital and St. Louis Shriners Hospital. Over a two- to three-year
follow-up period, Dobbs and his colleagues found that the Dobbs
brace is at least as effective as the traditional brace and resulted
in better compliance by parents.
Results of the study appear in the July/August issue of the Journal
of Pediatric Orthopaedics. Dobbs is senior author.
Dobbs first treated children with clubfoot deformity using the
Ponseti method. The treatment, developed in the 1950s by Ignacio
Ponseti, M.D., professor emeritus of orthopedics and rehabilitation
at the University of Iowa, involves weekly casting and manipulation
of the clubfoot soon after birth. When done correctly, the Ponseti
method greatly reduces the need for extensive surgery, which can
contribute to painful and arthritic feet in adulthood. The children
with clubfoot whom Ponseti treated with this method were likely to
have normally functioning, pain-free, flexible feet in adulthood.
Traditionally, children who have been treated for clubfoot using
the Ponseti method must wear a nighttime brace that turns their
feet away from the body for three to four years following the initial
casting treatment. The brace has open-toed, high-top shoes
attached to a shoulder-width fixed metal bar. Because of skin
blistering and the brace's restriction of leg motion, many parents
used the brace less than had been prescribed, which can allow
recurrent clubfoot deformities that may require extensive surgery.
In fact, past studies had shown that about 30 percent to 40
percent of families do not use the traditional brace as prescribed.
In contrast, the new brace has a soft, custom-molded interface
that is placed inside of a solid ankle-foot orthosis, an orthopedic
appliance designed to maintain alignment of the bones in the foot
and ankle. The bar connecting the feet has a release mechanism
that allows parents to easily detach and reattach the bar to place
the child in a car seat or high chair or change a diaper without
removing the entire brace. Other differences from the traditional
brace is that the Dobbs brace also allows children to move their
legs independently while wearing the brace.
Dobbs said these changes are key to preventing a recurrence of
clubfoot.
"While we've had good success in obtaining correction in clubfeet,
maintaining that correction has been more challenging," Dobbs
said. "If the child is tolerating the brace well, there is a higher
likelihood of parental compliance."
All 28 patients in the study had reached full correction for their
clubfoot before being fitted for the brace. Eighteen patients who
had not been wearing the traditional brace as prescribed were
fitted for the Dobbs brace. The remaining patients were fitted only
for the Dobbs brace. All but two patients wore the brace as
prescribed.
Of the two patients who were noncompliant in wearing the brace,
one patient had skin blistering due to improper use of the brace,
which was eventually corrected, while the other patient was not
kept in the brace because of the caregiver's work schedule.
"The newly designed, more flexible foot abduction orthosis is
equally effective, or more so, than the traditional brace,
considering rates of clubfoot relapse were less with the new
orthosis than those reported in several series using the traditional
brace," Dobbs said. "Although our experience with the dynamic
brace has been favorable, a randomized study comparing the
dynamic orthosis to the traditional brace would provide a more
accurate assessment of outcome."
Dobbs said the bar connecting the feet can be used with other
types of corrective footwear for clubfoot.
"Just having the flexible bar makes a huge difference in
compliance and convenience," he said.
_____________________________________
The Dobbs brace was patented and is licensed through the University's Office of
Technology Management.
Chen R, Gordon J, Luhmann S, Schoenecker P, Dobbs, M. A New Dynamic Foot
Abduction Orthosis for Clubfoot Treatment. Journal of Pediatric Orthopaedics,
July/August 2007, pp. 522-528.
Funding from the Barnes-Jewish Hospital Foundation supported this research.
Washington University School of Medicine's full-time and volunteer faculty physicians
also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School
of Medicine is one of the leading medical research, teaching and patient care
institutions in the nation, currently ranked fourth in the nation by U.S. News & World
Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the
School of Medicine is linked to BJC HealthCare.
clubfoot, a birth defect in which the foot is turned in toward the
body, has shown better compliance and fewer complications than
the traditional brace used to treat the condition.
Orthopedic surgeon Matthew Dobbs describes the differences
between a traditional brace for clubfoot and the new version he
designed. Dobbs' brace allows for more mobility, which helps
preserve muscles in the foot.
Matthew B. Dobbs, M.D., associate professor of orthopedic
surgery at the School of Medicine, designed the new dynamic
brace, called the Dobbs brace, to allow active movement, preserve
muscle strength in the foot and ankle and be less restrictive to the
child than the traditional brace.
Dobbs tested the brace on 28 patients who had already received
non-surgical treatment for their clubfeet at St. Louis Children's
Hospital and St. Louis Shriners Hospital. Over a two- to three-year
follow-up period, Dobbs and his colleagues found that the Dobbs
brace is at least as effective as the traditional brace and resulted
in better compliance by parents.
Results of the study appear in the July/August issue of the Journal
of Pediatric Orthopaedics. Dobbs is senior author.
Dobbs first treated children with clubfoot deformity using the
Ponseti method. The treatment, developed in the 1950s by Ignacio
Ponseti, M.D., professor emeritus of orthopedics and rehabilitation
at the University of Iowa, involves weekly casting and manipulation
of the clubfoot soon after birth. When done correctly, the Ponseti
method greatly reduces the need for extensive surgery, which can
contribute to painful and arthritic feet in adulthood. The children
with clubfoot whom Ponseti treated with this method were likely to
have normally functioning, pain-free, flexible feet in adulthood.
Traditionally, children who have been treated for clubfoot using
the Ponseti method must wear a nighttime brace that turns their
feet away from the body for three to four years following the initial
casting treatment. The brace has open-toed, high-top shoes
attached to a shoulder-width fixed metal bar. Because of skin
blistering and the brace's restriction of leg motion, many parents
used the brace less than had been prescribed, which can allow
recurrent clubfoot deformities that may require extensive surgery.
In fact, past studies had shown that about 30 percent to 40
percent of families do not use the traditional brace as prescribed.
In contrast, the new brace has a soft, custom-molded interface
that is placed inside of a solid ankle-foot orthosis, an orthopedic
appliance designed to maintain alignment of the bones in the foot
and ankle. The bar connecting the feet has a release mechanism
that allows parents to easily detach and reattach the bar to place
the child in a car seat or high chair or change a diaper without
removing the entire brace. Other differences from the traditional
brace is that the Dobbs brace also allows children to move their
legs independently while wearing the brace.
Dobbs said these changes are key to preventing a recurrence of
clubfoot.
"While we've had good success in obtaining correction in clubfeet,
maintaining that correction has been more challenging," Dobbs
said. "If the child is tolerating the brace well, there is a higher
likelihood of parental compliance."
All 28 patients in the study had reached full correction for their
clubfoot before being fitted for the brace. Eighteen patients who
had not been wearing the traditional brace as prescribed were
fitted for the Dobbs brace. The remaining patients were fitted only
for the Dobbs brace. All but two patients wore the brace as
prescribed.
Of the two patients who were noncompliant in wearing the brace,
one patient had skin blistering due to improper use of the brace,
which was eventually corrected, while the other patient was not
kept in the brace because of the caregiver's work schedule.
"The newly designed, more flexible foot abduction orthosis is
equally effective, or more so, than the traditional brace,
considering rates of clubfoot relapse were less with the new
orthosis than those reported in several series using the traditional
brace," Dobbs said. "Although our experience with the dynamic
brace has been favorable, a randomized study comparing the
dynamic orthosis to the traditional brace would provide a more
accurate assessment of outcome."
Dobbs said the bar connecting the feet can be used with other
types of corrective footwear for clubfoot.
"Just having the flexible bar makes a huge difference in
compliance and convenience," he said.
_____________________________________
The Dobbs brace was patented and is licensed through the University's Office of
Technology Management.
Chen R, Gordon J, Luhmann S, Schoenecker P, Dobbs, M. A New Dynamic Foot
Abduction Orthosis for Clubfoot Treatment. Journal of Pediatric Orthopaedics,
July/August 2007, pp. 522-528.
Funding from the Barnes-Jewish Hospital Foundation supported this research.
Washington University School of Medicine's full-time and volunteer faculty physicians
also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School
of Medicine is one of the leading medical research, teaching and patient care
institutions in the nation, currently ranked fourth in the nation by U.S. News & World
Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the
School of Medicine is linked to BJC HealthCare.
The following article is reprinted with permission from Beth Miller and the Wahsington University at St. Louis
School of Medicine. This article may also be viewed on the web by clicking here.
School of Medicine. This article may also be viewed on the web by clicking here.
| New dynamic brace developed to advance clubfoot treatment By Beth Miller |
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