Clubfoot Guide for Parents - Success with the Ponseti Method - Orthopaedic Institute for Children
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Clubfoot Guide
for Parents
Success with the Ponseti Method
As LA’s premiere clubfoot specialists, our goal is the same as yours. We want nothing less than the very best for your child and family, and the team at our award-winning Clubfoot Center is dedicated to ensuring that each child that walks through our door receives the care they so rightfully deserve. We’re here for you, and with you…every step of the way.
What is Clubfoot and what causes it?
Congenital clubfoot is a complex deformity that is readily apparent at
birth and affects the muscles, ligaments, bones and joints of the
developing foot and ankle.
The ankle is rotated downward, and the toes point inward towards the opposite leg.
All foot bones are usually present but are out of normal alignment. All of the foot
and leg muscles are also present, but some are smaller and weaker than normal.
Tendons and ligaments are contracted, especially behind the ankle and along
the instep. To this day, what casuses clubfoot it is unknown, but one thing is for sure.
It is NOT the parent’s fault!
When should my child begin treatment?
Babies suspected of having clubfoot are usually referred
right away to an orthopaedic team or clubfoot center,
such as OIC. Infants are seen within a few weeks and
treatment begins immediately.
Why is bracing so important in the
Ponseti method?
Clubfeet have a stubborn tendency to relapse,
or come back, after casting correction. To prevent relapse,
your doctor will prescribe a brace to hold the foot/feet in
the corrected position after removal of the last cast.
Relapse facts to remember:
If parents don’t use the brace as your doctor advises,
your child will relapse. Those who don’t use the brace
accordingly are 183 times more likely to relapse!
In fact, if the brace is not worn as directed:
9 out of 10 children will relapse the first year.
7 out of 10 children will relapse the second year.
3 out of 10 children will relapse the third year.
PLEASE USE THE BRACE AS ADVISED BY THE DOCTOR,
IT’S FOR YOUR CHILD’S GOOD HEALTH.
All you need to know about bracing your child.
What is a foot abduction brace (FAB)?
A foot abduction brace (FAB) is a brace specifically designed to “abduct”
the foot and dorsiflex the ankle (toes pointing upward) to maintain treated
clubfeet in a fully corrected position. It consists of two boots connected
by a bar that holds the feet in the same corrected position as the last cast.
How are my child’s brace set up?
The FAB will be set up by our orthotist. As your child grows,
larger shoes and longer bars will be supplied. It helps to be
knowledgeable about some of the adjustments.
Bar length: Your child’s shoulders should fit in the distance
between the inside heels of the boots.
Foot abduction: Each brace has a slightly different recommended
angle, the Ponseti AFO: 60 degrees for the clubfoot and 40 degrees
for the unaffected foot. We will guide you on what is best for your child.
Dorsiflexion: Usually 10 degrees of dorsiflexion is sufficient.
The Ponseti AFO has this built in.
How many hours a day will my child need to wear the brace?
The brace is worn for 23 hours a day for 3 months allowing an hour each day for brace-free bath time and
snuggle and cuddle time, and then during naptime and nighttime for approximately 3 years.
After 3 months your child will wear the brace about 16 hours a day.
The time in the brace will keep decreasing as your child becomes more active. When your child can walk,
they will wear the brace for 10 to 12 hours at night.
This is the goal until they are 5 years old.
How long will my child need to use the brace?
Every child varies, though the duration of brace wear will vary depending on the severity of clubfoot and will be
determined by your physician. You will follow up with us regularly as your child grows out of his or her boots or
as they need adjustment.
Bracing tips from your fellow clubfoot parents:
• Wrap pipe insulation around the bar to pad it, it will make for a more comfortable hold,
carry, and feeding time.
• Pick clothes that make bracing simpler, like onesies with snaps (avoid onesies with footies.)
• Make it part of your bedtime routine.
• Play with your child in the brace.
• They will cry, you are not hurting them. (Soothe them by gently moving the bar up and down,
push and pull the brace to help them learn how to bend their knee in the brace.)
• Babies get used to the brace, usually after the first night or two, and a normal routine
is established.
How do I put the brace on my child?
Step 1: P ut thin cotton socks on your child. The socks should go higher up on your child’s leg than
the top buckle of the shoe.
Step 2: P ush all the flaps on the shoe back and slide your child’s heel to the back and bottom part
of the shoe. The buckle on the shoe should be on the inside part of your child’s foot.
Step 3: P ull the tongue over the foot. Make sure this piece is lying flat and smooth across the foot.
Step 4: Buckle the middle strap first! Check that the strap is buckled snugly over the ankle.
Step 5: B uckle the top strap that goes over the ankle and the bottom strap that goes over the toes.
Step 6: L ook through the holes in the heel of the shoe.
• Make sure that your child’s heel is as far down and back in the shoe as possible.
• Readjust the tongue and the middle strap until the foot is in the shoe the right way.
• Retighten any straps that may have come loose.
Step 7: Repeat the other shoe.
Step 8: Click the shoe onto the bar.
What to expect, and what to look out for.
As a parent, you are always thinking about your child’s well-being. We understand that bracing at home can feel
overwhelming at times, it’s only natural to worry. But don’t fear, we’re here to help you look out for what’s healthy,
and what you should talk to your doctor about.
Normal:
Crying, fussiness
Redness that goes away in about 20 minutes
Your child’s ankle and foot may be smaller where the strap of the shoe fits.
Not normal:
Redness or blisters
When a shoe is not fitting right, it will cause blisters, some common causes:
• The straps are too loose, a very common reason
• Your child has outgrown the shoe
• Straps might be too tight
• Fabric of the shoes or socks are not smooth against the skin
A Special Note To Parents
For over 20 years I’ve had the honor of caring for our
community’s children, specializing in clubfoot. I know
treating clubfoot takes more than the highest levels of
training, more than mastering the Ponseti method,
more than decades of clinical experience. What it really
takes is passion and partnership. It takes an understanding
that you are not treating a diagnosis, you are treating
a family, who are depending on you. Together we can
work to ensure your child will stand tall.
Mauricio Silva, M.D.Downtown Los Angeles
403 West Adams Boulevard, Los Angeles, CA 90007
Clinic: 213 -741- 8362
Appointments: 213 -741- 8 330
Medical Professionals Only: 213 -742 -1109
Santa Monica
Luskin Children’s Clinic, UCLA Medical Center, Santa Monica
1250 16th Street, Suite 2100B, Santa Monica, CA 90404
Appointments or referrals: 424-259-9835
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