Club Foot

My baby was born with bilateral club foot. From 3 weeks old went through the casting correction series. After the 7th week he had the minor surgery where the tendons at the back of the feet were cut/lengthened. He now has to wear the Dennis Brown Bar shoes until he starts to walk. After than he the orthopedic suggests that he wears them at night only when he is sleeping.

He is now 4 months old and it has been about 4 weeks since he received the DBB shoes and he still hasn't gotten accustomed to the bar, partly because I keep taking them off when he gets really fussy. He doesn't sleep through the night with them and I am wondering if the bar is really necessary. Currently the bar is removed and he is wearing the shoes only. Should I reattach the bar? Is there any alternative? I just can't see him fussing and crying all the time when normally he is a happy baby.

Any suggestions or comments?

Please please please - before you give up on the DBB, look into modifications you can make so he will stay in it. While the AFO's seem easier at first, from what I've learned you may regret using them in the long run. The rate of relapse with the AFO's is huge, especially when compared to the DBB. While it is hard (believe me, I've been there) you must find a way to keep him in those shoes! It will be worth it in the long run.

Are the shoes fitting correctly - do they slip off or do his toes hang over the edge? Has he developed sores on his feet that are causing discomfort? Olivia was put in the shoes at 4 months and did NOT tolerate them... turns out her feet were just too small. Other times it was because the shoes were on too tight or causing her pain. Sometimes the orthotics department can put inserts into the shoes to make them fit better as well.

If you need a break from the shoes and it's just not working, talk to your doc about recasting him for a few weeks. That is what we did with Olivia - we got to start fresh with the shoes, fitting properly, and it made all the difference.

Unfortunately, we weren't great about keeping her shoes on for the length necessary and she DID relapse - had to have another tenotomy a few weeks ago. We'll start all over again once her casts come off.

Good luck! Don't give up!

Darby
Livi 3/15/04 bi cf 2nd tenotomy 3/15/05
EDD #2 5/12/05

I have had this same problem with my son Thomas.  Please keep him in them.  Thomas will be 4 months on the 3rd and has been casted, relaps, casted again and placed in the DBB for a month and I wouldn't have it any other way.  Thomas hates them and tends to slip out of them but its worth it.  I just took him to his Ortho check up and it was worth all the hassle and stress they can cause.  He to only has to wear his at night so what I do is alternate.  One day he wears them during the day and then the other he wears them at night.  This was he is getting the same amount of time in the shoes but doesn't get so fussy.  I have found this to work with him.  He has learned to maniputale the bar to help him roll over and it seems to me that he doesn't even notice it much anymore.  Give it a little while longer you will see a change in him.

There have been several studies done that found the relpase rate is very high (about 80 percent) if the brace (shoes and bar) is not used. So, as a mom who's been around for a while and know of children who have had relapses after discontinuing the brace too early, I say, yes! the brace is necessary.

Correction with casts and the tenotomy is only the beginning. Follow up with bracing is a vital part of the process. It's helpful, I think, to remember that clubfoot a condition that remains 'active' for several years.. the same processes which caused the foot to turn in in the first place are still 'working' on the foot for several years. And the brace, (FAB, or DBB, shoes attached to a bar) is the best way that has been found to keep relapse from happening.

Here's more information from the Global Health booklet on clubfoot treatment. The 'foot abduction brace' is the DBB:

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Importance of bracing

The Ponseti manipulations combined with the percutaneous tenotomy regularly achieve an excellent result. However, without a diligent follow-up bracing program, recurrence and relapse occur in more than 80% of cases. This is in contrast to a relapse rate of only 6% in compliant families (Morcuende et al.).

Alternatives to foot abduction brace

Some surgeons have tried to “improve” Ponseti management by modifying the brace protocol or by using different braces. They think that the child will be more comfortable without the bar and so advise use of straight last shoes alone. This strategy always fails. The straight last shoes by themselves do nothing. They function only as an attachment point for the bar.
http://www.global-help.org/publications/cf-english.pdf

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Here are more figures from Dr. Jose Morcuende at the Universisty of Iowa:

Overall, the odds of relapse if no bracing is used whatsoever
: <12 months = 80-90 %; <2 years: 60-70%; 3-4 years:
20%, 4-6 years; 1%.

I encourage you to stick with it. Even a short time without it on could lead to the beginning of a relapse and the need for more casting.

It's best to keep the brace on around the clock till the baby is comfortable and gets used to it. That usually only takes a few days to a week. Taking it off only prolongs the adjustment, as hard as it might be.. But if the feet are fully corrected, and the brace is set up right, there's nothing that is hurting the baby.. and in no time it will be part of his and your routine.

If you have any doubts about the feet being corrected or the brace not being right, follow your instincts and check into it to make sure.

You might also want to check out this parent support group for help with the brace.. there are many experienced parents there:
http://health.groups.yahoo.com/group/nosurgery4clubfoot/

Hope this helps .. hang in there.

Teresa and Claire
left cf, age 4 12