Clubfoot or Talipes Equinovarus deformity, is one of the most common correctable developmental deformities that affects approximately 150,000 – 200,000 babies worldwide each year (Ponseti International, 2017). Clubfoot can affect one or both feet and is considered a developmental deformity, as foetuses that develop club foot always start with a normal foot.
When clubfoot occurs, the foot begins to turn inward and down, and this condition often develops during the second trimester of pregnancy (Ponseti International, 2017 & Clubfoot: Ponseti Management, 2005).
In the majority of cases, babies who are born with clubfoot have all their muscles, bones and connective tissues intact.
The Ponseti treatment is an internationally recognised treatment method developed by Dr. Ignacio Ponseti over 50 years ago and has a reported 95% success rate in treating clubfeet. It is considered the most cost effective treatment method with no side effects (Ponseti International, 2017).
In Australia, the majority of babies born with clubfoot undergo the Ponseti management whereby their affected foot or feet are corrected during the first six to eight weeks of infancy through the implementation of gentle manipulation and a series of plaster casts. During this period, the displaced bones are gradually brought into the correct foot and ankle alignment.
Once correction has been achieved, a strict splinting (Boots and Bars) regime is implemented that usually lasts until the child is aged 4-5 years old. This stage of management is crucial in order to prevent any relapse of the clubfoot deformity from occurring.
Treatment of clubfoot should always begin in the first one to two weeks of the infant’s life in order to take maximum advantage of the elasticity of the connective tissues that form the ligaments, joint capsules and tendons in the child’s foot (Ponseti International, 2017).
It is important to note that only a small percentage (<5%) of infants are born with severely affected clubfoot that would sometimes require special treatment which may involve corrective surgery. The results of these surgical procedures are often favourable when performed by highly skilled orthopaedic surgeons.
Boots and bars are used as part of the Ponseti treatment protocol for clubfoot in order to hold and maintain the child’s foot and ankle in the corrected position and to prevent their muscles and ligaments from tightening again after the foot has been corrected.
Ponseti boots and bars are special high top, open-toed boots (Ponseti AFO) that attach to an adjustable bar set at 60-70degrees of external rotation on the affected side. In children with only one clubfoot, the boot for the unaffected foot is typically set on the bar at 40 degrees of external rotation.
Boots and bars should only be used after a child’s clubfoot has been completely corrected by manipulation, serial casting and possibly a heel cord tenotomy and will not cause any developmental delays for the child (Ponseti International, 2017). It is important to note that the rate of relapse increases without boots and bars or if the boots and bars are not used according to the Ponseti treatment protocol for clubfoot/feet.
The ADM is a new generation of foot abduction brace offering unrivalled levels of active control, comfort and convenience. The ADM enables new bracing strategies beyond the scope of the boots and bar to encourage active development. No otherDynamic AFO (DAFO) supports both sub-talar and tibio-talar joint functions in a single device.
As a night brace, the ADM is convenient and comfortable for use, well tolerated by children and may be used to prevent clubfoot relapse in accordance with the Ponseti Method. It can also be used to manage some cases of clubfoot relapse. The ADM permits full functional mobility and may be attached to normal footwear for children with dynamic supination.
The ADM is also available as a day brace for children dealing with a range of conditions that result in a supinated or foot drop type of gait such as neurological conditions like cerebral palsy or stroke.
Ambulatory ADMs have significant advantages over conventional AFOs in that they support the full normal range of motion of both the tibio-talar and sub-talar joints allowing for classic triplane foot motion but with enhanced abduction, eversion and dorsiflexion. Patients using the Ambulatory ADM report reduced tripping, enhanced comfort, mobility, independence and stamina and are able to play, run and climb, play football and tennis.
Patients using the Ambulatory ADM report reduced tripping, enhanced comfort, mobility, independence and stamina. Children wearing the Ambulatory ADM are able to play, run and climb, play football and tennis.
The following schedule is based on the Ponseti Protocol:
TYPES OF BOOTS AND BARS WE FIT AT MASSONS HEALTHCARE
Here at Massons Healthcare we have partnered with some of the industry’s best manufacturers in clubfoot related products in order to provide our patients and their families with the best clinical support available to them. Our clinicians are great believers in supplying the best products to our clients and it is through our partnership with MD Orthopaedics and C-Pro Direct that enables us to do so.