Clubfoot: Tips and advice for the Ponseti Brace

The brace for clubfoot in the Ponseti method: how to wear it and what is the correct positioning?

Explanations are given at the time of first placement.

Here you will find the explanatory video with explanations by Dr. Lampasi, a Ponseti International physician.

We also recall some points as a reminder.

• Always check that the child’s heels are well positioned at the bottom of the brace’s shoe (you can check this through the appropriate hole in the brace)
• check that the foot is held firmly in that position;
• tighten the straps properly (without blocking the circulation of the foot)
• If the foot is not held firmly in this position and tends to slip, there is a risk that excessive friction will be created at the level of the back of the foot and the heel, similar to what has been seen with casts; this leads to redness and bedsores.
• The most important strap is the central one , because it keeps the heel firmly in place at the bottom of the brace
• For the first few days it is possible to mark the hole used on the strap, but with the use of the brace the strap tends to loosen a little, so it will be necessary to change the reference
• Use long cotton socks (for the entire part that is in contact with the brace shoe); avoid socks with large seams (they could be pushed against the skin and cause bedsores); if necessary, turn the sock inside out (keeping the seam facing outwards)
• The brace’s shoes do not differentiate between right and left. It is
  recommended to always use them so that the buckles remain on the inside. It is useful to make a recognition mark (right; left) on the straps.

The brace for clubfoot in the Ponseti method: is it normal for the baby to be agitated for the first few days?

Yes. Don’t be discouraged.
The baby isn’t actually in pain, but he or she needs to get used to the new situation. Furthermore, the skin may be more sensitive after the last cast is removed.
In the first 2-3 days:

• remove the brace several times a day (every 2-3 hours) to gradually accustom your feet to the brace shoes and check the skin
• keep the limbs up
• perform simultaneous mobilization exercises of the knees in flexion and extension with the brace on, so that the child learns to kick with both limbs at the same time
• apply two pairs of socks to protect the skin (which is sensitive after the last cast is removed)

One important thing parents should remember is not to remove the brace when the baby cries. The risk is that the child will understand that he can free himself from the brace simply by crying and will always adopt this tactic.

The brace for clubfoot in the Ponseti method: how will the baby sleep?

There is some variability from child to child.
In most cases, babies get used to the brace and sleep without any problems; they generally do so by sleeping on their backs or by finding
comfortable positions themselves.
However, some babies have more difficulty and wake up repeatedly (especially those who are more restless or accustomed to sleeping on their sides). For these babies, parents will need to learn to hold firm (considering the importance of continuing to use the brace).
It can be helpful to place pillows between the legs to allow the child to remain stable on their side.
Another useful solution is to line the inside of the crib to prevent the baby from getting stuck in the bars while wearing the brace at night.

The brace for clubfoot in the Ponseti method: how long should the bar be?

The distance between the heels of the shoes should be equal to the distance between the outer edges of the shoulders.
It’s important to avoid a common mistake: placing a bar that’s too narrow, which prevents the child from moving easily, creating significant discomfort and intolerance to the brace.

The brace: is it normal for the child to have tightness in the skin at the ankle where the brace shoe begins?

Yes. It’s very common and shouldn’t cause concern (unless it’s accompanied by redness, blisters, etc.).
Some authors call it the “sandal sign.” It’s actually a sign that the child is wearing a brace. It corresponds to a different distribution of subcutaneous fat at that level and disappears completely once the brace is discontinued.

Tutorial: Manipulations for Congenital Clubfoot After Correction with the Ponseti Method (Dr. M. Lampasi)

Once complete correction of the clubfoot has been achieved with the Ponseti method and the brace has been applied, manipulations can support some important aspects: sensitivity, muscle activity, tissue elasticity, skin trophism, etc., which are often not considered enough in treatment.