Although we achieved correction of the clubfoot using the series of casts, the tendency for foot deformity still exists. Therefore, after completing the serial casting stage, we will transition to using an abduction brace (also known as Foot Abduction Brace, Alfa/Beta-flex, Denis-Browne Brace, Ponseti-Mitchell Brace, and Markell Brace). This device maintains the corrected position and allows the various tissues (bones, muscles, and tendons) to elongate and adapt to the corrected state. This is a crucial moment when the responsibility for the treatment shifts from the medical team to the parents.
It is essential to meticulously and consistently follow the treatment using the brace. As the baby grows, the likelihood of reverting to the clubfoot condition diminishes significantly (studies show a high probability of relapse by the age of one, but it is rare after 4-5 years old).
During the first three months of brace usage, we recommend wearing it for 23 hours a day, leaving one hour without the device for activities like bathing, playing, applying lotion, and massaging the feet. During this time, parents can observe the foot and identify any issues.
After three months, as guided by the medical team, the hours of brace usage will be reduced to only during sleep (daytime naps and nighttime). Our recommendation is to continue using the brace until the age of 4 years. The baby needs to become accustomed to the brace being a part of their sleeping position. Discontinuing brace usage during sleep will make it difficult to resume using it later. If you don't adhere to the brace routine, the clubfoot is likely to relapse. As mentioned earlier, the younger the baby, the greater the chance of relapse (90% in babies younger than one year).
It's important to stress that the brace does not delay the baby's development. It is only used for a short period while the baby is immobile and not yet walking. Babies who require the brace during crawling and sitting do not suffer from it. Research on the developmental stages of infants treated with the brace has shown no significant delays.
Many small details are crucial during the brace usage, particularly at the beginning of the treatment:
1. During the first week of brace application, remove the shoe each time you change the diaper (at least three times a day). Ensure there are no signs of pressure or redness, and the foot is correctly placed within the shoe without any folds in the socks.
2. In the first week, some babies might be restless due to the new sensation of the brace. You can remove the shoe from the brace for a few minutes until the baby calms down and then put it back on (without removing the brace).
3. Sometimes, when using the brace during the daytime, it may be challenging to put the baby in a stroller or a car seat. You can arrange for a wider seat to accommodate the brace. The shoe can be removed during car rides while the baby is safely in the car seat and then reinstalled without removing the baby's socks.
4. Older children may occasionally bump their feet on the bed's edges while using the brace.
5. If the foot comes out of the shoe during sleep, check the reason (loose strap, improper shoe fit, inadequate tightening of the straps). If the issue persists, contact the medical team without delay.
Please remember that using the brace is an essential part of the clubfoot treatment. It should not be underestimated. In our follow-up at the clinic (as well as in many other studies), we found that incomplete healing (relapse) of clubfoot was mostly associated with non-compliance in using the brace. If you encounter any issues during the brace application, don't hesitate to contact us, and we will help you handle the problem.
Please note that the text is formulated in masculine language for convenience and refers to both genders.