A New Dynamic Foot Abduction Orthosis for Clubfoot Treatment

Abstract

Recurrent clubfoot deformity after successful initial correction with the use of the Ponseti method continues to be a common problem and is often caused by noncompliance with wear of the traditional foot abduction brace. The purpose of this study was to assess the results of a newly designed dynamic foot abduction orthosis in terms of (1) parental compliance and (2) effectiveness in preventing recurrent clubfoot deformities. Twenty-eight patients (49 clubfeet) who were treated with a dynamic foot abduction orthosis in accordance with the Ponseti method were included in this study. Of the 28 patients, 18 had idiopathic clubfeet (31 clubfeet), 2 had complex idiopathic clubfeet (4 clubfeet), 5 had myelodysplasia (8 clubfeet), and 3 were syndromic (6 clubfeet). The mean duration of follow-up was 29 months (range, 24-36 months). Noncompliance was reported in only 2 (7.1%) of the 28 patients in the new orthosis compared with the authors' previously reported 41% (21/51) noncompliance rate in patients treated with the use of the traditional foot abduction brace. The two patients in this study, in which parents were noncompliant with orthosis wear, developed recurrent deformities. There were 2 patients (7%) who experienced skin blistering in the new orthosis compared with 12 (23.5%) of 51 patients who experienced blistering with the use of traditional abduction brace in the authors' previously reported study. Logistic regression modeling compliance and recurrence revealed that noncompliance with the foot abduction orthosis was most predictive of recurrence of deformity (odds ratio, 27; 95% confidence interval, 2.2-326; P = 0.01). The articulating foot abduction orthosis is well tolerated by patients and parents and results in a higher compliance rate and a lower complication rate than what were observed with the traditional foot abduction orthosis.

Ponseti Treatment for Idiopathic Clubfoot: Minimum 5-year Followup

“…Possible reasons can include the feet either (1) not being fully corrected before being placed in a brace or (2) the development of a relapse despite brace wear making continued brace use impossible. Various authors have suggested modifying the brace to improve brace tolerance [5,15,22,27]. In our study, late presenters were more brace-tolerant.…”

Update on Clubfoot: Etiology and Treatment

“…Although the Ponseti method has traditionally been applied only to individuals with idiopathic clubfoot, the Ponseti method is now being used successfully for the treatment of severe nonidiopathic clubfoot deformities such as clubfoot occurring with arthrogryposis [8], myelomeningocele [12], a host of different genetic syndromes [30], as well as neuromuscular disorders [8,30]. The method is also being applied to the treatment of complex clubfeet recently defined by Ponseti [55] and for clubfeet that have been previously treated with extensive soft tissue release surgery but have suffered a relapse [26].…”

“…One example is the development of a dynamic bar that allows independent movement of each leg rather than a solid bar. The dynamic bar has the potential to improve patient comfort thus resulting in improved bracing tolerance [8,12,30]. The rotation of the shoes on the bar is set at around 70°of external rotation for the clubfeet and around 40°of external rotation for the normal feet.…”

The influence of brace type on the success rate of the Ponseti treatment protocol for idiopathic clubfoot

“…Some of the features incorporated in the new braces are detachable shoes, soft silicone AFO-type inserts, leather or Velcro straps and articulating abduction braces, as in the dynamic brace introduced by Dobbs [8]. On the other hand, these new braces are much more expensive [18].…”

“…On the other hand, these new braces are much more expensive [18]. The approximate cost of commonly used foot abduction orthoses as Dobbs [8] is 1,200 USD, with the Mitchell brace costing around 350 USD, while the DB braces cost around 70 USD in the United States [19], and probably less than that in developing nations when manufactured locally. The foot grows quickly during infancy and usually in the first year, up to two pairs of shoes or orthotic shoes will be needed; this also should be taken into account in the calculation of price.…”