In a previous post, I discussed a deformity called clubfoot and how to correct it. The basic treatment involves the stretching, casting, and bracing of the affected foot using the Ponseti method in which I have been trained. Unfortunately, over a third of corrected clubfeet relapse and need additional treatment. A major cause of relapse is non-adherence to use of the foot brace. Therefore, this article discusses the reasons for this non-adherence and the importance of keeping to the bracing regimen so that relapse is greatly minimized.

Why Don’t Parents Stick with Bracing?

It is certainly true that bracing requirements can seem overwhelming and present a real challenge for parents. In the beginning, the baby must wear the brace for at least twenty-three hours per day. Although these hours are gradually decreased, the brace must be worn for two to five years – the average time span is thirty-three months. Even if the infant has been successfully wearing the brace in babyhood, as the baby turns into a toddler it often becomes difficult to convince them to sleep with the brace. Here are the main reasons why bracing is not adhered to.

  • Failure to understand the importance of bracing.
  • Forgetting the bracing instructions or being confused by them.
  • Difficulties in incorporating the brace regimen into the family’s daily life.
  • Lack of a sufficient support system at home.
  • Language and cultural barriers.
  • Practical problems in applying the brace.
  • A child who fusses and cries when wearing the brace.
  • Skin irritations.
  • Lack of continuity in medical care.

Why it’s Important to Help Your Child Wear a Brace

In the beginning, it’s relatively easy to get a baby to wear a brace because the child is sleeping most of the time. However, when a tot begins walking, they will naturally become more aware of the discomfort and awkwardness of the brace. Parents may relax the bracing schedule because it appears to them that the affected foot has regained normal function. Also, when the child cries, a parent may remove the brace if they assume the brace is causing pain rather than just discomfort. Unfortunately, with frequent removal of the brace, over time, the foot may begin to relapse. The change in foot position results in the brace becoming more difficult to apply properly because it no longer fits the foot correctly. This sets up a vicious cycle as the child experiences increased discomfort leading to more and more fussiness and complaining about wearing the brace.

What Type of Brace is More Comfortable?

Research shows that there’s practically no difference between different types of braces in terms of adherence to the bracing schedule. However, some things can be done to address the problems that can arise because of wearing a brace. Click here for a helpful article from Ponseti International.

  • Skin Irritations – Redness or skin irritation around the ankle affects about 30‑40% of babies when they start wearing a foot brace. The most common cause is a brace shoe that’s not tight enough enabling the foot to move up and down inside the shoe. Sores or ulcers are rare and are almost always caused by pulling the brace straps too tight. To remedy mild irritation, the fit of the brace can be adjusted, and a pressure-relieving pad can be used. If sores or ulcers have developed, the leg can be put in a cast until they’ve healed.
  • Support Groups – Knowing that you’re not alone can be very comforting. There are web-based parent support groups where parents can contact others with similar problems. For instance, how to deal with a child who regularly bangs their brace against a wall or the side of their crib to express frustration with its awkwardness. Helpful advice might be to cover the brace with a towel to minimize discomfort to the child and damage to the brace or crib. This is the type of problem that the baby’s podiatrist probably would not hear about. Click here for a list of support groups provided by Ponseti International.

Bottom Line – Your Infant Must Wear the Brace

At Rocky Mountain Foot & Ankle, we believe in thoroughly educating parents about how to properly apply a brace as part of a clubfoot treatment program. We explain the importance of bracing when you bring your baby in for their initial appointment. You can also practice applying a brace to a large doll under the supervision of a trained assistant. When the brace is ready, you will be asked to apply the brace to the child’s feet and remove it to ensure you are using the correct technique. We do everything we can to ensure your infant’s clubfoot does not relapse resulting in more treatment with castings or surgery. If your baby was born with a clubfoot or you are having problems with a bracing regimen, don’t hesitate to come to us for help.