Bracing in the treatment of children with clubfoot: past, present, and future

Lajja Desai, Florin Oprescu, Andrew DiMeo, Jose A Morcuende, Lajja Desai, Florin Oprescu, Andrew DiMeo, Jose A Morcuende

Abstract

Bracing is a critical component of the current standard of treatment for clubfoot. Adherence to the bracing protocol is the main factor for the long-term success of the treatment The purpose of this paper is to provide a review of clubfoot braces, best practices in brace design and recommendations for bracing in order to improve adherence with the bracing phase of the clubfoot treatment. There are a number of designs and offerings of braces available in various regions of the world. Although many new brace designs are being proposed and developed, evidence in the literature regarding biomechanical effects, clinical outcomes, functionality and patient adherence is limited. The current research that is available regarding brace design focuses on increasing patient comfort and satisfaction to improve adherence. Although the currently available braces are widely distributed in developed countries, access is limited to many parts of the world. When considering the future of the clubfoot treatment and prevention of relapses, since 80% of the cases are in developing countries with limited resources, brace cost and availability needs to be assessed.

Figures

Figure 1
Figure 1
Tin rectangular varus night-shoe.
Figure 2
Figure 2
Boot with inside leg-iron and varus T-strap (left) and boot with inside and outside leg-irons and varus T-strap (right).
Figure 3
Figure 3
From left to right: Walking apparatus with outer iron carried to pelvic girdle with T-strap on outer side; Mathieu's apparatus for producing eversion of the limb; Meusel's apparatus for correcting the inversion of the foot and leg after clubfoot correction.
Figure 4
Figure 4
Sayre's appliance for correcting inversion in bilateral clubfoot
Figure 5
Figure 5
From left to right: Beely*s boot for further correcting equinus; Steel spring for overcoming equinus; Sayre's boot for correcting equinus and varus by rubber cords; Stillman's boot for correcting the tendency for the foot to roll inwards.
Figure 6
Figure 6
Child in a FAB.
Figure 7
Figure 7
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Figure 8
Figure 8
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Figure 9
Figure 9
Figure 10
Figure 10
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Figure 11
Figure 11
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Figure 12
Figure 12
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Figure 13
Figure 13
Open-toed shoes with straps last approximately 4-6 months. The bar is adjustable and comes in two sizes (range: 19.5-37.0cm).39

Source: PubMed

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