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| Patient's
Information |
| Clubfoot |
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| INSTRUCTIONS FOR BRACE USE |
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| The foot abduction brace is used
only after the clubfoot has been completely corrected
by manipulation and serial casting. Even when well corrected,
the clubfoot has a tendency to relapse until the age of
approximately 4 years. The foot abduction brace, which
is the only successful method of preventing a relapse
when used consistently as described herein, is effective
in 90% of the patients. Use of the brace will not delay
your child.s sitting, crawling, or walking. |
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| FOOT ABDUCTION
BRACE |
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| The brace consists of an adjustable
aluminum bar with adjustable footplates to which straight
last shoes attach. The orientation of the footplates to
the bar is set by the orthotist. The shoes are straight
last, meaning they can go on either foot, but the shoes
are set up with the buckles on the inside, so that you
do not have to turn the baby over to tighten the straps
and laces. The foot strap is the key to this device; it
does not matter if the strap goes through the top or bottom
holes on the sides of the shoe. On the inside of the shoe,
above the heel, there is a pink pad that creates an area
for a normal heel to develop and grow into; it also helps
to prevent the heel from coming out of the shoe. |
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| WEARING SCHEDULE |
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| Use the brace once
the last set of casts is removed. The infant wears the
brace for 23 hours a day for the .rst 3 months after cast
removal. The brace is removed only for baths. For the
next 3 to 4 years, the brace is used at night and nap
time only. Your physician will decide on the duration
of bracing depending upon the clubfoot severity. However,
do not end treatment early. If you are unsure, ask your
doctor. |
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| WEARING INSTRUCTIONS |
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Always
use cotton socks that cover the foot everywhere
the shoe touches the baby.s foot and leg. Your baby.s
skin may be sensitive after the last casting, so
you may want to use two pairs of socks for the .rst
2 days only. After the second day, use only one
pair of socks. |
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If
your child does not fuss when you put the brace
on, you may want to focus on getting the worst foot
in .rst and the better one in second. However, if
your baby tends to kick a lot when putting on the
brace, focus on the better foot .rst, because the
baby will tend to kick into the second shoe. |
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Hold
the foot into the shoe and tighten the strap .rst.
The strap helps keep the heel .rmly down into the
shoe. Do not mark the hole on the strap that you
use, because with use, the leather strap will stretch
and your mark will become meaningless. |
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Check that the
child.s heel is down in the shoe by pulling up and
down on the lower leg. If the toes move backward
and forward, the heel is not down, so you must retighten
the strap. A line should be on the insole of the
shoe, indicating the location of the child.s toes;
the toes will be at or beyond this line if the heel
is down. |
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Lace the shoes
tightly, but do not cut off circulation. Remember:
the strap is the most important part. The laces
are used to help hold the foot in the shoe. |
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Be sure all
the baby.s toes are out straight and that none of
them are bent under. Until you are certain of this,
you may want to cut the toe portion out of a pair
of socks so you can clearly see all the toes. |
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| SET UP BRACE |
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| The brace will be set up for you
by your orthotist, but you may be responsible for changing
the shoes and widening the bar as your child grows. Change
the shoes only when the baby.s toes completely curl over
the edge of the shoe. The forefoot adduction (inward curving)
usually does not recur, so waiting will not affect the
correction but will save you money. If you do not know
what size shoes were used on the bar, measure the length
of the shoe and contact your orthotist. New shoes will
be two sizes larger than the current shoes. You may contact
your local orthotist to order new straight last shoes
for the foot abduction brace. Screws are used on the bottoms
of the shoes to attach the shoes to the footplate on the
bar. Mark the joints on the bar before changing the shoes
to ensure a return to the proper alignment. Attach the
shoes with the buckles toward the inside. You should adjust
the width of the bar at this time. Measure the distance
between the outside of the shoulders, this will be equal
to the distance between the center heel screws in the
shoe; lengthen the bar to match your measurements. Mark
a line for the location of the toes the .rst time the
shoes are worn to indicate that the heel is down. |
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| HELPFUL TIPS |
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EXPECT
YOUR CHILD TO FUSS in the brace for the
.rst 2 days. This is not because the brace is painful
but because it is something new and different. |
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PLAY
WITH YOUR CHILD in the brace. This is key
to getting over the irritability quickly. The child
is unable to move his/her legs independently of
each other. You must teach your child that he/she
can kick and swing the legs simultaneously with
the brace on. You can do this by gently .exing and
extending the knees by pushing and pulling on the
bar of the brace. |
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MAKE
IT ROUTINE Children do better if you make
this treatment a routine in your life. During the
3 to 4 years of night and nap time wear, put the
brace on any time your child goes to the "sleeping
spot." The child will know that when it is
that time of day, the brace needs to be worn. Your
child is less likely to fuss if you make the use
of this brace a part of the daily routine. |
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PAD
THE BAR A bicycle handlebar pad works well
for this. By padding the bar, you will protect your
child, yourself, and your furniture from being hit
by the bar when the child is wearing it. |
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NEVER
USE LOTION ON ANY RED SPOTS on the skin.
Lotion makes the problem worse. Some redness is
normal with use. Bright red spots or blisters, especially
on the back of the heel, usually indicate that the
shoe was not worn tightly enough. Make sure that
the heel stays down in the shoe. If you notice any
bright red spots or blistering, contact your physician. |
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IF YOUR
CHILD CONTINUES TO ESCAPE from the brace,
and the heel is not down in the shoe, try the following. |
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| a |
Tighten
the strap by one more hole. |
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| b |
Tighten
the laces. |
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| c |
Remove
the tongue of the shoe (use of the brace without
the tongue will not harm your child). |
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| d |
Try lacing
the shoes from top to bottom, so that the
bow is by the toes. |
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PERIODICALLY
TIGHTEN THE SCREWS ON THE BAR Tools have
been provided. |
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