Brace (Boots & Bar)

After the casting period, your child may not find the boots and bar a whole lot different to the casting and they still might not like it! While the casting treatment has worked very well for your child’s foot (hopefully), the chances of failure of the treatment are almost 90% if you did not use the boots and bar. So it is extremely important that the boots and bar are used.

Initially, it may be helpful to apply the boots and bar when the child is asleep- you can judge the fit and the legs are still. Ssssh! Apply the boots and bar with the child on their back (like you would for applying a nappy). As time goes by, allow the child to wear the boots before going to bed, and then apply the bar. Remember, babies like routines so make this part of their going to bed pattern. Clothes that snap on over the legs are best to that you do not have to remove the boots and bar when changing their nappy. Avoid carrying the child with the bar as the feet can slip out!

On first using the boots, treat the suede with protector. Use some varnish or nail polish on the straps so that they do not crumble with repeated use. Blistering can be an issue in the boots, particularly initially, so contact the orthopaedic paediatric clinic for an early review to learn of techniques for dressing and protecting the skin. If the feet have different levels of correction, then fit the lesser foot first. Hold the foot either side of the ankle, slide in the foot as far as it can go and do up the middle strap first. Sometimes the heel does not fit right in to the back of the boot but this should improve over a couple of weeks. Mark on the boot where the toes should be, so that you can keep an eye on it.

The bar will have been fitted at the outpatients department. Ensure that the length of the bar- from middle screw to middle screw is the same width or slightly longer than the width of the shoulders. This will need lengthening as the child grows. As your child grows, they learn to kick. Sometimes it is worthwhile wrapping the bar with foam to protect your furniture and your self!

Your child may also start to refuse to wear the device so be sure to keep some photographs of the foot or feet from the start of the treatment so that they can see the progress that they are making. Like signing a cast, go ahead and decorate the bar with stickers and fancy artwork! If the child kicks off the boots, check the straps, the heel and the length of the bar. Typically, the bar would be adjusted in the clinic by one of the healthcare team such as the orthopaedic paediatric physiotherapist or clinical nurse specialist.

Ponseti Casting

Club Foot