Information for parents / providers (Ponseti treatment)

Dear parents and caregivers,

Meanwhile, the best results are achieved in the treatment of clubfeet. For your child, the last phase of the treatment begins: wearing an orthosis. The use of this orthosis is essential for the long-term success of the treatment. With the information below we would like to give some advice about the use of the orthosis.

Why is an orthosis needed?
The clubfoot correction orthosis is a combination of orthopedic shoes (Clubycare shoes) mounted on a spreader bar (P.E.A.care splint). The orthosis ensures that the feet are fixed in a specific position (in an abduction and rotation position). The use of the orthosis starts immediately after the correction by serial plaster (possibly also a tenotomy).

Even after correction by serial plaster, manual redress, etc., the corrected foot could fall back to a clubfoot position within a period of four years. During this period, the foot abduction orthosis is the most successful way to prevent this relapse.

How long should my child wear the orthosis?
From receipt, the orthosis is worn 23 hours a day for the first 3 months. Thereafter the daily use is reduced to 14 hours, which in practice corresponds with the sleeping and resting times of the child. Daily use is gradually reduced during treatment until a relapse can be ruled out with certainty. Only the treating physician decides on the daily hourly usage and the treatment duration.

How is the orthosis worn?
When you receive the orthosis, the correct position of the shoes on the orthosis is already set. To ensure the success of the treatment, the orthosis may only be adjusted by specialized professionals (doctor, orthopedic consultant / technician, etc.).

It is important that you follow the instructions below when you apply the orthosis:
  1. Open the buckle, the belt and the laces of the shoe.
  2. Place the foot in the shoe. Make sure the heel is fitted firm at the back in the shoe. Check the position of the heel through the opening at the back of the Clubycare shoe.
  3. Pull the strap over the instep of the foot and close it. Keep paying attention to the correct position of the heel.
  4. Pull the top and bottom of the sock to prevent wrinkles.
  5. Tie the laces and repeat steps 1 to 4 on the other shoe.
  6. To attach the orthosis to the shoes, slide the shoe sideways onto the orthosis with the footplate. Press and click on the base plate on the adapter. To unlock, press the red unlock tabs together and slide the shoe with the footplate sideways away from the orthosis.
Maybe putting on the shoes for the first time is a bit uncomfortable, but you will quickly develop dexterity. Also which posture is most comfortable for your child donning the orthosis. After a while, donning the shoes and orthosis will become more routine and less time-consuming.

What else is important?
Make yourself familiar with the orthosis. At the beginning of the treatment, the orthosis feels strange to the child. The first few days your child may be a little bit upset, crying some more or sleeping a bit worse. This is generally nothing to worry about. Your child will become accustomed to the orthosis within a few days. It is therefore very important that you continue the treatment with the orthosis. In exceptional cases (e.g. development of red skin) treatment is interrupted. However, before interrupting or stopping treatment, always consult your doctor and orthopedic counselor / technician first. Only when the orthosis is worn regularly the child can get accustomed to it and take it for granted. See instructions "What problems may occur?".

Development of the child
The overall development of the child is absolutely not affected by wearing the orthosis. Most children quickly get used to wearing the orthosis.

Adjustment of the orthosis
Usually, the orthosis is initially set so that the affected foot is rotated outward by 70 degrees. In case of unilateral care, the unaffected foot is positioned at 40 degrees external rotation. This position of the feet is unusual for someone who is not familiar with the Ponseti method, but it is the necessary posture for proper treatment. The feet were also positioned in this position during treatment with the serial casting.
What problems can occur?
Redness and pressure points: the skin of your child is sensitive and often not suitable yet for wearing shoes. Although Clubycare shoes are made of soft and smooth leather, decubitus can possibly occur or even blisters. It is therefore very important that the foot is secured and correctly positioned in the shoe. If the foot can slide back and forth, pressure points or blisters may occur. If you notice a irritated red skin when donning shoes and orthosis are being stretched, check carefully whether this disappears automatically after a few minutes. If this is not the case, or even an aggravation occurs, contact should be made with the doctor and instrument maker. The doctor will then determine the further therapy.

Some more advice
Shoes: it is important to realize that the Clubycare shoes are not normal running shoes, but orthopedic shoes. Because of the rigid, inflexible sole, which has been specially designed for this therapy so that it is not possible to roll the foot correctly while walking. This results in a reduced grip on a smooth surface. Without the orthosis the shoes have no therapeutic value. The shoes should therefore only be worn in combination with the spreader bar. The Clubycare shoes have the same shape for left and right. Sometimes it can be easier for the accessibility of shoes - depending on the position of the shoe - if the strap closure is attached to the inside of the foot - instead of the usual outside.

Clothing: to prevent pressure ulcers, the child must wear socks without patterns or thick seams. Also, the socks should not be too large because pleats formation can cause pressure points. Wearing tights is no problem.

Precautions: depending on how lively and active the child is, the orthosis should not be worn without supervision to prevent injury. Although the bottom of the orthosis is completely flat, it can happen that the orthosis can scratch the floor or furniture when crawling or standing.

Child seats and prams: Most child seats are suitable for use with the orthosis. Buggies or prams are normally not a problem. When choosing a child seat or pinch, you have to take into account that the child can sit in it with the shoes and orthosis.

Sleeping: the child may wake up at night because the sheet is wrapped around the orthosis. We therefore recommend using a sleeping bag. Wearing the orthosis while sleeping becomes part of the "good night ritual" for the child.

Wearing time: when using the orthosis it is useful to keep a care diary and to note the exact daily wearing time. This is for your own control. The starting point is a daily wearing period of 23 hours a day during the first 3 months. The further course of treatment is determined by the physician.

We hope you will be satisfied with the orthosis and the subsequent treatment success. Do not hesitate to discuss questions and / or problems with the doctor or orthopedic instrument maker during the treatment period.