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Clubfoot third treatment phase

Clubfoot third treatment phase

Boots and abduction brace

The third and last phase is especially important. Not only is your child’s foot corrected, it is overcorrected, intentionally. This clinical overcorrection is necessary because over time the foot tends to want to return to its original position and turn inward. Wearing the abduction bar and orthopaedic boots helps to maintain this overcorrection while the baby is growing. If the foot were corrected solely in neutral position (toes facing forward), it would partially or fully turn back inward.

External rotation overcorrection of the affected foot at 70 degrees largely decreases the risks of relapse when treatment is consistent. Treatment involves wearing orthopaedic boots and the abduction bar 23 out of 24 hours per day for the first three months. During this period, your child can only go one hour a day without the boots and bar. As a second step, your child will wear the bar only at night up to 3 years of age. This is considered to be the most important phase since it will strongly impact the end result. The deformity will gradually, fully or partially, return for the vast majority of children who do not wear boots and the bar.

It is often difficult for parents to be consistent regarding wearing boots and the bar because this treatment lasts a long period of time (almost three years). Once the child has passed the adaptation phase of the first week, as he grows older he may complain about the bar or try to negotiate his way out of wearing the boots and bar at night. If you ever face problems with wearing boots and the bar, never hesitate to contact the cast room nurses or your physician’s clinical nurse coordinator who will provide advice and assist you with your child’s treatment.

boots and bar

Some helpful tips and advice for this third treatment phase

  1. Putting on the boots and the bar

    On the first morning of the treatment, in order to facilitate the transition to and adaptation of the boots and the bar, put on one boot and wait one hour. Your child will gradually get used to the presence of this new element. An hour later, put on the second boot and wait an additional hour. Finally, attach the boots to the bar. It is normal for your child to cry and indicate that he does not like the bar but, once it is in place, do not remove it until you verify the condition of his skin when you change his diaper.

    Orthopaedic boots are made of genuine leather, but they may cause irritation or blisters. As your child must wear them 23 out of 24 hours a day, it is important, especially for the first two days, to regularly check the condition of the skin (when changing diapers, for example). If you note a red spot on your child’s foot, cover it with an adhesive bandage (ideally in plastic to decrease rubbing within the boot). If the red spot is already becoming a blister, you can apply two or three bandages, one on top of the others. If you are worried about the condition of the skin DO NOT STOP PUTTING ON THE BOOTS. Contact the cast room nurses who can give you advice and/or schedule an appointment so your child can be quickly assessed.

    A lot of children try to remove their boots by pushing with their toes. To avoid red spots and having to continuously put the boots back on, try grip-free cotton socks (cotton reduces sweating and grip-free socks prevent the toes from gripping the sole). Children should always wear socks in the boots to avoid rubbing and sweating.

  2. Heel height

    It is very important to check the height of the heel in the boots. In fact, if your child tries to get out of his boot, his foot might stay in a pointed position for a long period of time without you noticing. If the heel remains in a raised position for an extended period, the Achilles tendon may gradually shorten. Your child will, therefore, no longer be able to put his foot down flat. To avoid this, make sure that your child’s heel is always visible in the hole at the back of the boot. It may be normal for the heel to not touch the bottom of the boot, but it should remain visible. If the heel is higher than the opening at the back of the boot, reposition the foot immediately by pressing down on the knee and tying the boot tighter. If your child continues to lift his foot despite your efforts, contact the cast room nurses who can give you advice and/or schedule an appointment so your child can be quickly assessed.

  3. Getting used to the boots and bar

    ALL CHILDREN REACT WHEN MOVING ON TO BOOTS AND THE BAR: THIS IS NORMAL. In the days following the installation of this device, your child will surely cry, sleep less and become more irritable. Most children need five to seven days to get used to the boots and bar. Getting help from someone you know who, from time to time, can take over for you during these few days is a good idea. Most importantly, NEVER REMOVE THE BOOTS AND BAR BECAUSE THE CHILD CRIES. If you remove the bar, the child will understand that he can use his tears to get rid of the boots.