New dynamic brace may improve compliance with clubfoot correction

Only two children experienced blistering compared with 12 of 51 children treated with traditional bracing in a previous study.

A new dynamic foot abduction orthosis can effectively prevent recurrent clubfoot deformities in children treated with the Ponseti method, a study found. Children treated with the new brace also showed a higher rate of treatment compliance compared to traditional foot abduction braces, the study authors noted.

Matthew B. Dobbs, MD, an associate professor of orthopedic surgery at Washington University School of Medicine, designed the new dynamic brace, called the Dobbs brace, to allow active movement, preserve foot and ankle muscle strength and to be less restrictive than the traditional brace, according a press release from the university.

Dobbs and colleagues evaluated the efficacy of the brace in a study involving 28 children with 49 clubfeet. This included 18 children with 31 cases of idiopathic clubfeet, two with four cases of complex idiopathic clubfeet, five with eight cases of myelodysplasia and three with six cases of syndromic clubfeet, according to the study, published in the Journal of Pediatric Orthopedics.

All children had reached full correction before being fitted for the brace, which was used in accordance with the Ponseti method of clubfoot correction. However, 18 of the 28 children had been fitted with a traditional brace, but were not fully complying with its use and thus were fitted with the Dobbs brace, according to the release.

Follow-up averaged 29 months, ranging from 24 to 36 months.

"Noncompliance was reported in only two (7.1%) of the 28 patients in the new orthosis compared with the authors' previously reported 41% (21 of 51 patients) noncompliance rate in patients treated with the use of the traditional foot abduction brace," the authors reported.

Both cases of noncompliance developed recurrent deformities, they noted.

In addition to improved compliance, children treated with the new brace had a lower incidence of skin blistering. Only two children (7%) experienced blistering compared with 12 of 51 children (23.5%) treated with traditional bracing in a previous study by the authors, they reported.

"The articulating foot abduction orthosis is well tolerated by patients and parents and results in a higher compliance rate and a lower complication rate than what were observed with the traditional foot abduction orthosis," the authors wrote.

The Dobbs brace features a soft, custom-molded interface placed inside a solid ankle-foot orthosis. The bar that connects the child's feet has a release mechanism allowing parents to easily detach and reattach the bar without removing the entire brace. The Dobbs brace also allows children to move their legs independently while wearing the brace, according to the press release.

"The newly designed, more flexible foot abduction orthosis is equally effective, or more so, than the traditional brace, considering rates of clubfoot relapse were less with the new orthosis than those reported in several series using the traditional brace," Dobbs said in the release.

"Although our experience with the dynamic brace has been favorable, a randomized study comparing the dynamic orthosis to the traditional brace would provide a more accurate assessment of outcome," he said.

For more information:
Chen RC, Gordon EJ, Luhmann SJ, et al. A new dynamic foot abduction orthosis for clubfoot treatment. J Pediatr Orthop. 2007;27:522-528.