Foot Abduction Braces
Bracing the foot in a position of abduction and dorsiflexion following correction is an integral part of the Ponseti treatment process and makes up the Phase 2 of treatment:
Phase 2: Maintain correction (using Foot Abduction Braces)
The braces recommended by the GCI for use in low resource settings are the Steenbeek Foot Abduction Braces (SFABs); these can be made at low cost using materials that are widely available. For detailed information resources on bracing, how to construct and apply SFABS and training materials about braces please go to the resources page.
Providing braces and explaining how to use them are the responsibilities of those providing Ponseti treatment. The responsibility of applying the brace daily and convincing the child to wear it, however, falls to the child’s parents or guardians. This undoubtedly creates extra work and pressure for parents: applying and removing the brace in order to clean the child takes time, the brace may make it more difficult to carry the child and some parents face stigma from their communities when taking the child out wearing the brace. If parents have to buy braces at full cost this may put them into severe financial difficulty which may eventually result in them stopping treatment. However, some programmes have found that asking parents for a minimal contribution towards the brace as a deposit can help with adherence and means parents take better care of the brace. For more information on adherence click here.
The consequences of not using the brace are clear from a number of scientific studies (26, 27). In children who do not wear the brace according to the Ponseti protocol outcomes are likely to be worse, with a less satisfactory correction achieved and far more frequent cases of relapse. One study in the USA found that relapse of the deformity was 183 times more likely in children whose families did not apply the brace as instructed (26)! These studies show that bracing is an essential part of treatment and that if foot abduction braces are not used success will be limited.
Some clinicians have reported that when they first started using the Ponseti treatment they did not have enough confidence to really convince parents to use the SFABs. This can result in parents failing to see the importance of bracing and to stop using the SFABs when they face difficulties with them. Parents also frequently believe that the child’s foot will remain normal once the correction phase of Ponseti treatment is finished; they do not realise that without bracing the deformity can recur. For these reasons it is important that efforts are made to explain to clinicians and parents the importance of bracing and what the scientific literature has found about the consequences of non-adherence with bracing.