Ponseti Bar responses
Jim And Kim
Description
Collection
Title:
Ponseti Bar responses
Creator:
Jim And Kim
Date:
9/25/2004
Text:
Thank you all for your excellent input! Here is a summary of the great responses you all sent in.
Jim
-----------------------------------------------------------------------------------
We have an MD who trained with Ponsetti. Ponsetti visited our hospital and we converted tot his technique and we had some of the same troubles you're experiencing. When they backed off on the extreme external rotation (from 70 degrees to around 45 degrees), most of it resolved. Our MDs have backed off on the external rotation as standard protocol. I believe that Ponsetti has somewhat too.
--------------------------
Take a look at the website www.mdorthopaedics.org . This gentleman has
worked with Dr. Ponseti to create a new style of sandal foot abduction
orthosis. I have been told they work great.
------------------------------------
Yes, we are using lots of Ponseti
bars, and we have the same problems. We use the same shoes and
additional padding above the heel. IMHO, the problem is always that the
heel is not being placed well down in the shoe and/or not strapped and
laced in snuggly enough to stay. That said, the technique that I use
that seems to work is to cut a huge hole in the heel section of the
shoe. The hole extends from the strap attachment to the buckle
attachment and from the sole to the stitching that keeps the heel pad in
place. I cut only through the white elk and heel counter reinforcement.
I then cut a couple of slits in the cream cow in order to reflect that
over the cut edge, gluing this to the outside of the shoe. I liken this
to an inspection port. I teach the families to look in this hole to
ensure that the heel is down in the shoe.
Once a blister forms on the heel, we are using hydrocolloid bandages,
especially Band-Aid Advanced Healing or Curad Hydroheal (these are
available OTC to families at major pharmacies, and are cheaper than
Duoderm).
---------------------------------------
Hi - here at shriners in Utah we do a ton of those. The markell shoes with the leather strap helps. Tell the parents to pull the sock at the toe to get the foot all the way in. then really crank the leather instep strap down and buckle it tight. then lace them up. I ALWAYS glue a horseshoe pad in above the heel. I use a rubbery foam called luna plast from Germany. Still we have a few kids who escape - we call them houdini's. In those cases we use the wheaton style brace - custom molded to keep the knee bent at 90 degrees, the tibia externally rotated the calcaneus everted and the forefoot abducted. With this brace, the thigh section serves as the dennis brown bar to stabilize the correction.
-------------------------
We also have the docs who have gone nuts for this treatment, and
have been through trial and error for about 3 years now. We routinely
stretch the heel out with a ball and ring stretcher, and then add the
crescent pad on the heel counter. Sometimes it is necessary to add a tongue
pad to the shoe also. We have also found that the kids with unilateral
involvement often have a smaller foot and it requires splitting shoe sizes
to get a good fit. We also advise double socks and lacing tightly. If the
physician has stopped serially casting prematurely the heel may be still
plantarflexed and may not stay in the shoe, and then again we have some
little Houdini's who get out no matter what we do. We have found that the
parent compliance and capability has a lot to do with it; the DB bar is not
easy to apply and if they are befuddled or disinterested we have poor
outcomes. Sometimes the patient goes back for another round of serial
casting, or we try a Wheaton style abduction afo. I am curious to know if
anyone has tried using the Langer torsion device that allows for movement
while maintaining the external rotation?
--------------------------------------
We do alot here ourselves and seem to run into the same problems(maybe 1 out of 20). See if the Dr. agrees to a custom Wheaton KAFO. Much easier to manage(don/dof) for caregivers.
-------------------------------------
We use a silicone horseshoe shape and cover it with a fabric type foot orthotic top cover and stick in the shoes. If that doesn't work we make the horseshoe out of plastazote.
--------------------------------------
A dorsal strap???
-----------------------------
Are you using Markells' redesigned shoe? I have also used custom wheaton type afo's and attached the db bar to it.
------------------------------
We fit a number of these children with the same Markel shoes and add a 1/2
pink plastzote crescent to contain the heels along with a 1/4 pink
plastazote tongue pad. The shoes have to be slightly larger to accommodate
this padding. I often add padding along the medial side of the first
metatarsal head to maximize the correction and set up frequent followups for
the child.
----------------------------
Don't know if this helps but I hope so
Jim
-----------------------------------------------------------------------------------
We have an MD who trained with Ponsetti. Ponsetti visited our hospital and we converted tot his technique and we had some of the same troubles you're experiencing. When they backed off on the extreme external rotation (from 70 degrees to around 45 degrees), most of it resolved. Our MDs have backed off on the external rotation as standard protocol. I believe that Ponsetti has somewhat too.
--------------------------
Take a look at the website www.mdorthopaedics.org . This gentleman has
worked with Dr. Ponseti to create a new style of sandal foot abduction
orthosis. I have been told they work great.
------------------------------------
Yes, we are using lots of Ponseti
bars, and we have the same problems. We use the same shoes and
additional padding above the heel. IMHO, the problem is always that the
heel is not being placed well down in the shoe and/or not strapped and
laced in snuggly enough to stay. That said, the technique that I use
that seems to work is to cut a huge hole in the heel section of the
shoe. The hole extends from the strap attachment to the buckle
attachment and from the sole to the stitching that keeps the heel pad in
place. I cut only through the white elk and heel counter reinforcement.
I then cut a couple of slits in the cream cow in order to reflect that
over the cut edge, gluing this to the outside of the shoe. I liken this
to an inspection port. I teach the families to look in this hole to
ensure that the heel is down in the shoe.
Once a blister forms on the heel, we are using hydrocolloid bandages,
especially Band-Aid Advanced Healing or Curad Hydroheal (these are
available OTC to families at major pharmacies, and are cheaper than
Duoderm).
---------------------------------------
Hi - here at shriners in Utah we do a ton of those. The markell shoes with the leather strap helps. Tell the parents to pull the sock at the toe to get the foot all the way in. then really crank the leather instep strap down and buckle it tight. then lace them up. I ALWAYS glue a horseshoe pad in above the heel. I use a rubbery foam called luna plast from Germany. Still we have a few kids who escape - we call them houdini's. In those cases we use the wheaton style brace - custom molded to keep the knee bent at 90 degrees, the tibia externally rotated the calcaneus everted and the forefoot abducted. With this brace, the thigh section serves as the dennis brown bar to stabilize the correction.
-------------------------
We also have the docs who have gone nuts for this treatment, and
have been through trial and error for about 3 years now. We routinely
stretch the heel out with a ball and ring stretcher, and then add the
crescent pad on the heel counter. Sometimes it is necessary to add a tongue
pad to the shoe also. We have also found that the kids with unilateral
involvement often have a smaller foot and it requires splitting shoe sizes
to get a good fit. We also advise double socks and lacing tightly. If the
physician has stopped serially casting prematurely the heel may be still
plantarflexed and may not stay in the shoe, and then again we have some
little Houdini's who get out no matter what we do. We have found that the
parent compliance and capability has a lot to do with it; the DB bar is not
easy to apply and if they are befuddled or disinterested we have poor
outcomes. Sometimes the patient goes back for another round of serial
casting, or we try a Wheaton style abduction afo. I am curious to know if
anyone has tried using the Langer torsion device that allows for movement
while maintaining the external rotation?
--------------------------------------
We do alot here ourselves and seem to run into the same problems(maybe 1 out of 20). See if the Dr. agrees to a custom Wheaton KAFO. Much easier to manage(don/dof) for caregivers.
-------------------------------------
We use a silicone horseshoe shape and cover it with a fabric type foot orthotic top cover and stick in the shoes. If that doesn't work we make the horseshoe out of plastazote.
--------------------------------------
A dorsal strap???
-----------------------------
Are you using Markells' redesigned shoe? I have also used custom wheaton type afo's and attached the db bar to it.
------------------------------
We fit a number of these children with the same Markel shoes and add a 1/2
pink plastzote crescent to contain the heels along with a 1/4 pink
plastazote tongue pad. The shoes have to be slightly larger to accommodate
this padding. I often add padding along the medial side of the first
metatarsal head to maximize the correction and set up frequent followups for
the child.
----------------------------
Don't know if this helps but I hope so
Citation
Jim And Kim, “Ponseti Bar responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/223683.
