Clubfoot-Shoes and Bar- Responses 2 of2

Clubfoot-Shoes and Bar- Responses 2 of2

Greg Straub, CPO

1/6/2007

Original Post 10-24-06: I am looking for an alternative to Markell Clubfoot Straight Last Shoes (1644). It's the age old problem of little 00N sized feet pulling out of the shoes even after tongue pads and Achilles wraps are installed. Any recommendations would be appreciated.

 

Gregory Straub, CPO

 

Below are responses that I find very informative and useful. Thanks to those who took the time to share their insight.

 

Greg Straub, CPO

Asheville, NC





I have replied directly to Gregory with assistance however I am
wondering if there are more members who would be interested in help
with this issue. I have information, tips files for
parents/orthotists, photos, and countless other resources to help
Orthotists with this *age old* problem that I am more than happy to
share. This *age old problem* does not need to be a problem anymore
and I am hoping to be able to help anyone who needs it.

Please email me directly should you like to see the
Parents/Orthotists Tips and Tricks .pdf brochure (I can email you a
copy for use and free distribution), or if you need information about
shoe and bar modifications for the Markells. There ARE alternatives
to the Markell shoes now, which are absolutely fabulous and have no
intolerance issues. The best one is the Ponseti/Mitchell brace, you
can see it here: <URL Redacted>

Another valuable resource is the Global HELP booklet found at
<URL Redacted>

I am available for consultation, free free free! Please contact me
if you would like assistance or information that can end intolerance
with foot abduction bars for clubfoot children.

Kori Rush
Oregon

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hi, one help is place 1/8 th plastazote on tongue and create a similar horshoe pad for heel area,this helps. the ponsetti brace by mitchell has been tried with limited sucess. we have used a dafo #3 softee, attached to a 1/8 piece of pe at the desired ext rotation. this set up is very lt. wt. and flexible. the child can kick a little w/o coming out. so far our ortho's love it.

 

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I don't know if CAMP/ALLARD USA'S BEBAX Clubfoot system would assist you. I
am a patient, not a practitioner, but here are the details

 

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We have been using a DAFO 3.0 softy, with a stong medial extension on the foot plate and mounting them to a polypro (1/8 in for 6in bar), and (3/16 for 8in bar) made inhouse. The key to keeping their heels down is to use a Heel Pillow in the order special instructions and a thick instep pad to really help seat them against the back of the AFO. The other trick is to not over shoot their Dorsi ROM. If they can only get to -2 degrees of Dorsi set them there. We were originally using chicago screws to attatch the bar to the AFO's, now were using rivits. (one at the heel and one at the toe) We have probably done 50 pairs with good success. We call it the Sequoia brace after our Children's Orthopedic Group that we developed it with. Just like the shoes we set the club foot side to 65 degrees and the uninvolved to 45. This system also preserves the ROM following the TAL casting of the Ponsetti correction method. The Dr.'s send them over for a casting between their final cast change, we request a medical rush on the dafo order form, which they do at no extra charge and the day the casts come off at or Children's Hospital is the day they get their Sequoia brace.

Hope that helps!

Jason Schott CPO

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I have just received your enquiry regarding an alternative to the Markel boot for the treatment of CTEV.

Chas a Blatchford and Sons Ltd are a leading provider of both Prosthetic and Orthotic service and offer a wide range of prosthetic and orthotic products. In association with our Spanish manufacturing partner, we have developed a range of boots to be used in conjunction with, and as part of, the Ponseti treatment method.

Please send me your direct mailing address and contact details so that I can send you a sample of our A Line boot.

Kind Regards

John Stephen
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I work with Dr. Ponseti's group and he uses the MD
Orthopaedic's Ponseti orthosis. This works well for
infants or complex clubfeet. The leather is very soft
of the upper of the shoe, so it tends to get a better
hold on the feet. You may order the parts for the
orthosis through the following website:
www.mdorthopeadics.com

Please contact me with any further questions.

Sincerely,

Michelle Hall, CPO

American Prosthetics & Orthotics, Inc.
Iowa City, IA
319-356-2420
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Greg, I am pretty sure that Markell now has a new Ponsietti shoe with the
heel cut out to help with this problem. The Model is TM-1645.
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I am sure you have many replies by now but here is our experience in Charleston.

If the child has been corrected according to the Ponsetti method you should not have as many problems. I have the most trouble with chubby feet. #1645 has an open heel so you see where the heel is in the shoe. Most parents are afraid to pull the strap tight enough. When the child gets used to the system there is less slippage as the Ponsetti protocol we use is 23 hours a day for the first 3 months. The infant will realize it is a part of life in a few days. The Global HELP booklet is very good. It gives some tips for fitting the shoes. You have to bend the bar to evert the feet even if they have good correction.

The biggest problem we have is getting the system paid for by some insurance companies.


Sometimes the physician needs to put the child back in casts a little bit longer.

Hope this helps.

Patricia Hazard, CO
Floyd Brace Company, Charleston
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END OF RESPONSES