Bracing in Clubfoot: What is Different in 2021?

Abstract

Bracing is an integral and essential part of Ponseti's management of clubfoot. The standard foot abduction brace (FAB) maintains the affected foot in 60-70° abduction and 10-15° dorsiflexion while keeping the foot apart at a distance approximately equal to both shoulders' width. Foot abduction brace is recommended to be worn full time for the initial 3-4 months and subsequently night/nap time till 4-5 years of age. Foot abduction brace prevents relapse by continuous stretching of posteromedial soft tissue of the foot and gradually ensuring their stress relaxation. Several designs of FAB are marketed like Denis Browne splint, Steenbeek brace, Mitchell-Ponseti brace, Dobbs brace, etc. The prolonged use of brace required for maintenance of deformity correction is however marred with issues of non-adherence and recurrence. Furthermore, several genetic, socioeconomic, parental, healthcare-related factors affect the overall functionality of the brace. Bracing in clubfoot is an evolving science. There are efforts to achieve better patient outcomes by eliminating these barriers, better brace designs, and following strategic guidelines.