For the treatment of both clubfoot and vertical talus, the child is fitted for a brace after the last casting is complete. One of the brace options used at St. Louis Children’s Hospital is the Dobbs Dynamic Clubfoot Bar (also known as the Dobbs Brace), developed by Matthew Dobbs, MD, orthopedic surgeon at St. Louis Children’s Hospital. The specially-designed bar allows active movement, preserves muscle strength in the foot and ankle and is less restrictive than traditional fixed bars.
By letting children move and kick their legs independently, the Dobbs Dynamic Clubfoot Bar gives children being treated for clubfoot and vertical talus the freedom to crawl and remain active in the brace. These children fuss less and sleep better in the Dobbs Dynamic Clubfoot Bar because it is more comfortable and less restrictive, and parents are more likely to continue with bracing therapy.
Benefits of the Dobbs Dynamic Clubfoot Bar
- Children can kick and move their legs independently so they can crawl and remain more active.
- The brace moves with the child, reducing heel friction and preventing blisters and red spots on the back of the heels.
- The independent movement and greater mobility of the brace prevents children from escaping and pulling out of the booties.
- Children can sleep with one leg straight and the other bent, reducing stress on the knees and leading to a better night’s sleep.
- The bar is adjustable from 8 to 14 inches to adjust to the growth of the child.
For children with clubfoot, the Dobbs Dynamic Clubfoot Bar should be worn 23 hours a day for the first three months, then at nighttime and naps for three to four years. For children with vertical talus, the brace should be worn for 23 hours a day for the first two months, then at nighttime and naps for two years. Bracing is critical in maintaining the correction of clubfoot and vertical talus. If the brace is not worn as prescribed, there is a near 100-percent recurrence rate.
Helpful tips for parents
- Expect your child to fuss in the brace for the first two days. This is not because the brace is painful, but because it is something new and different.
- Play with your child in the brace. This is the key to getting over the irritability quickly. Though the articulating bar allows for independent movement, it is helpful to teach your child this by gently moving his or her legs up and down.
- Make it a routine. Children do better if you develop a fixed routine for the brace wear. During the four years of nighttime wear, put the brace on anytime your child goes to sleep. Your child is less likely to fuss if this is a consistent routine.
- Pad the bar. A bicycle handle bar pad works well for this. By padding the bar you will protect your child, yourself, and your furniture from being hit by the bar when the child is wearing it.
- Your child should always wear cotton socks with the brace. The socks should be higher than the top of the shoes, sandals or orthosis. Allow your child’s toes some freedom.