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New Innovation in Clubfoot Treatment

A new brace that maintains correction for clubfoot, a birth defect in which the foot is turned in toward the body, has shown better compliance and fewer complications than the traditional brace used to treat the condition.

Matthew B. Dobbs, M.D., associate professor of orthopedic surgery at the School of Medicine, designed the new dynamic brace, called the Dobbs brace, to allow active movement, preserve muscle strength in the foot and ankle and be less restrictive to the child than the traditional brace.

Dobbs tested the brace on 28 patients who had already received non-surgical treatment for their clubfeet at St. Louis Children's Hospital and St. Louis Shriners Hospital. Over a two- to three-year follow-up period, Dobbs and his colleagues found that the Dobbs brace is at least as effective as the traditional brace and resulted in better compliance by parents.

Dobbs first treated children with clubfoot deformity using the Ponseti method. The treatment, developed in the 1950s by Ignacio Ponseti, M.D., professor emeritus of orthopedics and rehabilitation at the University of Iowa, involves weekly casting and manipulation of the clubfoot soon after birth.

When done correctly, the Ponseti method greatly reduces the need for extensive surgery, which can contribute to painful and arthritic feet in adulthood. The children with clubfoot whom Ponseti treated with this method were likely to have normally functioning, pain-free, flexible feet in adulthood.

Traditionally, children who have been treated for clubfoot using the Ponseti method must wear a nighttime brace that turns their feet away from the body for three to four years following the initial casting treatment.

The brace has open-toed, high-top shoes attached to a shoulder-width fixed metal bar. Because of skin blistering and the brace's restriction of leg motion, many parents used the brace less than had been prescribed, which can a
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