Key Points

  • Pink marks should fade away within 20 to 30 minutes.
  • Make sure the straps are snug so your child’s feet don’t slip out.

Most parents are very excited to be done with the casting portion of their child’s clubfoot treatment. However, it is important to remember that in order to maintain the correction that was achieved through casting, continued treatment is necessary. 

In this next phase of treatment, your child will be wearing Ponseti sandals which are attached to a foot abduction bar, also called a Denis Browne Bar. 

Fitting

After the final cast is removed, your child will be fit with the sandals and bar. The bar width will be approximately the width of your child’s shoulders. Your child’s doctor will prescribe the amount of external rotation (turning out) of your child’s feet. Commonly, the rotation is set at 70 degrees for the clubfoot or clubfeet and 40 degrees if there is a non-affected foot. 

Applying

  1. Remove both sandals from the bar. 
  2. Bend your child’s knee and place their foot into the first sandal. The buckle should be on the inside of the foot. 
  3. Keep your thumb across the instep to hold the heel in place. 
  4. Tighten the middle strap first (this keeps the heel down in the sandal), then tighten the other two straps. The straps should be snug enough to keep the foot in the sandal. 
  5. Look through the opening in the heel to make sure the heel is down or almost down in the sandal. If the heel isn’t down, try re-applying the sandal. 
  6. Put on the other sandal using the same method. 
  7. ‘Click’ the sandals onto the bar. The toes will be rotated outward. 

If your child’s foot slips out of the sandals, check to see that the sandal straps are tight enough to hold the foot in place. You can also try using socks that have rubber grips on the bottom to help hold the foot in the sandal. 

It is very important that the sandals fit properly at all times to maintain your child’s corrected foot position. If your child’s foot continues to slip out, contact the Assistive Technology Department for a follow-up appointment. 

Wearing schedule

The sandals and bar are to be worn 23 out of 24 hours each day for about three months, as prescribed by your health-care provider. During the day, your child can have several short breaks out of the sandals. Your child shouldn’t need to take a break from the sandals during the night. 

It is important to stretch your child’s foot and ankle during the breaks. Follow the stretching exercises prescribed by your health-care provider. If your child’s foot and ankle seem to be losing range of motion, call your healthcare provider’s office for a follow-up appointment. 

After several months of wearing the sandals full time, your health-care provider might decrease the amount of time your child needs to wear the sandals and bar. At this time, the wear schedule is commonly reduced to wearing the sandals and bar for sleeping only. This wear schedule is usually continued until age 3 or 4. 

Skin Care

It is important to take care of your child’s skin in order to prevent the skin from breaking down: 

  • Carefully follow the wearing schedule given to you by your health-care provider. 
  • Check the skin for red and pink areas during breaks. All red and pink areas should disappear within 20 to 30 minutes after the sandals are removed. If they don’t fade within this time frame, contact Assistive Technology. 
  • Socks should fit well. If they are too big, they could create wrinkles that may irritate your child’s skin. Socks that are too big also can allow your child’s foot to slip out of the sandal. 
  • The sandals, skin and socks must be clean and dry at all times. Moisture can cause breakdown of skin tissue and encourage bacterial growth. 
  • Witch hazel (purchase at the drugstore) can be used to stimulate circulation and “toughen” the skin. Avoid using lotion because it softens and weakens the skin. 

If problems such as swelling, severe pain, excessive stiffness, open sores or blisters occur, discontinue use and call your care provider immediately. 

This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team.