Some FAB's such as the Iowa Brace, the gold or red fixed length bars used with the Markell shoes, the Steenbeek brace, C-Pro Direct's Boots and Bar System, and the MiracleFeet & Clubfoot Solutions plastic bar are all fixed length bars that need to be replaced with longer bars many times as baby grows. This is important to note.
C-Pro Direct Provides the full range of bar sizes with each purchase of the Foot Abduction Brace.
*If your bar is a fixed length, you must allow for your child to grow into the length. This means you should start with a wider bar than just shoulder length heel to heel. An inch longer will allow your child time to grow into the bar over the next few months.
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At NoSurgery4Clubfoot, we prefer the adjustable bars. Because, well... bar length should be easily adjusted at home any time it is needed. The act of lengthening the bar should never require a trip to the Orthotist shop, or a prescription for a new bar.
Waiting for a new bar for weeks while baby can't comfortably sleep and the whole household is disturbed at night is stupid. And should never occur.
Therefore, please consider a brace with an adjustable bar, if at all possible.
**If you can't get an adjustable bar, make sure to plan to order a new bar early because when baby begins to wake at night due to the bar being too short, you're going to want that new bar immediately.
Hands down, the prevailing reason why a previously happy and sleeping child is suddenly waking and not tolerating bracing is bar length.
Almost every time this happens, the parents lengthen the bar to shoulder width (or wider, as some children prefer), the sleeping/waking problems subside.
Try abducting your feet to 60-70 degrees. And then pull them inwards towards each other. Also, dorsiflex your feet at least 10 degrees above neutral. How does that feel? Do your heels pull up?
A wider bar helps keep heels down. This is a simple matter of physics.
From the Ponseti International Bracing Tips Page:
"Importantly, the distance between the inside edges of the heels of the shoes is equivalent to the child’s shoulder width. This distance is the most comfortable for the child and prevents knee or hip problems. If you lay the brace on the floor with the shoes facing upward, the child’s shoulders should fit snugly in between the shoes. Children go through major growth spurts, so if your normally agreeable child is suddenly waking and fussing, it is appropriate to check the length of the brace to see if an adjustment needs to be made prior to their next follow up appointment with the doctor."
Checking BnB Bar Length
1" Hose Clamp - Available at any hardware store
Send someone to the hardware store for a hose clamp! This will work in a pinch. Then order a new black Ponseti clamp from MDOrthopaedics.com.
Dr. Ponseti made sure that the bar he put his name on was adjustable, and each one a actually comes with an Allen wrench to adjust it. If you didn't get this with your brace, talk to the orthotics shop. They probably have them all in a drawer somewhere or you can get one at the local hardware store for a very reasonable price. These also arrive in your furniture needing assembly. It is a standard size.
The Dobbs bar also is adjustable with the very same #52 Allen Key. The Dobbs bar is to be sized exactly the same, with the shoulder width to be heel to heel with the shoes mounted on the bar. There is a leeway of 1" either way shorter or longer than shoulder width that is acceptable for proper bar width according to the Dobbs Bar video showing how to adjust that bar. There is is no precise measurement, or some kind of absolute for bar width that isn't parent based, and parent presented as super logical, because we are the parents...
NoSurgery4Cubfoot.com is of the opinion that Heel to Heel is the most appropriate size of bar length for most children. Some children do better at even longer bar width. Night waking is the biggest clue to what length your child prefers. Generally about an inch or so leeway either shorter or longer than shoulder width heel to heel seems to be in the region of appropriate.
Bar length is ALL ABOUT BABY'S COMFORT LEVEL - and secondary to any concerns of hip or knee issues that can not be proven with any kind of literature or research. Make your doctor prove that your child will have knee or hip issues vs you and your family being able to sleep.
Bar length is all about baby's comfort and the family's ability to sleep.
