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There are several braces that might be used for bracing clubfeet, however within the Ponseti Method only the Foot Abduction Brace or BnB is knows to be effective for preventing relapse. Several other braces have been studied, and you can see the results of that research on the Bracing Studies page. Below are examples of the main types of braces that have been tried and might be recommended to you as an alternative to BnB/FAB. Please read the information for each brace to better understand how they work (or do not work) for preventing relapse in Ponseti Method feet.
In general, unilateral (one side) braces (not connected by a bar) have been found to be very ineffective to failing at keeping a clubfoot corrected. The only promising unilateral brace is the ADM, and at the time of this writing there is no research showing that it is effective for preventing relapse in the same way as BnB/FAB. However, it's better than all the rest because it has the ability to dorsiflex and abduct feet which none of the other unilateral braces are capable of doing at all.
BnB/FAB - Boots and Bar/Foot Abduction Brace
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Mitchell Boots & Ponseti Bar BnB/FAB
FAB - Foot Abduction Brace
BnB - Boots & Bar
The Foot Abduction Brace or BnB consists of two shoes attached to a bar that has options for external rotation (abduction) and dorsiflexion (toes up). There are several manufacturers and styles, but the basic brace is the same across all brands and styles.
This brace is often called by it's nickname "BnB" which stands for "Boots & Bar". The technical term for this brace is a Foot Abduction Bar/Brace (FAB) and sometimes it is referred to as a Foot Abduction Orthosis (FAO). Most often in research and other literature.
The FAB/BnB is the only brace that is known to be effective in preventing relapse of clubfeet corrected with the Ponseti Method. It must be worn every day as directed by your Ponseti Method provider instructs. Children who wear this brace for 5 years can expect to have a 5% or less chance of relapsing.
Non-compliance with bracing with THIS brace is the main reason for clubfoot relapse. There are no other braces known to be effective in preventing relapse.
You may see the shoes for this brace described on websites as an AFO, however this is primarily for insurance purposes or technicalities since the term AFO is usually reserved for a tall hard plastic splint which is also described on this page. AFO is not effective for clubfoot and carries an 83% risk of relapse.
ADM - Abduction Dorsiflexion Mechanism
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ADM - Abduction Dorsiflexion Mechanism
The ADM® from CPro-Direct is available as a night brace to provide an alternative to traditional Boots and Bar clubfoot braces and as a day (ambulatory) brace for the management of dynamic supination in certain clubfoot patients and patients with other related conditions.
The ADM was originally developed for older children who need additional bracing options however it has been used by many parents with younger children.
This brace is marketed as an alternative to BnB/FAB bracing however is not yet accepted as an equal for the FAB/BnB due to the lack of research on efficacy. Research is potentially underway and we hope to learn more about how well this brace works for maintaining a corrected clubfoot very soon. It is however the best possible alternative for BnB/FAB bracing and if it comes down to bracing or no bracing, this is the preferred option.
There are two versions of the ADM. One is the brace pictured here which is a nighttime brace, not meant to be walked in. The other is a daytime ADM spring which attaches to a standard trainer/sneaker type of shoe for older children who need additional bracing support. There is also a kit that can be added to your own shoes to attach the ADM spring to for daytime use.
Other Braces - Not Recommended for Clubfoot Bracing.
AFO - Ankle Foot Orthosis
AFO - Ankle Foot Orthosis
AFO is a type of brace used to support and control the ankle and foot. These are usually custom molded for your child's foot, however there are some universal AFO's available for children.
The AFO is NOT an appropriate brace for maintaining a corrected Ponseti Method clubfoot. This brace and several other unilateral braces were studied extensively and multiple studies found it to be very ineffective. The AFO carries an 83% risk of relapse before the age of 2 and also causes muscle atrophy. Due to the inflexibility of the AFO, the foot can not flex and bend and grow strong.
Some providers will ask patients to use an AFO once they begin bearing weight. This is not recommended for most clubfeet. Most clubfeet once corrected are perfectly strong and have no muscle weakness or hyper-flexibility/hyper-mobility. Using the AFO for every clubfoot is contraindicated in the Ponseti Method.
Occasionally a child will have weak ankles/muscles, excessive pronation, or hyper-mobility and need more support when bearing weight. In this case, a short SMO that allows the foot to flex and bend as seen next may be a better option than an AFO.
AFO's are commonly used for children after the ATTT (tendon transfer) surgery for support. They should not be worn full time in most cases. Sometimes a hinged AFO is prescribed.
SMO - Supra-Malleolar Orthosis
SMO - Supra-Malleolar Orthosis
The SMO a type of ankle-foot orthotic (AFO) that provides support and stability to the foot and ankle, particularly the subtalar joint, which is crucial for side-to-side movement and balance. SMOs are often prescribed for children with conditions like flat feet, toe walking, or low muscle tone to help improve gait and overall mobility.
The SMO offers support and stability for feet that may have some weakness or hyper-flexibility that need that little bit of support while bearing weight. The SMO allows the ankle to flex and bend which is an important part of the Ponseti Method. This helps the foot and calf to grow strong through movement while bearing weight. The standard AFO does not allow this.
Children who use the SMO usually do not need to have it custom molded, but some orthotics shops do this automatically for all AFO type splints.
The Cunningham (DKAFO) brace is a dynamic knee ankle foot orthosis. This brace is only made in Maine and parents must travel to Main to receive it. It is custom made and takes about two weeks.
The DKAFO is not known to be an effective brace for Ponseti Method corrected clubfeet. The manufacturer states that it is effective, however no unbiased research on efficacy has ever been done to date. This brace has been around since the early 2000's without becoming accepted by Ponseti Method physicians as effective. We hope for some research someday that will tell us more about this brace.
KAFO
KAFO - Knee Ankle Foot Orthosis
NOT FOR CLUBFOOT
A Knee-Ankle-Foot Orthosis (KAFO) is a type of leg brace that provides support and stability for the knee, ankle, and foot. It is used to address a range of lower limb issues, including muscle weakness, paralysis, and skeletal problems, helping individuals improve mobility, posture, and overall function.
KAFO has been extensively studied in relation to clubfoot and efficacy and the results are very poor. KAFO is not recommended for clubfoot.
Bebax
Bebax Shoe
NOT FOR CLUBFOOT
The Bebax correction orthosis is prescribed to babies to correct forefoot deformities.
Bebax is a padiatric orthosis designed for progressive and dynamic correction of congenital forefoot deformities.
The Bebax shoe is NOT recommended for treatment of clubfoot or intended for use while walking.
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