Bracing for clubfoot is the most essential part of the Ponseti Method. Bracing is the only thing that maintains a fully corrected foot, and the longer your baby wears their brace, the better. For most clubfeet, it is the only thing that will prevent relapse. It is possible, yet rare that a clubfoot will relapse despite bracing exactly as is needed but that chance can be as low as 3%
One of the first things parents often want to know about is the bracing schedule. Many doctors do not follow the specific bracing schedule that Dr. Ponseti prescribed, so we will be tackling that first.
Bracing is often described as 23/7 for 3 months, and then nights and naps thereafter till 4-5 years old. Many doctors tell their parents this means 23/7 for 3 mo's, then 12 hours till 4-5yo (or less years).
But "nights and naps" does not mean just 12 hours a day. It means 12-14 hours per day. Additionally, Dr. Ponseti never suddenly weaned a baby from full time (23/7) to 12 hours. Bracing hours should be gradually reduced, a couple hours at a time every 2-3 months so that baby is down to 12-14 hours a day at or around a year old.
So why is this important if so many doctors are doing it? You may be wondering... Well there are some very good reasons for slowly weaning bracing hours over the first year which we will explain below.
Babies are really quite terrible with transitions. Heck, most kids have issues with transitions well into adolescence. But this can be especially difficult for infants expected to wear a brace at sleeping time. And even worse if they're all of a sudden not wearing their brace all day like they used to. What's worse when suddenly weaned from full time to nights only is that now the brace is what they have to do at bedtime, and some babies will now associate the brace with sleep time and will cry and wake and generally not want to wear their brace.
When baby has been gradually weaned over the first year, by the time they are at nights (and naps), not only they are perfectly happy to wear it every night at bedtime because they are very, very used to it but they are also much better transitioning between daytime/no brace to nighttime/brace on. For these children, transitioning from daytime with no brace, to night time bracing is usually a total breeze.
If your child suddenly cries all night after being suddenly weaned from 23hr/day, increasing hours back towards full time (but less, try 18-20) might be the key to some sleep for the whole family.
Clubfoot wants to relapse. The fact that a clubfoot corrected without surgery is prone to relapse is the only real drawback to non-surgical treatment (this does not mean surgical treatment is better, not at all). Relapse is however combatted with bracing, and when it comes to bracing, strict compliance is the best way to reduce your child's risk of relapse. The only brace proven to prevent relapse is the Foot Abduction Brace (FAB) or boots and bar (BnB). The very best relapse statistics come from those feet braced long hours in the first year, and also those braced for at least 4 years, although it is widely known now that 5 years is the true minimum.
The first year of bracing requires the long hours bracing. This is not what many doctors tell their parents, and there is a general trend towards only bracing full time (23/7) for three months, then to drop to 12 hours only. It is not only the opinion of this site's owner, but also many other doctors including the few highly specialized and well known clubfoot doctors that a gradual weaning schedule is appropriate for the first year. Dr. Ponseti prescribed gradual weaning, and many others still do as well. By gradually reducing bracing hours over the first year, your child's chances of relapse is reduced. There are no brace police. Therefore you can actually brace as little or as much as you like. Your doctor will not come to your home and make you either take the brace off, or put it on. It is your choice how to brace your child. We hope to encourage you to brace long hours when your child is still young. It is a lot easier to do the long hours when the child is young. It is never fun to go back to full time bracing after a relapse. Relapses before the age of 1 are almost always the result of not bracing long enough.
One of the best papers describing bracing protocols: Bracing in clubfoot: do we know enough? June 2019 - C. Alves
This paper also discusses how long hours bracing in the first year are beneficial: Perspective Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: should it affect bracing protocol when using the Ponseti method? June 2019 - Y. Hemo, R Gigi, S. Wientroub
This paper discusses early relapse: Factors Related to Early Recurrence of Idiopathic Clubfoot Post the Ponseti Method 2019 Nov - N Limpaphayom, MD corresponding author and P Sailohit, MD
The following papers describe extended bracing and associated relapse rates. For more bracing studies and others regarding everything else CF, please check out our Clubfoot Studies page.
