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There’s really only two reasons that the shoes slip or are kicked off as long as the shoes aren’t too big. Either the foot isn’t corrected properly and not ready for the brace, or they aren’t tight enough. In most cases it’s the latter, but if you suspect your baby’s feet aren’t fully corrected you can send some pictures and do some tests to see for yourself.
There’s no amount of kicking that any baby can do that could ever be the cause of slipping. It is always caused by the fit (and tightness) of the shoes.
There’s really only two reasons that the shoes slip or are kicked off as long as the shoes aren’t too big. Either the foot isn’t corrected properly and not ready for the brace, or they aren’t tight enough. In most cases it’s the latter, but if you suspect your baby’s feet aren’t fully corrected you can send some pictures and do some tests to see for yourself.
There’s no amount of kicking that any baby can do that could ever be the cause of slipping. It is always caused by the fit (and tightness) of the shoes.
Try this: bend the knee 90 degrees and push down hard with one hand while dorsiflexing the foot (point toes up) with the other hand/boot. Push the heel back and deep into the heel pocket and hold it there with your thumb, then cinch very tightly. It’s going to seem to be much tighter than you would normally think is tight.
That’s important, it must be very tight. But not too tight (it's nearly impossible to make them too tight, actually).
Only tighten enough to stop the movement.
Snug down the other two straps and then give the boot a little tug and a pull and watch for any movement of the heel inside the shoe.
If the foot moves/slips, repeat the above and try to get the middle strap a hole or more tighter till you get no movement at all.
It may take a few times at first but you’ll soon be used to it and it’ll go a lot better.
This page has some images that help illustrate the above techniques. Below those image are two showing how to check dorsiflexion and abduction. You are welcome to send those pics to the Facebook Groups you're a member of if you’re unsure of the results.
https://Nosurgery4clubfoot.com/donfab
This may be helpful as well with some non-specific bracing tips. https://Nosurgery4clubfoot.com/markell-tips.pdf
Remember that blisters are caused by friction. Friction means that the foot is moving inside the boot. This tells you that the boot is not tight enough. When you solve the movement, you solve the blister problem. Even the smallest amount of movement can be enough friction to cause a blister.
Keep in mind that those baby legs are quite strong, and they can put considerable leverage against each other so make sure to give the shoe a really good push and pull after tightening and watch for movement.
Try this: bend the knee 90 degrees and push down hard with one hand while dorsiflexing the foot (point toes up) with the other hand/boot. Push the heel back and deep into the heel pocket and hold it there with your thumb, then cinch very tightly. It’s going to seem to be much tighter than you would normally think is tight. That’s important, it must be very tight. But not too tight. Only tighten enough to stop the movement. Snug down the other two straps and then give the boot a little tug and watch for any movement. If the foot moves, repeat the above till you get no movement at all. It may take a few times at first but you’ll soon be used to it and it’ll go a lot better.
Insofar as what to use on the blister, duoderm is the best but the blister band-aid product is about the same, yet sometimes too small or the wrong shape to last very long. It is meant to be put on and stay till it falls off. It will heal the sore/blister as well as provide a barrier between the shoe and the skin. Cut a large round disc, larger than the blister/sore (about 2cm larger) so that in case the edges lift, it will still cover the sore. Baths are ok while using duoderm.
This page has some images that help illustrate the above techniques
This may be helpful as well with some non-specific bracing tips.
Nosurgery4clubfoot.com/markell-tips.pdf
There are many options for treating bllisters and sores that occur while bracing. There are a number of factors associated with treating sores and blisters and there is no single method that will work for every sore. However, depending on the position and severity of any skin issue we can offer some ideas and options and hopefully a solution that works for your child.
The main factor that must occur initially is to figure out WHY and HOW the sore formed in the first place. Once you have identified how the sore formed, you can solve that and move forward with healing and continuing to brace.
In general, the advice to stop bracing or leave the brace off is NOT the best course of action. If the sore is so bad that you absolutely can not brace, do not just go without bracing if at all possible. Ask your provider for a holding/healing cast instead.
