If you would like to participate in this page or project, please use the contact form at Contact Us. We welcome any images that can help parents with any techniques you find useful when putting any Foot Abduction Brace (FAB/BnB) on. There are several different shoes and bars and we welcome any contributions that can help other parents.
The techniques shown below are mostly universal for any clubfoot brace, shoe, or boot. Just because your shoe and bar looks different, the same basic techniques apply:
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.
For detailed text instructions and general bracing tips please check out the original Tips & Tricks for Parents of Clubfoot Kids published in 2005. It has specific tips for modification of the Markell shoes, but the concept of bending the knee and dorsiflexing the foot is the very same as it is for the Mitchell Shoes and Ponseti or Dobbs Bars. It also includes some general bracing tips that any clubfoot parent can use.
Please take a moment to read the instructions associated with each image and bookmark this page so you can refer back any time you need.
These techniques can both prevent blisters and sores, as well as help them heal while still continuing bracing with Duoderm as a dressing for healing.
Open the shoe fully and focus on the heel. Make sure the sock is smooth and pulled up tight.
Slide your finger along the sides and check for anything folded or bumpy
Dorsiflex foot and push deep and back into the heel. You may have to push harder than seems normal.
Press, Dorsiflex, and Hold
Press thumb over tongue and hold tight
Press, cinch, hold, and cinch
Tighten the top and bottom strap so they are snug. You should be able to get your fingertip under the edge of all straps. The middle strap is usually the one that keeps the foot in the shoe mostly, however the other straps need to be snug enough to keep the shoes on.
Pul at the toes to get the seams away from babe's toes
Give the shoe a little tug, watch for movement
Push to check for movement
Snap into the Foot Abduction Bar
If your baby's heels slip or move inside the shoe when you push and pull, you need to repeat the above step to bend the knee and dorsiflex the foot, so you you can get the foot as deep and back into the shoe as possible. Hold tight and tighten the middle strap. Keep doing this till you see no movement. If you think you have gone too far, loosen the strap one hole and push and pull on the shoe. If the heel slips, go back to the tighter hole. But make sure to dorsiflex the foot and push at the knee and heel together to seat the heel deeply into the shoe.
Always check for slipping (at first), if the foot slips, you have to tighten it (after pushing snd dorsiflexing).
60-70 Degrees or Better
To check abduction, bend knee, turn foot outward like the brace is set. The foot should abduct to 70 degrees or better.
10-15 Degrees or Bettter
To check dorsiflexion, bend knee and use whole palm on the whole sole. Push toes up as far as possible. You're looking for at least 10 degrees past neutral, but 15 or better is optimal.
Some parents feel most comfortable having the child sitting on their lap facing away from them
while they put the brace on; others say it’s easiest for them to have the baby lying down in front of
them. Many parents work together installing the FAB, especially at first. If you can do it when
your child is relaxed and calm, you will probably have a much easier time. Find out what works
for you and your child.
♦You won’t have to do this step forever—in fact before you know it, you’ll be able to put the FAB on your child with your eyes shut—but it really does help for the first few months. At first, it is much easier to put the shoes on your child separate from the bar and then, when they are on nice and snug, attach the shoes to the bar. If you have a gold fixed-length bar, taking the shoes off the bar is very simple: you just need to unscrew the nut on each shoe and the bar slips right off. Once you’ve taken the shoe off the bar, screw the nut back onto the bolt so that you don’t lose track of it (and so that you don’t get kicked with that sharp bolt). If you have the red adjustable bar, it is harder to get the shoes back on correctly once they’re off. Instead, take the bar itself apart by loosening the black clamps. Mark your bar so that you can easily set it back to the right length before taking it apart for the first time. This method will lead to wear on the clamps. Should they break, you can substitute metal automotive hose clamps (available at hardware or auto parts stores) in a pinch. Your orthotist can also provide you with replacement parts.
♦Open the shoe up as far as you can by loosening the laces up all the way to the knots and pulling the tongue up as far as it will go under the laces. If you punched a new hole at the end of the strap, buckle the strap into that hole loosely so that it doesn’t get pulled into the shoe when the foot goes in.
♦Insert the foot into the shoe and bend the knee 90o . Push on the top of the knee and hold the sole of the shoe. Press the heel deeply into the back of the shoe and flex the toes upward (dorsiflex) as far as possible. Make SURE the heel is seated well into the bottom and back of the shoe. When working with the shoes attached to the bar, follow the same procedure one foot at a time. If the child is unilateral (left or right clubfoot), start with the clubfoot.
♦With the knee still bent, press a finger on the strap where it goes through the tongue keeper slit: this will hold the heel in the back of the shoe. Buckle the strap but don’t thread it through the lower portion of the buckle just yet. Dorsiflex the foot again and press on the bent knee with one hand and on the sole of the shoe with the other to make sure the heel is in properly. Re-tighten the strap: you may get it another hole or two tighter. If there is any wiggle or looseness, press the foot into the shoe again, put pressure on the strap and re-tighten.
♦Now try to pull the shoe off by bending at the ankle and dorsiflexing the foot. If the foot slips in the shoe, it is not tight enough: retighten using the above technique until the foot is secure in the shoe.
♦Center the tongue and pull it down over the toes so that the top of the tongue lies at or just below the ankle of the boot. The strap is essential to keeping the foot well seated in the shoe, it needs to be tight—probably tighter than you think it should be at first. Don’t worry, if the heel is well-seated at the back of the shoe, you will not be able to make the strap too tight. If the foot cannot slip around in the shoe, blisters and friction sores cannot form. Pay attention to which hole on the strap you are using and remember to adjust as your baby’s foot grows and the leather on the strap stretches out.
♦Pull the sock at the toes to make sure the seams aren’t going to press into baby’s toes. This also helps make sure the heel is well seated. Run a fingertip under the baby’s toes to make sure that they have a little room to wiggle and that you haven’t folded any of them under.
♦Tighten the laces nice and snug all the way up and tie them. The shoe should get a little tighter. In particular, make sure that the ankle area of the shoe is very tight. If you’ve been having issues with slipping, try lacing the shoes only to the second hole from the top and tying them off there.
♦Check whether the foot can slip out of the shoe at all. If it can, you will need to repeat the procedure. Most important is to put pressure on the knee and push the heel into the bottom of the shoe with the foot dorsiflexed (toes pointing toward the baby’s head) all at the same time. This isn’t easy at first, but it will soon become second nature. It is absolutely essential that your baby’s feet not slip in the shoes. Slipping feet are not held in correction and can compromise the effectiveness of the FAB and lead to relapse. Slipping feet may also cause painful sores and blisters.
♦Once you have the shoes on both feet nice and snug, re-assemble the FAB. For the non-adjustable bar, this is a matter of slipping the bolts back through the holes in the bar, making sure the shoes are set at the right degree of abduction and re-tightening the nuts. Secure the nuts by hand, but take care to make them very tight. Not only do loose bolts not maintain correction, they also will strip the teeth on the aluminum bar. With the adjustable bar, you just need to set the pieces back to the right length and tighten down the clamps.
♦Until you are very comfortable with the process, you can expect to spend a fair amount of time and energy getting the FAB on your child. However, you—and your child—will get used to it. Veteran parents can get their child into a FAB in 4 minutes flat!
♦Over the first few days of FAB wear, you may want to take the FAB off your baby every few hours. This will allow you to check for beginning sores or blisters(both of which are often signs of improper foot position or slipping in the shoes). You will also get some good practice in putting the FAB on. A normal-tempered baby is usually a sign that you have the FAB on correctly and you don’t need to keep checking so often.
