Clubfoot 

describes a range of foot abnormalities usually present at birth (congenital) in which your
baby's foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the
bone (tendons) are shorter than usual.

The method of Correcting the congenital clubfoot is called Ponseti method. This method comes in two
ways, the casting and bracing phase. So in the casting phase, the baby will wear a cast a week after it is
born when the congenital clubfoot is detected. Each cast is adjusted every once a week and it will be
done for several sessions, approximately 4 to 8 casts that will last for 2 months or 3.

In the other hand, after casting, the Bracing Phase comes right after. In bracing phase, or also known as
BNB (Boots and Bar) is the phase where the baby will wear boots with attached bar under it which also
aids in correcting the congenital clubfoot. It should be wore by the baby 24/7 with 1 hour rest time for
three months or more, depending on the severity, and right after that it will only be worn during
bedtime for 4 years.

Cast Care at Home:

 Check the circulation every four to six hours after the application and then four times a day.
Press the toe for blood flow. If it turns pink after pressing, the flow is good but if it dark and
pale, the cast is tight.
 Note the space between toes and cast. If toes are shrinking back to the cast, pressure is not
maintained. Inform the heath care provider
 Keep the cast clean and dry to prevent accumulation of microbes. Wash it with damped clothes
if soiled
 When drying cast, put pillow under it. Also put pillow under the leg to elevate leg and prevent
pressure to the heels when your child is lying down.
 Change diapers frequently and avoid the cast from getting soiled
 Notify the doctor if the cast have foul odors, the skin is irritated, poor blood circulation in toes,
cast is not holding on feet, and child is febrile.

Wearing Instructions for BNB

 Use cotton sock over the foot where the boots touches in baby’s foot. Use only 1 pair of socks
 When the baby did not respond when putting the shoe on one foot, you should begin in putting
shoe on the worse foot. But if the baby responded while putting shoe on its foot, you should
begin in the foot where he will not respond as he will kick as his response.
 Hold the foot into the shoe and strap the ankle strap first as it provides firmness and the shoe is
intact
 Check if the heel of the foot is on the sole of the shoe by pulling the toes backward forward. If it
moves, then it is not down to heel. Mark line as a basis where the opening of the shoe should be
beyond it. If the opening of the shoe exceeds from the line, then it is properly worn.

Additional Teaching

 Expect your child to fuzz when putting brace

 Always be with your child. Teach them to move their feet even when their brace is on
 Do exercise of the feet
 Do not use lotion In red skin, blisters, or red spot. Call your physician
 Pad the bar in BNB using bicycle handlebar pad
 If the baby escape from the brace, tighten up the lace and straps
 Remove the tounge of the shoe
 In lacing, begin lacing from up to bottom as the bow will be on toes
 Always tighten up the screw of the bar over period of time