Unilateral Abduction Dorsiflexion Mechanism Brace as an Attractive Alternative of Congenital Talipes Equino-Varus Treatment – a Preliminary Report

Document Type : CASE REPORT

Authors

Department of Trauma and Orthopedic Surgery, University Hospital Crosshouse, Scotland

Abstract

Ponseti method of CTEV treatment includes use of a foot orthosis, compliance with this can be a 
challenge. A new brace- Abduction Dorsiflexion Mechanism brace (ADM, C-Prodirect) was introduced 
to address this. The aim of the study was to assess whether the new AD M brace improves compliance 
and prevents relapse in children with corrected clubfoot. Eight children with unilateral CTEV who did 
not tolerate the standard brace were included in the study. All children had been previously treated with 
Ponseti casting, Achilles tenotomy and Ponseti AFO Abduction Brace (C-Prodirect®). The mean age 
of children included was 27 months. Parents’ satisfaction with the brace was assessed using Client 
Satisfaction with Device (CSD) questionnaire. Parents reported better tolerance o f the brace by the 
child in six out of eight cases. ADM brace is viable alternative in maintaining correction of unilateral 
idiopathic CTEV when compliance to standard AFO abduction brace is poorly tolerated.
 Level of evidence: IV

Keywords

Main Subjects


1. Alves C. Bracing in clubfoot: Do we know enough? J Child 
Orthop. 2019; 13(3):258-264. doi:10.1302/1863-
2548.13.190069
2. Chang C, Wang S, Kuo K. The Ponseti Method Decreased the 
Surgical Incidence in Children with Congenital Clubfoot. J 
Bone Joint Surg Am. 2019; 101(21):1955-1960. 
doi:10.2106/jbjs.19.00245
3. Ponseti IV. Treatment of congenital club foot. J Bone Joint 
Surg Am. 1992; 74(3):448-454. 
4. Thomas H, Sangiorgio S, Ebramzadeh E, Zionts L. Relapse 
Rates in Patients with Clubfoot Treated Using the Ponseti 
Method Increase with Time. JBJS Rev. 2019; 7(5):e6-e6. 
doi:10.2106/jbjs.rvw.18.00124.
5. Zionts L, Dietz F. Bracing Following Correction of Idiopathic 
Clubfoot Using the Ponseti Method. J Am Acad Orthop Surg. 
2010; 18(8):486-493. doi:10.5435/00124635-201008000-
00005.
6. Richards B, Faulks S, Felton K, Karacz C. Objective 
Measurement of Brace Wear in Successfully Ponseti-Treated 
Clubfeet. J Am Acad Orthop Surg. 2020; 28(9):383-387. 
doi:10.5435/jaaos-d-19-00163.
7. Sangiorgio S, Ho N, Morgan R, Ebramzadeh E, Zionts L. The 
Objective Measurement of Brace-Use Adherence in the 
Treatment of Idiopathic Clubfoot. J Bone Joint Surg Am. 2016; 
98(19):1598-1605. doi:10.2106/jbjs.16.00170.
8. McCartney S, Turner S, Davies K, Morris J, Sproston C, Kiely N. 
A new unilateral abduction orthosis for Ponseti-treated 
clubfoot. Prosthet Orthot Int. 2019; 43(3):325-330. 
doi:10.1177/0309364618814866.
9. Pirani S, Hodges D, Sekeramyi F. A reliable and valid method 
of assessing the amount of deformity in the congenital 
clubfoot deformity. J Bone Joint Surg British Volume. 2008; 
90.
10. Dyer P, Davis N. The role of the Pirani scoring system in the 
management of club foot by the Ponseti method. J Bone Joint 
Surg Br. 2006; 88-B (8):1082-1084. doi:10.1302/0301-
620x.88b8.17482
11. Bravini E, Franchignoni F, Ferriero G et al. Validation of the 
Italian version of the Client Satisfaction with Device module 
of the Orthotics and Prosthetics Users' Survey. Disabil Health 
J. 2014; 7(4):442-447. doi:10.1016/j.dhjo.2014.04.002.
12. Magnusson L, Ahlström G, Ramstrand N, Fransson E. 
Malawian prosthetic and orthotic users’ mobility and 
satisfaction with their lower limb assistive device. J Rehabil 
Med. 2013; 45(4):385-391. doi:10.2340/16501977-1117.
13. Jarl G, Heinemann A, Norling Hermansson L. Validity evidence 
for a modified version of the Orthotics and Prosthetics Users’ 
Survey. Disabil Rehabil Assist Technol. 2012; 7(6):469-478. 
doi:10.3109/17483107.2012.667196.
14. Mahan S, May C, Kasser J. Early Experience with the C-PRO 
ADM Brace in Clubfoot. J Orthop Res Ther. 2020(5):1-4. 
doi:10.29011/2575-8241.001164.
15. Sangiorgio S, Ebramzadeh E, Morgan R, Zionts L. The Timing 
and Relevance of Relapsed Deformity in Patients with 
Idiopathic Clubfoot. J Am Acad Orthop Surg. 2017; 25(7):536-
545. doi:10.5435/jaaos-d-16-00522