Humans have needs. Some needs are important and others are less important. In this regard, Abraham Maslow’s hierarchy of needs published between 1943-1954 which is a popular theory in psychology, depicts exactly the different types of needs humans have. First are the Physiological needs, second Safety, and the theory is that a person cannot reach the higher levels if there is a disruption in this hierarchy. You cannot skip steps in the building process and if there is a constant struggle on one of the levels a person cannot reach the higher levels.
Being comfortable in a clubfoot brace is highly important as sleep is one of the most important human needs. The need to be physically comfortable and to feel security and trust is second most important. So how did clubfoot children fare in the past regarding their most basic needs? How does clubfoot treatment affect these babies and children? What is the impact of incorrect treatments and casting that went wrong or bracing that went wrong and how important is this for successful outcomes?
Over the past several years the CLUBFOOT RESEARCH FORUM often heard from parents and patients in this regard. Stories of parents complaining about the size, fit, comfort levels without being ‘heard’. It goes without saying, that a brace that is causing sores and allergic reactions cannot possibly help any human achieve the basic need of sleep, yet often when parents complain about their children not sleeping while bracing, this complaint is ignored by medical professionals.
After many years researching and hearing this feedback from parents, the numbers uttering the same objections adds up. One of the most common complaints parents utter is that they are told to ‘ignore’ their children if they cry or don't settle and that they need to toughen up. They tell people that the ‘child just does not want to wear the brace’ or that a baby of a month old is just ‘naughty’.
Mostly, after parents submit pictures of the brace wear to us, it turns out that the brace was provided in the wrong size, (too big or too small), settings were wrong, fit was incorrect for the foot type etc. Many brace providers only use or offer one type of brace, but one brace type certainly do not fit well on all foot shapes! Over the years we have collected a lot of feedback and one thing is clear, blanket treatments do not work for all the patients. Clubfoot as a condition present to many variations to be served by a single brace type.
There is also limited brace comparison studies let alone peer reviewed publications. The few doctors that are willing to stray from the standard issue are few. People are scared off from trying and using newer designs and threatened with 'potential relapses' that might happen because it is not in the standard blanket care currently provided. If no new braces are used in the future, there will never be any future comparison studies.
That being said, it is notable that even the gentlest of braces can become a source of great discomfort if it is too small, not padded enough, not fitting properly, and difficult to put on a wiggling baby or toddler. Also if the brace is not used (no matter the type) a relapse is possible. Reasons parents cite for struggling to brace also include statements such as “braces can only be replaced once a year due to medical aid requirements or limits” or that a larger size is only available in a month from now as the provider do not have stock of a certain size etc. Also many parents to do not live close to these facilities and sometimes have to travel some distances for the next brace check-up.
As a result it is very important that the person responsible for brace fit and follow up delivers the best possible service and make appropriate judgment calls on size etc. Additionally, alternative solutions for hard to brace feet types should be available. For very small feet one such option is the Dobbs brace with custom AFO's. Underlying conditions also determine different approaches such as lesser degrees in the bar type braces or even a single leg device.
On top of this, adults would also like to sleep with braces if it will help them avoid a future procedure, or help them with pain levels. Only one adult off-loading brace is currently available, but it is again not suitable for everyone. More solutions are needed.
Parents get emotional about bracing, even more so when things have not turned out well for them and many errors occurred, none of which they could prevent. It is not hard to understand their emotional responses. The effects of improper or wrong application of bracing methods usually are devastating and mostly it could have been prevented.
If you would like to know more about bracing methods and troubleshoot problems, you are welcome to join our Facebook group if you follow the link on the first page of this website.
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