Bracing For CTEV (a.k.a. Clubfoot) - A New Era Update!

Braces used for Clubfoot: A new era!

First Published April 2017

Updated Sep 17, 2022

Updated August 2, 2024

Updated February 2025

Congenital Talipes Equinovarus (CTEV), or Clubfoot, is a common congenital birth disorder that requires years of brace use to stave off a relapse of the disorder. Bracing keeps the foot or feet flexible and functional and postpones invasive surgeries in young children.

Not all case types respond well to the standard brace option, according to recent scientific studies. Unilateral CTEV patients, in particular, show low tolerance, as evidenced in some studies testing alternative braces Zgoda, Tan & Whelan:2023.

Alves:2019 confirms non-compliance affects as much as 34-61% of patients further supporting such reports. This data is also supported by the Clubfoot Research Foundation feedback polls and posts across social media groups.

New bracing designs show promise in addressing discomfort, blisters, and impacts on unaffected joints, with limited but supportive clinical outcomes. A 2023 study by Zgoda, Tan & Whelan confirms the ADM brace effectively maintains correction after relapses, after standard product use.

Since the ADM brace launch in 2016, thousands have reportedly used it successfully, with no significant increase in relapse rates observed in the Clubfoot Research Foundation's ADM user group. We compared the feedback in our groups with the manufacturer company's insights to form an understanding of whether the results in the Foundation's groups are matching up to trends and reports to the manufacturer and it matched.

Two new brace designs, the DTKAFO by Cunningham Prosthetics (USA) and the ADM brace by C-Pro Direct (UK), show promise in improving patient outcomes and comfort. Both unilateral products have been successfully tested in young babies and unresponsive cases.

Increased tolerance leads to longer bracing hours, and eventually case reports to the Clubfoot Research Foundation provided visible evidence (pictures or X-rays) of improved bone positions and reduced crease depths. In some instances unresponsive to treatment cases gained the ability to walk.

The education burden in CTEV is extremely high for patient families with a steep learning curve that is overwhelming. Yet ultimately, it is the family's responsibility to recognize if progress has halted or declined, or if issues may persist into adulthood. Only parents can make the most appropriate decision for their child, as they may be aware of co-morbidities, syndromes, or genetic factors not diagnosed in orthopedics clinics directly.

There is also now a long series of products. For example the Iowa Brace by Clubfoot Solutions were launched and resembles current bar brace designs. It is made out of softer materials to reduce blistering and it seems to be more tolerable and affordable. Its efficacy is yet to be studied though despite its widespread use globally.

A new Dobbs Bar Brace with Variable Spring settings has been added, accommodating more dorsiflexion levels. The Dobbs Brace and ADM Brace can be ordered online via Kiddfoot LLC or at any Hanger Orthotics Company in the USA and Canada. Other countries should order directly from C-Pro Direct unless a local provider is available to source it from.

The best understanding we can pass on to patient fmailies is that if you feel stuck and you notice no progress or decline of function despite perfect use of any product, trial another dynamic product. Also instead of giving up on bracing, rather than going unbraced try something new and include recasting in this process.

Using something that fits and is tolerated better is preferable to using nothing, a suggestion shared in our social media groups since 2012 when the Dobbs bar emerged and other AFO's and KAFO's were trialed in studies.

Stopping bracing early due to discomfort only leads to a relapse of CTEV sooner according to many validated scientific studies including Dr. Ponseti:2002.

This edit to our 2017 blog post is necessary due to changes in the ADM brace since its 2016 launch and new supporting research that emerged for the use of newer products.

After several years, our feedback groups show no difference in outcomes between the two sandals used by C-Pro Direct, confirming the manufacturer's experience also. You can see all study links for the products on our social media groups and website groups by joining via the group tag at the top of this page to learn about all brace options.

Pictures on our website have been provided with permission to use in our educational materials by the manufacturers or authors of the Clubfoot Research Foundation All rights reserved to the Clubfoot Research Foundation Org/LLC and respective copyright owners, whether old or new (C) 1980-2025.