Steenbeek Foot Abduction Brace for Clubfoot

NewsBot · Jan 26, 2017

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The Dynamicity of Steenbeek Foot Abduction Brace for Clubfoot in Dorsiflexion and Pronation
A Pilot Study
Anil Agarwal et al
Foot Ankle Spec April 1, 2016

Purpose. Steenbeek foot abduction brace (SFAB) has been widely used in various national clubfoot programs. The aim of the study was to define effectiveness and dynamicity of SFAB in terms of dorsiflexion and pronation for the corrected clubfoot. Methods. Differences in foot dorsiflexion and pronation measurement with brace in knee flexed and extended position were recorded as dynamicity1 and dynamicity2, respectively. The residual soft tissue stretch lag despite brace use was calculated by determining the difference between maximum foot dorsiflexion (stretchlag1) and pronation (stretchlag2) achievable without and with brace in knee flexed. Statistical difference between measurements were calculated using paired t tests. Results. There were a total of 63 feet in 40 patients. The mean foot dorsiflexion with brace on in knee extension was 7.57? and in flexion was 15.20?. The foot pronation with brace on in knee extension was 9.46? and in flexion was 16.77?. Thus, SFAB exerted statistically significant differences in foot dorsiflexion and pronation between the knee extended and flexed positions. Dynamicity1 and dynamicity2 were 7.63? and 7.31?, respectively. Stretchlag1 was 18.47? and stretchlag2 was 17.63?. Conclusions. SFAB demonstrates effective dynamicity in maintaining corrected foot dorsiflexion and pronation. There is a residual soft tissue stretch lag both in dorsiflexion and pronation in corrected clubfoot despite use of SFAB.
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NewsBot · Jan 26, 2017

The foot abduction characteristics following Steenbeek foot abduction brace.
Agarwal A, Kumar A, Mishra M.
J Orthop Surg (Hong Kong). 2017 Jan;25(1):2309499016684085

PURPOSE:
We prospectively investigated the foot abduction characteristics following Steenbeek foot abduction brace (SFAB) use in corrected clubfeet. The foot abduction achievable in SFAB with knee flexion and extension was calculated to find the effectiveness and stretch exerted by it.
METHODS:
Only children with corrected idiopathic clubfeet using SFAB for greater than 3 months were enrolled. The foot abduction with and without brace in knee extended and flexed positions was measured. Hip range of motion (ROM) with and without brace was also recorded.
RESULTS:
The average age of 42 children ( 62 feet) was 24.25 months (range: 5-48 months). There was difference in foot abduction of 22.2° in knee extension and flexion with SFAB on. A significant change in foot stretch of 25.5° observed when the knee was moved from extended to flexed position indicated SFAB dynamicity. The SFAB was found to be an effective orthosis as it brought the corrected clubfoot into maximum abduction permissible in the foot during the phase of knee flexion. The tibial rotation accounted for a major component (61%) of apparent foot abduction with the brace on. A hip ROM of 52.2° was required for SFAB function.
CONCLUSION:
SFAB is a dynamic brace that functions better in flexed knee position. It is able to induce a near equivalent actual abduction available in the foot in flexed position of knee. There is a significant component of tibial external rotation in SFAB-induced foot abduction. SFAB function is also dependent on hip mechanics.
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NewsBot · Jun 28, 2017

Steenbeek foot abduction brace for clubfoot: Cost-effective but is it effective? A prospective study.
Thatikonda, Sai Dinesh and Kotian, Prem and Premjit, Sujir and Varghese, Joe C and *, Rajendra Annappa (2017)
Asian Journal of Pharmaceutical and Clinical Research, 10 (5). pp. 99-101. ISSN 0974-2441

Objectives: To evaluate the effectiveness of Steenbeek FAB (SFAB) to maintain correction achieved and to study the reasons for failure and
complications associated with the brace.
Methods: In Kasturba Medical College, Mangalore and allied hospitals between June 2014 and August 2016 25 patients (38 feet) who were treated
by Ponseti method of cast application were given the SFAB and followed up for a minimum duration of 1 year. The status of the foot was assessed
using Pirani score before brace application and at every follow-up. Compliance with the brace protocol was assessed and compliance defined as brace
application for 23 hrs/day for the first 3 months, and nap time brace application for rest of the duration of study.
Results: In 36 of 38 feet on the brace the correction was maintained (94.7% effective). In two patients (feet) there was worsening of the Pirani score
after brace application and recurrence was seen. The reason for failure was found to be noncompliance. The correlation between noncompliance and
recurrence was significant (p<0.001) using Fischer exact test. Pirani score improved significantly in a compliant group with significant worsening
noted in noncompliant group. There were no other brace related complications.
Conclusions: The significant correlation between noncompliance and recurrence shows that SFAB is effective in maintaining correction and can be a
cost-effective alternative to the more costly braces, for use in developing countries.
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NewsBot · Jul 20, 2017

COMPARISON BETWEEN TWO TYPES OF ABDUCTION
ORTHOTICS IN TREATING CONGENITAL CLUBFOOT
Luiz CarLos ribeiro Lara et al
Acta Ortopédica Brasileira

Objective: The objective of this study was to analyze and compare
the effectiveness of two types of abduction orthotics used for the feet,
the Denis-Browne type (traditional) and the Dobbs type (dynamic),
with regard to maintenance of deformity correction and prevention
of recurrence. Method: In this comparative retrospective case study,
information was collected from the medical records of children with
idiopathic congenital clubfoot (CCF). We evaluated a total of 43 feet
in 28 patients, which were divided into two groups. Group 1 was comprised
of 16 patients with a total of 24 CCFs treated with the traditional
orthotic device. Group 2 consisted of 12 patients with a total of 19
CCFs treated with the dynamic orthotic device. The statistical analysis
used the ANOVA test to compare the categorical variables between
the groups. A significance level of 5% was adopted (p-value≤0.05).
Results: In Group 1, recurrence was observed in 2 feet (8.33%), and
in 1 foot in Group 2 (5.26%). No significant difference in effectiveness
was seen between the two types of orthotic devices. Conclusion:
Both abduction devices were seen to be effective in maintaining
correction of congenital clubfoot deformities. There was no statistical
significance between type of orthotic device and recurrence.
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NewsBot · Sep 5, 2017

Flatfoot in the contralateral foot in patients with unilateral idiopathic clubfoot treated using the foot abduction brace
Shirai, Yasuhiro et al
Medicine: September 2017 - Volume 96 - Issue 35 - p e7937doi: 10.1097/MD.0000000000007937

While the foot abduction brace (FAB) plays an important role in the Ponseti method, the true function of the FAB in the treatment of idiopathic clubfoot remains unknown. In our clinical experience, we have noted that many patients with unilateral idiopathic clubfoot developed significant flatfoot in the contralateral foot during brace treatment. The purpose of this study was to investigate the natural history of the contralateral foot development during and after brace wear. We also discuss the effect of the FAB on the contralateral foot.

We retrospectively reviewed 21 contralateral feet of 21 patients with unilateral idiopathic clubfoot who were treated using the Ponseti method and were conservatively followed up until the FAB was taken off (6 years of age or older). We evaluated flatfoot indicators of the contralateral foot on standing radiographs during and after brace wear and compared them against the normal reference ranges. We also evaluated the changes in the flatfoot indicators of the contralateral foot during and after brace wear.

Although there was a significant difference in the flatfoot indicators between the contralateral foot and normal reference ranges during brace wear, there was no significant difference in the flatfoot indicators after brace wear. While there was no significant improvement in flatfoot indicators of the contralateral foot during brace wear, there was a significant improvement or a trend to improve after brace wear. There was no significant correlation between the contralateral flatfoot and original joint laxity.

Significant flatfoot deformity was observed in the contralateral foot during brace wear. The contralateral flatfoot persisted during brace wear and improved to within normal reference ranges after brace wear. Our findings suggest that the FAB may influence the development of the contralateral foot, leading to the flatfoot.
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NewsBot · Sep 30, 2017

COMPARISON BETWEEN TWO TYPES OF ABDUCTION ORTHOTICS IN TREATING CONGENITAL CLUBFOOT.
Lara LCR et al
Acta Ortop Bras. 2017 Jul-Aug;25(4):125-128. doi: 10.1590/1413-785220172504155890.

OBJECTIVE:
The objective of this study was to analyze and compare the effectiveness of two types of abduction orthotics used for the feet, the Denis-Browne type (traditional) and the Dobbs type (dynamic), with regard to maintenance of deformity correction and prevention of recurrence .
METHOD:
In this comparative retrospective case study, information was collected from the medical records of children with idiopathic congenital clubfoot (CCF). We evaluated a total of 43 feet in 28 patients, which were divided into two groups. Group 1 was comprised of 16 patients with a total of 24 CCFs treated with the traditional orthotic device. Group 2 consisted of 12 patients with a total of 19 CCFs treated with the dynamic orthotic device. The statistical analysis used the ANOVA test to compare the categorical variables between the groups. A significance level of 5% was adopted (p-value≤0.05) .
RESULTS:
In Group 1, recurrence was observed in 2 feet (8.33%), and in 1 foot in Group 2 (5.26%). No significant difference in effectiveness was seen between the two types of orthotic devices .
CONCLUSION:
Both abduction devices were seen to be effective in maintaining correction of congenital clubfoot deformities. There was no statistical significance between type of orthotic device and recurrence. Level of Evidence III, Retrospective Comparative Study.
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NewsBot · Sep 11, 2019

Effect of bar length on foot abduction and ankle dorsiflexion in Steenbeek foot abduction brace
Agarwal, Anil; Barik, Sitanshu
Journal of Pediatric Orthopaedics B: September 9, 2019 - Volume Publish Ahead of Print - Issue - p

We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (−2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abduction (46°) but not for dorsiflexion. The varied bar lengths tested did not significantly altered available dorsiflexion or abduction. The currently used Steenbeek foot abduction brace were larger than shoulder widths. The Steenbeek foot abduction brace was dynamic but required prefabrication for its effectiveness. The changes in bar length did not significantly alter foot dynamics occurring with brace.
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NewsBot · Mar 7, 2022

Orthotic configuration and its effect on clubfoot: A bench research with modifications of orthotic bar length, dorsiflexion and abduction
Anil Agarwal
J Clin Orthop Trauma. 2022 Feb 12

Purpose: We determined the effect of changes in abduction orthosis for clubfoot (bar width, dorsiflexion and abduction) on ankle dorsiflexion and foot abduction.

Methods: The study included 31 children with clubfoot. An adjustable Steenbeek foot abduction orthosis permitting variations of bar width [distance between anterior superior iliac spines, shoulders and 'standard'], dorsiflexion (0, 15 and 30°) and abduction (30, 45 and 70°) was used for measurements. Ankle dorsiflexion and foot abduction were measured with and without orthosis and compared using repeated measures analysis of variance (ANOVA).

Results: Foot abduction was same as orthotic abduction in all configurations. A better ankle dorsiflexion was found with a shorter bar width, larger orthotic dorsiflexion and abduction. Contrarily, the arc increased with a wider bar. A 30° inbuilt orthotic dorsiflexion and 70° abduction produced better foot dynamics.

Conclusions: A foot abduction orthosis with modifications of shorter bar length, 30° dorsiflexion and 70° abduction may offer better soft tissue stretch and foot motion in clubfoot.
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NewsBot · Apr 12, 2022

Measuring Foot Abduction Brace Wear Time Using a Single 3-Axis Accelerometer
Benjamin Griffiths et al
Sensors (Basel). 2022 Mar 22;22(7)

The recommended treatment for idiopathic congenital clubfoot deformity involves a series of weekly castings, surgery, and a period of bracing using a foot abduction brace (FAB). Depending on the age of the child, the orthotic should be worn for periods that reduce in duration as the child develops. Compliance is vital to achieve optimal functional outcomes and reduce the likelihood of reoccurrence, deformity, or the need for future surgery. However, compliance is typically monitored by self-reporting, which is time-consuming to implement and lacks accuracy. This study presents a novel method for objectively monitoring FAB wear using a single 3-axis accelerometer. Eleven families mounted an accelerometer on their infant's FAB for up to seven days. Parents were also given a physical diary that was used to record the daily application and removal of the orthotic in line with their treatment. Both methods produced very similar measurements of wear that visually aligned with the movement measured by the accelerometer. Bland Altman plots showed a -0.55-h bias in the diary measurements and the limits of agreement ranging from -2.96 h to 1.96 h. Furthermore, the Cohens Kappa coefficient for the entire dataset was 0.88, showing a very high level of agreement. The method provides an advantage over existing objective monitoring solutions as it can be easily applied to existing FABs, preventing the need for bespoke monitoring devices. The novel method can facilitate increased research into FAB compliance and help enable FAB monitoring in clinical practice.
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