Effect of a modified dynamic accordion hinge Denis Browne brace on the success rate of the Ponseti method in idiopathic clubfoot: a preliminary study

Barriers and facilitators to lower extremity orthotic compliance in the pediatric population: A scoping review of the literature

Despite the purported benefits of lower extremity orthotics in the literature, pediatric compliance rates remain low. This scoping review synthesized the available literature regarding barriers and facilitators to lower extremity orthotic compliance in the pediatric population using the framework of the International Classification of Functioning, Disability and Health: Children and Youth (ICF). A comprehensive search of MEDLINE, EMBASE, and CINAHL was conducted on May 11, 2021, and of PsycInfo on May 12, 2021. Article reference lists and gray literature were also searched. A total of 81 articles were included. Factors described in at least four articles were labeled as universal barriers or facilitators. In the International Classification of Functioning, Disability and Health: Children and Youth domain of Body Functions/Body Structures, universal barriers were present in the global mental functions, experience of self and time, sensory functions, function of joints and bones, and structures related to the skin subcategories, with no universal facilitators identified. For the Activity Limitations/Participation Restrictions domain, one universal facilitator was identified in the mobility subcategory. In the Environmental Contextual Factors domain, universal barriers were found in the attitudes of immediate and extended family and societal attitude subcategories, with both universal barriers and facilitators found in support & relationships: immediate and extended family, support and relationships: health professionals, services, systems, and policies, and products and technology. The reviewed literature strongly emphasizes the importance of proper orthotic fit and comfort, and the child's experience of self, for lower extremity orthotic compliance, along with multiple environmental factors.

Orthotic configuration and its effect on clubfoot: A bench research with modifications of orthotic bar length, dorsiflexion and abduction

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.

Factors that Influence Acquisition of Lower Extremity Braces in the Pediatric Orthopaedic Population

BACKGROUND

Lower extremity brace-wear compliance has been studied in pediatrics, but failure to acquire a prescribed brace has not been included. The purpose of this study was to evaluate brace acquisition as a component of brace-wear compliance.

METHODS

Records of patients (0 to 21 y) prescribed lower extremity braces from 2017 to 2019 were reviewed. Diagnoses included cerebral palsy, spina bifida, short Achilles tendon, clubfoot, and other. Brace type was categorized as clubfoot foot abduction orthosis, ankle-foot orthosis, knee, hip, or custom/other braces. Brace prescription and acquisition dates were recorded. Insurance was classified as government, private, or uninsured. Patient demographics included age, sex, race, and calculated area deprivation index.

RESULTS

Of the 1176 prescribed lower extremity braces, 1094 (93%) were acquired while 82 (7%) were not. The odds ratios (OR) of failure to acquire a prescribed brace in Black and Hispanic patients were 1.64 and 2.71 times that in White patients, respectively (95% confidence interval: 1.01-2.71, P=0.045; 1.23-5.6, P=0.015); in patients without insurance, the OR was 8.48 times that in privately insured patients (95% confidence interval: 1.93-31.1, P=0.007). The ORs of failure to acquire were 2.12 (P=0.003) in patients 4 years or more versus 0 to 3 years, 4.17 (P<0.0001) in cerebral palsy versus clubfoot, and 4.12 (P=0.01) in short Achilles tendon versus clubfoot. There was no significant association between sex or area deprivation index and failure of brace acquisition.

CONCLUSIONS

In our cohort, 7% of prescribed braces were not acquired. Black or Hispanic race, lack of insurance, and older age were associated with failure to acquire prescribed braces. Braces prescribed for clubfoot were acquired more often than for cerebral palsy or short Achilles tendon. Brace-wear compliance is an established factor in treatment success and recurrence. This study identified risk factors for failed brace acquisition, a critical step for improving compliance. These results may help effect changes in the current system that may lead to more compliance with brace wear.

LEVEL OF EVIDENCE

Level III-retrospective cohort study.

Effect of bar length on foot abduction and ankle dorsiflexion in Steenbeek foot abduction brace

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.