The Cunningham Brace is the brainchild of Jerald Cunningham who runs his own clinic in Maine, USA. Jerald graduated cum laude from Cornell University with a degree in Physics and Cognitive studies. He is a guest lecturer at the University of New England’s Ph.D. Physical Therapy programme.
Jerald started developing the brace at the request of the orthopaedic surgeon he worked with. The consultant felt that whilst the Boots and Bar offered a successful treatment, they often caused a lot of distress to the child and parents. They can be difficult to put on, keep in place and children can find it difficult to sleep.
Jerald has worked on it for over a decade, continuously making development changes based upon the evidence provided by the in-brace x-rays taken after every patient fitting.
The Cunningham Brace (also known as the Dynamic Torsional KAFO or DTKAFO) is a flexible brace that is only fitted to the affected leg and allows movement for all of the normal activities such as crawling, rolling, standing and even walking.
The brace is always gently stretching the baby into the correct position so it is acting as though the therapist is always there manipulating and correcting the foot. In the case of a unilateral (single) club foot, because each leg is treated separately only the affected foot is involved (with the boots and bar approach, both feet have to be attached to the bar regardless.)
The end result is a very effective treatment protocol that has reduced treatment times to about a third of other treatments, and which typically requires only two braces during the two years that it is worn.
After a brief period, the baby is not even aware of the presence of the brace. This really improves comfort and compliance (and decreases stress for parents).
The big difference is that the Cunningham Brace is flexible and only fitted to the affected leg. This allows for the sort of dynamic movement you’d expect in babies, such as crawling, rolling and standing. Greater activity helps build a more developed muscular system – particularly calf muscles. Anecdotally we’ve seen a lot more symmetry in calf muscles using the Cunningham Brace than boots and bar. And because it’s a different kind of mechanism we don’t have to strap the feet up so tightly, which reduces issues such as blistering on the legs.
The Cunningham Brace is made from a series of measurements that we can either take in the clinic or help you to take during a virtual appointment. We hold a range of Cunningham braces in stock that we can adapt to the correct size and foot type of your baby. This process normally takes a few hours unless your child has a size that is out of the normal range or we do not have it in stock.
It depends on your child and the complexity of their case. On average, though, we’ll be looking to review your baby’s progress once a month over the course of treatment.
Treatment lasts about two years – this is around one-third of the time other methods require. In the first year, your baby will wear the brace for 23 hours a day – compared with boots and bar which can only be done for three months. This means we can help correct your baby’s foot while their tissue and bones are at their softest and most compliant. Once your baby is standing, they will only wear the brace during nighttime and naps.
The exact number will depend on your child and their condition, but typically a child will only need to wear two to three braces over a two-year period. The first for about six months, then a year each for the second and third.
Very often parents contact us before their baby is even born, having discovered the club foot on a scan. However, they first need to go through the Ponseti method with their consultant and then be triaged by a specialist physiotherapist before we can start treatment.
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