The Ponseti method is the gold standard treatment for club foot in the UK and most of the world. It is well evidenced to be the most effective way of correcting the initial deformity and is the procedure used and endorsed by Great Ormond Street Hospital.
The method involves gently manipulated the baby's foot into a better position and then being put in a cast. This is repeated weekly for around five to eight weeks. After this stage, a tenotomy (small surgical incision) of the Achilles tendon is performed under local anaesthetic.
Following this, babies will then need to wear special boots attached to each other with a bar, to prevent club foot returning. The “Boots and Bar” are worn full-time for the first three months, then overnight until the child is four or five years old. Together this treatment has been well evidenced and can yield excellent results.
The London Orthotic Consultancy (LOC) has recently introduced a new brace that replaces the Boots and Bar – the Cunningham Brace.
Boots and Bar
LOC has been given the exclusive rights to prescribe & fit the Cunningham brace in the UK and Europe which forms a key part of our Clubfoot treatment.
The Cunningham Brace is an alternative to the traditional boots and bar approach commonly prescribed.
The Cunningham brace is used for paediatric treatment whereas adults can benefit from LOC's bespoke orthotics.
The Cunningham brace is the brainchild of Jerald Cunningham, a certified American prosthetist and orthotist.
It is a flexible brace that is only fitted to the affected leg and allows movement for all of the normal activities.
Gerald developed his brace in response to observing the distress to both child and parent with the Boots and Bar approach.
Adults with club feet can have trouble walking with curled toes, fused ankles, callouses and pain.
At LOC, we offer bespoke orthotic treatments such as bespoke insoles, custom-made footwear and AFOs.
Upon consultation at LOC, we can discuss your goals and what you want to achieve via treatment.
Club foot, or clubfoot, is the general name given for a medical condition called congenital talipes equinovarus (CTEV). Congenital means that you’re born with the condition, which can occur in one or both feet. It is quite common, occurring in around one in every 1,000 babies born in the UK.
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.
At your first appointment we will take measurements and fit your child with their first Cunningham Brace. We’ll show you how to put the brace on and take it off and book you in for a review a week later. We then schedule a series of reviews as your child grows to check progress and ensure that your child is maintaining the correction. This can be done in the clinic or virtually via a system like Skype. There are lots of simple things we can adjust to encourage correct development.
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.
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.
At the moment we can fit the brace at our clinics in Kingston-upon-Thames and Bristol; in addition, we can do follow up appointments at our Manchester clinic. There is a certain amount we can do virtually, but your first fitting would need to be done in person.
If your patient has asked you for more information about club foot treatment or the Cunningham Brace, our director Sam Walmsley would be happy to speak with you directly to explain the process. We can also offer your team an online presentation. Contact the LOC team if you’d like to know more.
The Ponseti method was only introduced in the UK in the late 1990s, which means there are lots of adults living with the long-term impact of untreated club foot. The good news is that many of the common problems that adults experience can be treated effectively with orthoses. Take a look at our treatment for adults with club foot page for more information.
If you would like to talk to us about your baby’s club foot and Cunningham Brace treatment, please don’t hesitate to get in touch via our Request an Appointment form or by calling us on 020 8974 9989.
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