Effect of a modified dynamic accordion hinge Denis Browne brace on the success rate of the Ponseti method in idiopathic clubfoot: a preliminary study
After the success of Dr Ponseti’s method for the treatment of idiopathic clubfoot deformity, the number of patients who need soft tissue release has decreased, but the use of foot abduction orthosis is crucial for maintaining correction after this method. The lack of adherence to the orthosis regimen is reported to be a major factor for recurrence. Noncompliance with brace may be because of skin ulceration and blistering or irritability of children because of restrictiveness of the leg motion in the brace. The aim of this article is to introduce a new design of Denis Browne brace (accordion Hinge DB brace) and evaluate the results. We treated a total of 90 patients with idiopathic clubfoot (145 clubfeet) by Dr Ponseti’s method and then prescribed a new design accordion to a hinge DB brace after correction of the deformity. We retrospectively reviewed the rate of complications, noncompliance, results, and effectiveness of this newly designed brace. The mean follow-up duration was 36 months (range 14–50 months). All 145 (100%) clubfeet showed complete correction after applying Dr Ponseti’s method before brace prescription. Then, the accordion hinge DB brace was applied after removal of the last cast, 23 h a day for 3 months, followed by nightly use subsequently for up to 4 years. Noncompliance was encountered for 15 (10.3%) clubfeet and in 11 (7.5%) clubfeet, relapse was observed. The mean time to relapse was 14 months. Among 15 noncompliant patients, 13 were older than 2 years of age and only one relapse occurred in a patient younger than 2 years old. We did not encounter any case with skin ulceration. On the basis of the results, and compared with our previous study with a classic DB brace, a considerable reduction in noncompliance and relapse was observed. We did not encounter any case with skin ulceration. This accordion hinge DB brace reduces the rate of the complications of classic DB brace, and we strongly recommend the accordion hinge DB brace after the Ponseti method and serial casting. Level of evidence: 4.