We at The Clubfoot Store like to be very active on Facebook, Instagram and anywhere we might be able to reach out to someone just starting or struggling in the Clubfoot Journey. Recently, I have noticed there to be a lot of curiosity surrounding the new ADMs (non-bar boots) and repetitive questions we are all looking for the answers too. Thus we interviewed Stella Morris, the co-creator/wife/super-clubfoot-warrior-mama on what exactly is the ADM.
Q: What is ADM stand for?
A: Officially it stands for Abduction Dorsiflexion Mechanism. Unofficially it stands for the initials of our 12-year son who has bilateral atypical clubfeet. His name is Anthony Dean Morris.
Q: What is the purpose of the ADM?
A: To assist with abducting and dorsiflexing the foot, using two springs which are anatomically aligned to sub-talar and tibiotalar joints thus allowing the normal, natural movement of the foot. When the ADM springs are working, they hold a low-intensity stretch when the wearer is resting.
Q: What or who has particularly inspired you in your journey to creating the ADM?
A: Our son Anthony wore the Mitchell boots and bars from the age of 4 months. My husband Philip (Morris), is an engineer and was convinced that a unilateral bar must be possible, which could do the same job as the boots and bar, and without impacting the knee or hip joints.
Q: Please elaborate on your journey with the ADM. When did you start developing this product? How did you go about designing, prototyping and eventually manufacturing the ADM?
We have been working on the ADM design since approx. 2010. When we had the first prototype ready in 2012, we invited about 20 renowned doctors from around the world to attend a meeting with us at Heathrow airport to show them our design. We expected them to be very skeptical as we knew that unilateral bars were frowned upon and had never been recommended before. However, we were pleased that they could see the potential, and this spurred us on to develop the brace further. We started to refine the design and eventually, in 2014 we were ready to try the ADM on children. We decided not to make an ADM for very young children and babies at this stage. We wanted to prove it was safe first.
We initially were working from a shed at the bottom of our garden, then we rented a bigger workshop and took on staff to help make the ADM. Now we own a large workshop where we can manufacture the ADM from the molding stage, through to the cutting out of materials, and final assembly and quality assurance. MD Orthopaedics have been very supportive and make the ADM sandal that the ADM attaches to.
At first, we hand made all the ADMs and had issues with breakages. But now we have those parts injection molded, so they are much stronger. As we have received feedback since 2014, we have refined the design further and introduced more spring strengths and ADM sizes.
Alongside designing the ADM, we also ensured that the ADM met all health and safety regulations in Europe, USA and other countries. It is CE marked and approved by the FDA.
What qualifications do you have? Philip, who designed the ADM is an Engineer. Before setting up C-Pro, we both had over 20 years experience in Project Management, Risk Analysis, and Management. We worked on large government computer design, implementation and rollout projects.
Q: What set backs have you encountered?
A: The main setback is from doctors (and some parents) who will not entertain the idea of an alternative brace. The difficulty we have is that the ADM is classified as a low-risk class 1 medical device. This means we are allowed to sell it over the counter, but also means that it does not require trialling (as a drug would). Instead, we have a responsibility to obtain feedback – known as post-market surveillance and to act on any feedback accordingly. Therefore the onus now falls on the medical community to run their tests and trials if they wish to do so. Many doctors are waiting for the results from other hospitals before trying the ADM themselves. This is a very common situation – just like the boots and bar did not have to go through formal trialling.
Who are the doctors that you worked with on creating this product? I cannot give their names, but they are all doctors who use the Ponseti method. The doctors who attended our original meeting in 2010 are all on the list of Ponseti Certified doctors.
Q: What were the doctor’s roles?
A: Mostly Consultant Paediatric Orthopaedic Surgeons and a few physios. We have also worked with a Surgeon specializing in other neurological conditions as the ADM can help children with other conditions that affect gait such as CP, trauma, diplegia.
Q: How do children react to ADM use?
A: The feedback we have been given is that most children accept the ADM extremely well. We don’t expect that it will work for everyone and accept there will be good and bad feedback. However, we are pleased to be able to offer parents an alternative.
Q: What do you foresee in the future with the ADM?
A: We hope to expand the ADM into other areas affecting children’s gait, such as the children with CP and other neurological conditions. We have had heart-rending feedback from parents who have told us that their children's’ lives have been changed for the better so this spurs us on. We have also been asked to make an adult ADM for a trauma patient. We are working on this and hope to have an adult ADM in mainstream production within a couple of years. With regards to the CF community, we hope that eventually the ADM will be accepted as a feasible bracing alternative.
Q: What are your goals for the ADM?
That it will become an accepted alternative brace to the other products already in the market.
A: Who would you recommend using an ADM at this time? Anyone who has a child with clubfoot, who is not tolerating boots and bars, has corrected feet, and doctor’s approval to try the ADM. We have had feedback that the ADM can help with sleep and family life, as well as keeping the feet flexible. We think this is important and can make the clubfoot journey for parents and families a whole lot easier.
For children with other conditions such as different sized legs, hip or knee issues, or non-compliance with BNB, the ADM appears to be a good option so far. For non-compliance with BNB, other factors should be considered as to why non-compliance is occurring, before switching to the ADM. Otherwise, these issues may continue or worsen.
We are aware of some hospitals starting to use the ADM for ‘normal’ CF cases where there are no other issues. Especially in regard to unilateral patients.
Q: What research has been done on the use and effectiveness of the ADM?
A: We are aware of some medical institutions carrying out their studies. It will take years for these studies to be published (if at all), but they are ongoing. One short-term study which was presented at BSCOS (British Society of Consultant Orthopaedic Surgeons) stated that all the children in the ADM had increased abduction at the end of the trial period (3 months). This is only a tiny study, and we hope to have more results being published over the coming months/years, although it is out of our hands.
Is there any on-going research on the effective of the ADM?. Yes, at various places throughout Europe. We do not know if these results will be published or just provided for internal use. Although we have been told some will be published. We are in touch with a doctor in the USA who has said he will conduct a study soon.
Q: If parents have completed bracing as per their doctor’s “okay” is the ADM a good alternative to continue bracing with?
A: If the bracing has been ‘completed’ as per Ponseti protocol, then there is no need for further bracing. However, if further bracing is indicated, then both our night and day ADM’s could be good options.
Q: I believe you to be parents of a clubfoot child, is this true?
Q: How old if your child now?
Q: How was your child treated for clubfoot?
Originally he was treated by staff who did incorrect casting and made his feet worse. We wrote to Dr. Ponseti who advised us to go to another doctor, and to get the Mitchell sandals and bar rather than the Markells. We moved hospitals, and the difference was amazing. We went to see Dr. Ponseti when our son was 8 months old, and he confirmed treatment was now back on track.
Q: Did your child use the ADM?
He was and is our chief tester! He wears a day ADM occasionally.
Q: How is your child’s clubfoot/clubfeet
A: Anthony has had issues with relapse and has been cast three times again since the age of 4. His right foot is fine, but his left leg gets tight still. We were advised to have an ATT but decided against it. We manage his relapse now through casting if needed, and occasionally wearing a day ADM if he is very tight.. He has extremely good days and worse days. But no bad days. He is never in pain, loves the sport and is very active. Mostly his gait is great, and you would not know he had clubfoot. I think he tightens up when he has growth spurts. At age 12 he is 5’ 2” so very tall! Our hospital is happy for him to wear the day ADM.
Q: Do you have any words of advice or inspiration for children with clubfoot, parents of a child with clubfoot or organizations and individuals seeking to treat clubfoot?
Always find a good doctor, experienced in treating clubfoot. Consult PIA and other parents.
Speak to other parents for lots of hints and tips and support. Facebook forums are great for this
Don’t ignore Mother’s instincts.
Exercise for your children. Particularly good is swimming and cycling in our experience. Clubfoot does affect the whole body, so it’s important to keep the whole body fit and flexible.
Parents should be aware and be ready in case of relapse occurs. While the majority of children don’t relapse, many do. It is wrong for parents to be fooled into thinking that coming out of boots and bar at age 4-5 years is the end of the journey. Growth spurts, tightness, relapses need to be looked out for, prepared for and managed.
Dr. Ponseti was a true inspiration. He had a rocking chair in his office. He liked a calm environment. If a child were crying, he would let parents feed the child, or go for a walk until all was calm. I think this should be taught in clinics. The calmer the child, the better the whole experience for everyone, including better fitting of casts.
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Thank you, Stella, Philip, and Anthony for your dedication to the treatment of clubfoot, hard to ameliorate families on this journey and for taking the time to educate and enlighten our readers about your product.
ADM's can be purchased in the here in the United Kingdom or here in the United States/Canada.