Boot and Bar Basics


BOOTS AND BAR BASICS (aka bnb)
Getting to know your way around the post cast-world of clubfoot. There are many options available today for boots and bars here are some of the most popular:

Markell  Boot:


Mitchell Boot:


Ponseti Bar:



Dobbs Bar:



ADM:




STANDARD PROGRESSION of wear:
23hr wear for 3 months following the last cast.
14-16hr* wear up to 1 year of age.
12hr* wear after 1 year of age.

*Not all Doctors follow this routine. Please ensure you are following the guidance of your doctor.
   
ROUTINE:
Setting precedents and routine is paramount to your child’s success with BnB. Ensure you are rigid with your routine for two reasons. 1) The baby/child will know what to expect, this will reduce the ambiguity of, “Will I have to wear my boots tonight?” when the answer is always, “yes.” 2) It will reduce the chances of relapse.

Every doctor will have their suggestions on how to split up the 1 hour of free time in the first three months after casts. Do what works for you, your baby and at the direction of your doctor. Personally, we split it into 30 minutes in the morning and 30 minutes at night for bath time.

For the first seven days of BnB, every time you change the diaper, remove the shoes. Use this time to check both feet for blisters or red spots. If you see any red spots cover with a slippery band-aid, a fabric band-aid will cause more friction and more damage and breakdown to the skin.

If you do have a blister appear, try and buy some Duoderm and cover the entire area (aka heel, etc.) for 5-7 days with Duoderm this will allow the skin to heal.

Always be consistent and aware of your child’s mood when you are about to remove the BnB. The baby will cry.  As hard as it is, DO NOT REMOVE the boots due to crying. This will teach the baby that if they cry hard enough and long enough, the BnB will be removed. Remove the BnB when the baby is happy, content & awake.

You can use the timer on your phone or stove to remind yourself to put the BnB back on.

Once you have removed, the boots check again for red spots or blisters. Do not add moisture, cream, wipes, etc. to baby’s feet. You do no want the build up of products on baby’s sensitive skin while back in the socks and back in the BnB. Baby powder is also not recommended, if baby's feet are too sweaty, it is suggested that socks be changed more frequently.

Do 5-10 minutes of stretching to the foot and heel.  Use different fabrics and textures (and touch!) on their feet. 
Allow baby to kick and play.

Change baby into a new pair of socks before putting the BnB back on.

GETTING INTO BNB:

Mitchell Boots:

The Mitchell boots have two holes in the back on either side, so you can make sure your baby’s heel is visible.  It is important to prevent blisters and keep the foot in place. 

    *It can take a few weeks for your baby’s heel to drop all the way, so it might not sit correctly in the boot at first.  Get the heel in as deep and as far back as far as possible.

**strapping the toes too tight can be painful and cause the baby to kick and fight more against the BnB, thus causing blisters or boots slipping.  If a foot ever slips out of the boot, try loosening the toes. Not too much, but just enough to be able to get a little lift in the strap and tighten the middle strap. Remember leather stretches so if you have marked your holes on your straps it might be time to tighten them.


Markell Boots:

The Markell boots have a large hole in the back of the boot. Ensure you put your baby’s heel as deep into the heel pocket as possible. Check to see that you can view it through the hole. This is important to prevent blisters and keep the foot in place.


  *It can take a few weeks for your baby’s heel to drop all the way, so it might not sit correctly in the boot at first.  Get the heel in as deep and as far back as far as possible.

**Strapping the toes too tight can be painful and cause the baby to kick and fight more against the BnB, thus causing blisters or boots slipping.  If a foot ever slips out of the boot, try lacing from the second hole from the bottom, leaving the first one empty. Remember leather stretches so if you have marked your holes on your pressure strap it might be time to tighten to tighten it.


BLISTERS:
BnB can cause nasty blisters to due to babies' sensitive and soft skin. Not to mention this skin has been in casts for the first 5-7 weeks of their life making it even more delicate and unused to touch. Some preventative steps can be taken to avoid blisters.  Here are the steps I took on advice from our casting tech/BnB fitter at Shriner's due to some nasty blisters we got:

Ensure you will have your BnB for your cast removal and that your doctor can check that you have the correct size of boots. Your cutie might need two different size shoes for each foot. It is not uncommon.

If you have the Mitchell shoe, you can wash these to soften the leather. (Do this before first wear.) Put the Mitchell boots in a pillowcase and washed them in warm water (do not add soap) on gentle cycle,  throw in some towels to protect the boots and wash-machine.  It will help loosen up the leather.  (You can/should do this for every new pair of shoes, blisters are only common with first-time BnB wearers, they can happen at any time.

There are three options you can use to lessen the pressure of the strap that rides the top of the foot.

1) Pressure Saddle
Mitchell Boots:
It can be done by ordering a latex pressure saddle with your boots.

Markell
The boot comes with a leather pressure saddle, but most find this is not enough.


2) Sheep Skin/ Cotton Padding
Mitchell Boots:
Have sheepskin sewn or glued the tongue on the boot.


Markell Shoes
Have a piece of cotton felt glued to the tongue

3) Make-Up Pads
Can be used on both the Mitchell and Markell boots under the tongues.

Finally, if you have done everything to prevent/treat blisters and the BnB are still causing an issue see your doctor. There are other options such as custom AFO's attached to a bar. Additionally, blisters can be a sign that the foot is not or never was fully corrected and the foot is relapsing.

Moleskin


Glue moleskin in the heel of the boot. This will prevent chafing of the heel, especially if your little one’s heel has not dropped.

 
BAR WIDTH:


Dobbs:
Check instructions that came with bar, as this bar will grow with your child. The typical rule of thumb is that the bar should be shoulder-width on your child.

Ponseti:
Some Ponseti bars are stationary if there is a need for a larger one consult your orthopedist. If your Ponseti bar is adjustable, the typical rule of thumb is that the bar should be shoulder-width on your child.


DEGREES:


Typical Clubfoot: 60-70 degrees
Unilateral Clubfoot 60-70 degrees with Typical Foot at 30-40 degrees.

SOCKS:

There are unlimited numbers of socks recommended by doctors, nurses, other clubfoot moms, and dads. Here is a list compiled from the various Facebook groups that people commonly like.

Black Robin Socks -  MD Orthopaedics
Triple roll socks - Old Navy, Children's Place & The Gap
Growing socks by Peds* - Wal Mart
Retro Baby & Toddler Tube Socks - Hank and Jojo
Turn Cuff Socks - Hanes
Circo Bobby Socks (aka Cat & Jack) - Target
Happy Foot by McGregor Socks* - Wal Mart


*In regards to the non-slip grips on the bottom of shoes - numerous people and their doctor's recommend getting the non-slip grips for their BnB while in the Mitchell shoe. I do not. For the same reason that when we were in the Markell. The small points plastic non-slip grips on the bottom of the socks can become hard over numerous washes, these are like pressure points and considering the foot in the same harnessed position all night long, I believe they are what make it so uncomfortable for babies. Think of it like a pebble in your shoe, the size only "grows" the longer it is in there. We use the Growing Socks by Peds and Happy Foot by McGregor Socks (both found at Wal-Mart), and we love them.


We especially love the Happy Foot socks as they made with rayon from bamboo, combed cotton fibers, cushion soles and comfort toe seams. McGregor Kids socks are available in three sizes; small, medium and large. Sizing is knitted into the socks to make sorting socks a breeze after washing, in particular for moms with more than one child.

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