Illustration of a child's foot in a supportive brace, symbolizing clubfoot treatment.

Cracking the Code: How to Improve Brace Adherence in Children with Idiopathic Clubfoot

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"Unlocking the mysteries behind brace adherence in children with idiopathic clubfoot: A guide for parents and practitioners."

Idiopathic clubfoot, a congenital foot deformity, has seen a dramatic shift in management over the past two decades. The introduction of the Ponseti method, a non-surgical approach involving serial casting, revolutionized treatment, offering high rates of success and reproducibility. This method replaced invasive surgical procedures, providing a less traumatic experience for young patients.

While the Ponseti method has proven highly effective, its long-term success hinges significantly on one crucial factor: consistent adherence to a prescribed bracing schedule. Following the casting phase, children are typically fitted with a foot abduction orthosis, which they are required to wear for a significant portion of the day, often during sleep. This brace helps maintain the correction achieved through casting and prevents relapse.

However, maintaining consistent brace wear can be challenging for both children and their families. Despite the best intentions, adherence rates can fluctuate, impacting the overall outcome of the treatment. Understanding the factors that influence brace adherence is critical to optimizing the long-term success of the Ponseti method and improving the quality of life for children with idiopathic clubfoot.

Why is Brace Adherence So Challenging?

Illustration of a child's foot in a supportive brace, symbolizing clubfoot treatment.

Even after successful initial correction with the Ponseti method, recurrence remains a concern. Studies show that recurrence rates can be significant if bracing protocols are not followed diligently. This highlights the critical role of consistent brace wear in maintaining the correction achieved through casting.

Several factors can contribute to difficulties in adhering to bracing schedules. These challenges can stem from various sources, including:

Practical Difficulties: The brace schedule, often requiring 10-12 hours of daily wear, can be disruptive to a child's routine and family life.
Sensory Issues: Some children may experience discomfort or irritation from the brace itself, leading to resistance and non-compliance.
Socioeconomic Factors: Access to orthotic stores and the ability to afford necessary supplies can present barriers for some families.
Lack of Understanding: Parents may not fully grasp the importance of bracing or the potential consequences of non-adherence.
Neurodevelopmental Factors: Emerging research suggests that subtle neurodevelopmental differences in children with idiopathic clubfoot may also play a role in adherence.

It's important to recognize that brace adherence isn't simply a matter of parental will. Many factors, both practical and intrinsic, can influence a family's ability to consistently follow the prescribed bracing schedule.

Empowering Families for Bracing Success

Ultimately, successful brace adherence requires a collaborative approach. By understanding the challenges families face and implementing targeted strategies, practitioners can empower parents and children to achieve optimal outcomes. Further research into the neurodevelopmental aspects of clubfoot may pave the way for even more personalized and effective interventions, ensuring a brighter future for children with this condition.

About this Article -

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Everything You Need To Know

What is Idiopathic Clubfoot, and how is it managed?

Idiopathic clubfoot is a congenital foot deformity. The Ponseti method, a non-surgical approach involving serial casting, has revolutionized its treatment. This method is followed by the use of a foot abduction orthosis (brace) to maintain correction and prevent relapse. The effectiveness of the Ponseti method relies heavily on consistent adherence to the prescribed bracing schedule.

Why is brace adherence so important in treating Idiopathic Clubfoot using the Ponseti method?

Brace adherence is critical because it directly impacts the long-term success of the Ponseti method. Consistent brace wear helps maintain the correction achieved through casting and prevents recurrence of the foot deformity. Studies have shown that non-adherence to bracing protocols can lead to significant recurrence rates.

What are the practical difficulties that can hinder brace adherence?

Several factors can make brace adherence challenging. Practical difficulties include the brace schedule itself, which often requires 10-12 hours of daily wear. Sensory issues, such as discomfort or irritation from the brace, can lead to resistance. Socioeconomic factors, like access to orthotic stores and the ability to afford necessary supplies, can also present barriers. Furthermore, a lack of understanding about the importance of bracing among parents can contribute to non-adherence.

How do sensory and neurodevelopmental factors impact brace adherence for children with Idiopathic Clubfoot?

Sensory issues can cause children to experience discomfort or irritation from the brace, leading to resistance. Emerging research suggests that subtle neurodevelopmental differences in children with idiopathic clubfoot may also play a role in adherence. These factors can influence how a child perceives and tolerates the brace, thereby affecting their willingness to wear it consistently.

What are the long-term implications if bracing protocols are not followed diligently after the Ponseti method for Idiopathic Clubfoot?

If bracing protocols are not followed diligently, the long-term implications include a higher likelihood of recurrence of the Idiopathic Clubfoot deformity. This means the initial correction achieved through casting may be lost. Recurrence can lead to the need for further interventions, potentially including more invasive treatments. Consistent brace wear is crucial to ensure the long-term success of the Ponseti method and improve the quality of life for children with Idiopathic Clubfoot.