Paediatric Bracing

Orthoses are externally applied medical devices used to prevent or correct musculoskeletal deformities and improve physical functioning; these devices are typically custom made.

We work closely with Paediatric medical professionals to ensure that each child that enters these doors get the correct, most up to date orthotic treatment possible.

Having a child with developmental or congenital problems can be very stressful and daunting for a parent. We understand that and will support you through the entire treatment process. We will provide you with as much information possible about the Orthopaedic appliances that are available, as well as support and follow up care after the appliance has been fitted.

Please follow the links to read more about what you can expect on your first visit, as well as additional information on fitting and manufacturing of orthotics and recommended footwear.

CTEV

We use the Mitchells system with a Ponsetti or Dobbs bar for CTEV (clubfoot) bracing, and have the ADM system available.

Aware Bears

Aware Bears and Never-ending stories are two very important platforms for Cerebral Palsy awareness, managed by Lesley Potgieter, who has CP herself and made it her mission to create awareness using Helen and Harold, two aware bears who travel South Africa and visits children all over the country.

Please go and visit them at:

http://www.awarebears.co.za/

Paediatric first visit, what to expect

When you come and visit us for the first time, you would have probably been referred to us by your doctor or physiotherapist.
We do require you to make an appointment, and schedule at lease 30-45 minutes for your appointment.

Please take your baby/child’s routine into consideration when you make an appointment. Doctors are normally not their favourite people, and having a tired hungry baby makes assessment quite difficult, and causes unnecessary stress on you as a parent as well. So please ensure that your baby/child has had his/her nap and have a full tummy to make his/her visit as pleasant as possible.
Please remember to bring your referral letter along.

Although we as professionals phone each other as a courtesy, your referring doctor/physiotherapist might be busy with another patient and it is just easier to see what they need us to look out for during our assessment, to achieve the same goal.
Sometimes, we need to discuss the treatment plan with your referring practitioner, thus will have a follow up consultation to measure your baby/child for whatever appliance it is we are going to use as treatment.

Most often however we are clear on the plan and measurements will be taken immediately.

If we do need to cast your baby for moulded innersoles, Ankle foot Orthosis (AFO) or prosthesis, we will use casting material to do so.

Depending on your child’s age, size and co-operation, we might either use plaster of Paris (POP) bandages or fibre glass casting tape.

To take this cast, we first don a thin stocking over the part, say ankle/foot that is being casted. Then we mark the bony prominences with an indelible pencil. This might leave a mark on your baby’s skin but will come off during her bath.

  • We then place a protective strip against your baby’s skin and cover the area with wet POP or casting tape bandages.
  • The bandages will get warmer during the curing process, but NEVER too warm for your baby’s skin.
  • Once the bandage has cured, about 5 to 10 minutes, the cast is removed.
  • We then have a negative cast of your baby and will use this to build the brace.
  • Normally manufacturing takes 7 to 10 days and you will be phoned to come in for a fitting as soon as the Orthotist is ready with your brace.

Please make provision for a 30 to 45 minute consultations when we fit your baby’s brace, as minor adjustments can be done on the spot.

You will be required to make a follow up appointment to check if the brace fits correctly and if it is achieving the results it was set out to do.

Please read the guidelines on the fitting, care and maintenance of the brace. You will also find handy information on the correct selection of shoes.

Donning Instructions

Donning the Brace
1. Position your patient in front of and facing you with his/her hips and knees flexed. Apply a moderately thick sock extending above the brace brim on the child’s foot, and make sure the fit is snug without any wrinkles.
2. Slide the foot into the brace while opening the forefoot portion of the brace. The heel needs to be positioned firmly in the back of the brace. Pushing down on the child’s flexed knee will help you to seat the heel more easily. While resting child’s t foot on your knee, wiggle the brace up and down while pushing the top of the foot back into the heel area.
3. Lifting one side of the forefoot opening of the brace makes it possible to place the instep pad underneath the foot. Position the pad down onto the foot and place the foot back into the brace.
4. Dorsi-flex the foot by pushing up under the child’s forefoot. Secure and tighten the instep straps to the required tension.
5. Fasten each strap firmly to optimise foot control, as each of the straps are put there for a specific reason.

Getting used to the braces, break-in period
It is recommended to allow break-in period for the patient to get used to the brace.
1. New patients wearing time should only be an hour or two a day in order to allow monitoring for problems, and checking the feet for areas of discomfort and possible blistering.
2. Increase wearing time by one hour per day. This process can last for up to three weeks until the child can fully adapt to wearing the braces, but can be adapted to each child.
3. The child might have less balance during this time and additional therapy may be very useful.
4. If discomfort persists after this amount of time including irritation and red marks, contact your
Orthotist, also if functionality does not improve.

Concerns
1. Contact your Orthotist if any of the following problems arise. These may indicate a need for the brace to be adjusted:
2. If the child complains of discomfort, even after the brace has been worn comfortably for a time.
3. If there are any red mark or irritation that does not go away within twenty minutes after
removing the brace. Immediately discontinue wear if redness or irritation does not go away.
4. If the function does not improve after a week of wearing.

Looking after your braces:
1. The plastic that the braces are made out of is thin and flexible, but durable when worn properly. The temperatures in South Africa doesn’t get so cold that the plastic may get brittle, but the braces will however deform if left in the back window of hot car, so be aware of extreme temperatures.
2. The braces should be worn with shoes. Without shoes, the braces could get damaged and functionality could be compromised. The patient could also slip as the bottom of the braces is smooth.
3. Clean the braces with mild soap and warm water and towel dry. Do not dry with heat the braces as this may dis-configure the shape of the braces
4. Over time the braces will show signs of wear and tear. If your brace has distinct wear, arrange a follow-up visit with the Orthotist, who can replace worn straps for extended use out of your brace.

Socks:
Look for socks that:
• Fit without bunching or folding on the skin.
• Have breathable material to reduce perspiration.
• Are seamless.

Shoes:
Most tekkies work quite well with the braces.
• Look for shoes that:
• Have heel support (deep heel cup)
• Opens wide over the instep
• Fasten firmly over the instep (Velcro straps are quite handy)
• Have a toe box to accommodate the size and shape of the braces (width and depth)
• Have an insole in the bottom that can be easily removed after purchase to increase the available volume needed for fitting the braces.

Trying the shoe on:
Find the smallest shoe that can hold the brace. You may have to wiggle and push the brace into the shoe before the heel drops in. The shoe is too big if the brace slides into it too easily. If it is hard to get the brace in, the shoe will not be that much longer thus easier to walk with. If the shoe is too long, your child may trip over the toes.
A shoe horn helps you get the braced foot into the shoe.
Shoes can also be altered to improve the fit of the braces.
Consult with your Orthotist in choosing the appropriate shoes for this purpose.

If your child wears a brace on only one foot, the brace will slightly increase the length of the leg it’s on. To maintain even leg height, a moulded insole will be used in the un-braced foot’s shoe.
For a bulky brace, you may need two different sized shoes, one for the unbraced foot and a larger size for the braced foot.

Wait till you have the brace before spending unnecessary time and money on shoe shopping!!

Phone your Orthotist immediately if you have any questions or concerns.