The Use of the Abduction-Dorsiflexion-mechanism (ADM) in Clubfoot: Early Experience

Background:
Contemporary management of clubfoot consists of early serial application of plaster-casts and long term night-time bracing. As contrary to the obligatory bilateral design of boots-and-bar devices that are commonly used today, the ADM is a unilateral spring-hinged, ankle-foot-orthosis. Thus, it may be an alternative to the use of foot-abduction braces (FABs). The ADM has very limited evidence of effectiveness in prevention of recurrence and compliance with its use. This device was suggested in this clubfoot clinic, for children/parents who were not using the FAB for various reasons (non-compliance, late recurrence, parental preference)

Goal:
This is a preliminary retrospective study, collecting data of all children, in a single clubfoot clinic, who were offered the ADM for various indications.

Methods:
All children that were offered to use the ADM were detected. Data regarding the indication, compliance and problems encountered, were all collected.

Results:
Nineteen children were using the device (4 used it on both feet; 23 orthoses). During this period there were 346 new clubfoot cases (5.4%). Children were 1-9 years-old at the start of treatment, 4 were females (21%), and 10 had bilateral clubfoot (5 of them used unilateral ADM). Seven children were offered the ADM but did not purchase it (aren`t included). The duration of use is currently short (4-18 months), cracking of the device was reported by 2 families (replaced). Substantial side-effects were not reported. Out of 19, only 2 families (10%) were reporting low compliance while all other children are using it compliantly.

Discussion:
This is an early experience with ADM as a substitute for the FAB. This is new device, and indications for its use have not been established yet. Compliance was satisfactory and complications were minute. Future studies should evaluate its effectiveness in the prevention of recurrence in the Ponseti method of treatment.