Relapse FAQ

Signs of relapse include tightness in heel, loss of dorsiflexion, toe walking, forefoot turning in, dynamic supination in walking children, or suddenly not tolerating the boots and bar due to change in foot.

If you have a stretching routine in place with your child it can be a great way for you to check your child’s feet for signs of relapse. If you notice a decrease in range of motion or flexibility, it may be a sign of relapse and important that you discuss with your provider. If you do not have a stretching routine in place, you can also quickly check your child’s mobility before putting on the BNB at bedtime. You can also watch for any change in the way your child walks. For example, if you start to notice toe walking it may be a sign of relapse and important to discuss with your doctor. Parents are the first line of defense against relapse, as they are with their children the most and will notice a change if it occurs.

Dorsiflexion is the backward bending and contracting of your hand or foot. This is the extension of your foot at the ankle and your hand at the wrist. Dorsiflexion occurs in your ankle when you draw your toes back toward your shins. You can also dorsiflex your foot by lifting the ball of your foot off the ground while standing, keeping your heel planted into the ground.

Treatment of a relapsed clubfoot typically includes the application of 2-3 stretching casts and, if the muscle is too strong to prevent future relapse, a tendon transfer surgery after the child is over 2.5 years old.

Nearly all relapses occur in the maintenance phase of treatment (bracing). Relapses usually occur after 1 or 2 years of age when ossification is more advanced. Relapses are rare after 5 and extremely rare after 7.

Ossification is the natural process of bone formation.

Wearing braces correctly for three to four years is the most important part of treatment to reduce relapse. Incorrect wearing of the boots and bar, or insufficient time in the BNB, will not maintain the corrected foot position as the bones do not ossify until four years of age.

When the muscles and tendons on the inside of the foot and calf are stronger and pull the foot back into a clubfoot position. Incorrect use of the BNB as well as growth spurts or muscle and ligament issues may cause relapses.