Steenbeek foot abduction brace for clubfoot: Cost-effective but is it effective? A prospective study

Introduction: Foot abduction brace (FAB) is recommended to prevent recurrence after casting phase in Ponseti method. Various types of braces are described, most current braces with proven efficacy are costly (100-300$) and difficult to acquire especially for the common man in India. Steenbeek brace can be made with locally available materials and is very simple to make and is cost-effective (10$). Its efficacy is largely untested. Aim: To evaluate the effectiveness of Steenbeek FAB (SFAB) to maintain correction achieved and to study the reasons for failure and complications associated with the brace. Methods: In Kasturba Medical College, Mangalore and allied hospitals between June 2014 and August 2016 25 patients (38 feet) who were treated by Ponseti method of cast application were given the SFAB and followed up for a minimum duration of 1 year. The status of the foot was assessed using Pirani score before brace application and at every follow-up. Compliance with the brace protocol was assessed and compliance defined as brace application for 23 hrs/day for the first 3 months, and nap time brace application for rest of the duration of study. Results: In 36 of 38 feet on the brace the correction was maintained (94.7% effective). In two patients (feet) there was worsening of the Pirani score after brace application and recurrence was seen. The reason for failure was found to be noncompliance. The correlation between noncompliance and recurrence was significant (p<0.001) using Fischer exact test. Pirani score improved significantly in a compliant group with significant worsening noted in noncompliant group. There were no other brace related complications. Conclusions: The significant correlation between noncompliance and recurrence shows that SFAB is effective in maintaining correction and can be a cost-effective alternative to the more costly braces, for use in developing countries.