1. Dynamic abduction brace for Clubfoot Abdul Razak Sulaiman Department of Orthopaedics School of Medical Sciences abdrazak@kb.usm.my 0129896565

2. background ● Incidence of clubfoot – 1- 6.8 per 1000 ● Treatment is Ponsetti methods – manipulation and casting – bracing

3. Copyright ©2004 American Academy of Pediatrics Morcuende, J. A. et al. Pediatrics 2004;113:376-380 Fig 2. Serial photographs at weekly intervals of the correction of a severe clubfoot deformity in a 3-week-old infant Fig 2. Serial photographs at weekly intervals of the correction of a severe clubfoot deformity in a 3-week-old infant. A, At initial visit. B, After first cast. C, After second cast. D, After third cast. E, After fourth cast. F, Treatment result after percutaneous tendoachilles tenotomy.

4. Copyright ©2004 American Academy of Pediatrics Morcuende, J. A. et al. Pediatrics 2004;113:376-380 Fig 3. Foot-abduction brace -a bar with shoes attached at the ends. -full-time basis for 2 to 3 months - at night and during naptime for 3 to 4 years

5. ● North america (Ponsetti centre) – Recurrence is 5% ● New Zealand – Recurrence is 45% due to poor complince to abduction brace.

6. Reason for poor compliance ● Child refuse to sleep and keep crying ● Especially if the treatment started after 3 months ● It prevent a bigger child from walking

7. Aim of the project ● Primary aim: – Allow the child to sleep in various position yet keep the feet in abduction. ● Secondary aim: – Allow the child to walk with the feet in abduction

8. Step I ● Find the movement angle in normal population – Base on foot progression angle= M1 and M2

9. M1 M2

10. Step 2 ● Find the range of angle in front and hind foot – Maximum degree of M1 + M2 to be determined by measurement of gait in normal population.

11. Step 3 ● Production of hinge between bar and shoes – Allows reciprocating (Rt and Lt) movement M1 and M2 – Keeping the foot at 70 degrees abduction

12. Hinge between bar and shoes ● Location at the side instead of sole – For walking ● Dynamic instead of rigid – Walking – Different legs position during sleeping

13. Step 4 ● Pre- trial – Clinical usage under supervision ● Refinement of construct

14. Step 5 ● Clinical trial – Compliance ● Walker ● nonwalker – Result – Sustainability of the brace

15. Potential benefit ● All ctev patients – Especially bigger child ● Noble invention – Publication in High impact factor journal ● Market – National  regional  world market