• Reference Number: HEY1477/2024
• Departments: Paediatrics
• Last Updated: 31 July 2024

About the Boots and Bars

Your baby’s foot should now be in a corrected position.  However, this needs to be strictly maintained over the next 12 weeks to avoid subsequent tightening and failure of the treatment.

Your baby is therefore supplied and fitted with a pair of boots that attach at the bottom with a bar. The buckles on the boots should face inwards. It is most important to make sure the heel is placed at the back of the boot and held firmly in place by the tongue and the middle strap.  Once the heel is in place the remaining buckles can be fastened.  The second boot is fitted in the same way.  The boots can then be clicked onto the bar.  To remove the boots from the bar press the clip on the sole of each boot and the boot can then slide forward off the bar.  When the boots are fitted correctly the heel will be flat and this can be seen through the viewing hole at the back of the boot.  If you notice that your child’s heel has raised up it means the foot has moved and the boots need to removed, the skin needs to be checked and then the boots need to be reapplied.

It doesn’t matter if only one or both feet are affected, both boots still need to be worn. The ‘boots and bar’ will maintain the new corrected position and need to be worn for 23 hours a day.  The boots are removed for 1 hour to check for pressure areas, to bathe the child if wanted and to allow the child to kick their legs freely.

It is important that your child does not use a baby bouncer or walker as this encourages them to point their foot downwards which is the position the treatment has been working against.

After Application of the Boots

The first 24 to 48 hours after the boots are applied can be a little stressful as the baby is unable to kick their legs independently and therefore can be upset. The boots and bar are not painful and these problems usually settle quickly, sometimes requiring minor adjustments to the ‘boots and bar’ by the Ponseti team.  Your child will be reviewed after 1 week and then at intervals over the next 12 weeks.

Care of your Child’s Skin

When you remove your child’s boots you need to check the skin. It is common to get red marks on intact skin that blanche with pressure (goes pale when pressed and then back to pink once pressure is released within a couple of seconds), these marks usually go within the hour out of the boots. Any red marks, like the above, but that do not disappear during the hour off need dressing with the Duoderm supplied by the Ponseti team. Cover the mark completely and leave the dressing in place for several days or if it peels off sooner.  If the dressing is removed more regularly, it can cause soreness. The skin / mark can be observed through the Duoderm to ensure it has not broken down.

The recommended way to remove the dressing is by gently peeling away the edges and then pulling either end until it lifts off.

Blisters/Other Skin Marks

If you find a blister, broken skin or non-blanching marks you should apply the other non-adherent dressing that you have been given. You should then contact the Ponseti team ASAP and we will arrange a review. The skin will be assessed and re-dressed. While the dressing is in place the skin needs to be kept dry so it is important that your child does not have a bath.

Socks

Socks must be worn at all times with the boots, they should be snug fitting, with no seams or creases in them which can cause pressure marks.

Important Information

There is evidence that poor compliance can cause relapse and so it is vital that strict compliance to this stage is maintained to minimise this risk. The Ponseti team is able to help advise if you are struggling with any aspect.

Please contact us on tel: 01482 674539 or  tel: 01482 674532 (Monday to Friday 8 am to 4 pm)

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.