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"W-sitting" is when a child sits with their bottom on the ground, and their knees bent so that their feet are on either side of them on the floor. If you looked at the child from the top, their legs would form the "W" shape. This is a common stance for kids wearing the DBB since their feet are linked together with the bar. Try to teach the child in the DBB to put their legs in front of them when sitting on the ground.

1. "How did your baby break its leg(s)?"

There's no way to prepare yourself for the comments, stares and questions from the general public. Some days will be easier than others. You'll be helping to spread the word about clubfoot by explaining to strangers the treatment that your baby is enduring. Sometimes, you can use humor to deflect the comments "It was a bad skiing accident!", or train older siblings to pipe up, but the best way to keep your spirits up is to connect with other clubfoot families who know what you're going through!

2. Using moleskin for cast and DBB/FAB comfort

Sometimes the padding at the ends of the cast can wear away, or there may be a tight spot in the DBB shoes, it helps to have a supply of moleskin with adhesive backing on hand for padding. It's sold at most pharmacies or department stores.

3. Socks for the DBB/FAB

Some parents swear by socks from Gap or Old Navy so they can fold the tops down over the laces. Some like the grippers on the bottom of the socks to help keep the foot from slipping in the shoes, others don't like the grippers. Some parents use socks from the department store. The main things to look for are nice weight socks without large seams.

4. Managing carseats, highchairs, swings, shopping carts etc.

You will want to avoid devices that have a permanent bar or strap between the legs. You will not be able to put the child in the seat without taking off the brace, and it may be difficult to put a child in casts (especially both legs) in also. Look for devices with an adjustable strap, or a bar that swings out of the way. Infant carriers eliminate some of the worry about managing outside of home. Most infant carriers snap onto shopping carts and many restaurants now carry table-side slings for infant carriers. If your child has started treatment when they were older, they may outgrow the infant carrier before you've completed your 3 month full-time wear of the brace. In this case, it helps to have a stroller and an assistant when you go shopping so you won't need to use the seat in the shopping cart. Otherwise, if the child can sit up well, you can line the bottom of the basket with a blanket and have the child sit in the basket. (Don't do this if your child can pull to a stand!) You may also be able to find a sling that will work with the casts and brace. It helps to use rolled up blankets to prop up legs that are in casts when using strollers, swings, carseats etc. Carseats usually aren't a problem, but you may find that your child's feet touch the backseat of the car while rear-facing while wearing the DBB/FAB (if they're older and started treatment later) because their legs are so long. This is a personal decision that you will have to make whether you keep the child rear-facing, or forward-facing. It is suggested that a child stay rear-facing until they are one year old, however, some suggest that it is not safe for a baby's legs to be bent because they might be crushed during a collision. In our case, our daughter was fairly tall for her age, and wore the DBB/FAB full time between 5-8 months of age. We turned the seat around during this period because her legs were too long to sit backwards and she was not comfortable. Consult your physician before putting your baby in a swing or device like an Exersaucer where the legs are dangling.

5. Clothing a baby in casts

Most sleepers and bag style outfits work really well for a baby with casts. If you have a baby with one cast, it helps to put an adult sock on the cast to prevent irritation on the non-casted leg. If the weather is cold, look for a roomy bunting or snowsuit to allow room for the casts. Keep socks on the end of the cast to keep the toesies warm in cool weather.

6. Clothing a baby in a DBB/FAB

Look for pajamas and outfits without feet, and with snaps that run all the way around the crotch down both legs. (You want to avoid closed cuffs) Don't try to put footed outfits in the shoes. The seams and gathered material will irritate the child's feet. Pants without snaps will work for diaper changes, you just have to gather them at the ankles, but you'll need to remove the brace in order to take them on/off.

7. Skin checks while wearing the DBB/FAB

It is important when you first start using the brace, and when you get new shoes for the brace to check for improper fit. Any marks on the foot should disappear within a half hour after the shoes are removed. If your baby gets sores on their feet, pad the spot in the shoe with moleskin or corn pad etc. and call your physician.

8. Mildew in the DBB/FAB shoes

If the weather is hot, or the child has sweaty feet, mildew might form in the shoe. Try to change the socks often, wash the feet and dry them thoroughly, maybe put some powder in the shoes. Use a little bleach or alcohol on a cotton swab to remove the mildew and dry the shoe with a hair dryer.

9. Where to order shoes for the brace

Call American Prosthetics at the U of Iowa at (319) 356-2420 and they can ship you the next size in the shoes when you need them. They can also be ordered from most local orthopedic shoe stores or directly from the manufacturer. The shoes used by the U of Iowa are Markell, Tarso open toe boots with single strap, style #1644. Markell's web site is at http://www.markellshoe.com/ These other sources may not be experienced in putting in the plastizode insert to help hold the heel down in the shoe.

Some parents have used carseat strap covers that velcro on, others have used the padding for a bike handlebar, others have used foam insulation for pipes (covered with fabric (hot glue on) and velcro straps). Padding the bar isn't necessary, but it helps save wear and tear on your shins, your furniture, your pets, the child's siblings, your child's forehead, etc.

10. Padding the DBB/FAB bar

11. Visit the on-line parents' support boards.

12. Teach the child to kick with both legs when adjusting to the DBB/FAB

When you first put the brace on your baby, show them how to bend their legs together when kicking. This exercise will also help to build up their leg muscles. (Remember that it may take a few days for their muscles to get over the tenderness of being out of casts)

Utilize the plastizode inserts in the shoes. Make sure that the strap is buckled as tight as can be without irritating the foot. Lace the shoes all the way to the top and make sure the laces are snug. Use socks with grippers on the bottom. Make sure your child can't hook the back of the shoes on a ledge (such as in the carseat) to pull their foot out. Make sure that the distance between the shoes is correct. Get lace locks for the child who picks the laces open. Fold the socks down over the laces. Get prepared for frustration and keep putting the shoes back on until your child's feet get big enough so they can't escape from the shoes! Dr. George Brown of New Mexico has had success utilizing high top sneakers adhered to the bar with a strong adhesive when the child's feet are too small for the orthopaedic shoes. Consult your physician about this method as a temporary fix until the child's foot/feet grow larger. For babies who like to pick the knots open, try plastic lace keepers purchased from a store or lace the shoelace upside down so the knot is at the toe end of the shoe. This makes the brace harder for the parent to get on and off, but the shoes won't slip if the child unties the laces.

13. Tips for the "Houdini child" that won't keep the brace on

Some children develop sensitive skin when they're free from casts. Consult your physician about techniques to help the skin toughen up.

14. Skin sensitivity

Even though it may seem cooler to let the child wear the shoes without socks, socks are needed to provide cushioning to prevent blisters and sores, and will provide a way to wick moisture away from the child's feet.

15. Make sure socks are always worn with the DBB/FAB

16. Try to avoid excessive "w-sitting"

The best support and advice often comes from other clubfoot families. See the links page for links to the support boards.

17. Shoelace tips

Purchase shoelaces that are made for shoes with 2 or 3 more sets of eyelets than the shoes that are on the brace. The shoelaces that come with the Markell shoes are usually pretty short and can make for some tough wrestling matches when you're trying to knot the laces. When you're lacing the shoes, put a knot in the center of the shoelace to keep the lace centered between the bottom eyelets and prevent too much mismatch of lace length from one side to the other.

18. Take lots of pictures!

You'll want to take lots of pictures from the beginning and throughout the whole treatment process, and you'll be glad you have them when your child is old enough to start asking questions about their clubfoot. You'll be glad you have them to see where you started and where you ended up!

19. Sleeping comfort for a child with leg casts.

In bed, the child can be made more comfortable by placing a small pillow, rolled up towel or blanket under the legs. This also helps when the baby is in their carseat/infant carrier.

20. After a new cast is applied, the plaster will be cold and damp for a while until it sets.

Bring small blankets or towels to prop up the cast(s). This will help to protect the heel area of the cast from damage incurred by a kicking child, it will keep the stroller/car seat cover etc. dry, help to keep the child comfortable, and also aid in keeping the other leg away from the cold plaster for unilateral cases.