# Situation: A nurse on the pediatric ward cares for children with congenital and developmental conditions and supports their families. An infant with bilateral clubfoot has finished Ponseti casting and a percutaneous Achilles tenotomy. The parents ask how the foot abduction brace will be worn. What should the nurse answer?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629646  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse on the pediatric ward cares for children with congenital and developmental conditions and supports their families.

An infant with bilateral clubfoot has finished Ponseti casting and a percutaneous Achilles tenotomy. The parents ask how the foot abduction brace will be worn. What should the nurse answer?

## 보기

1. Full time for about 3 years, then only at night until school age
2. At night only for about 3 months, then it can be stopped for good
3. Full time for about 3 months, then nights and naps to about age 4 **✔ 정답**
4. Full time until he begins to walk, then it is no longer needed

**정답: 3**

## 해설

After the weekly Ponseti casts and tenotomy, the foot abduction brace (shoes on a bar) is worn full time for about 3 months, then at night and during naps until about age 4. The correction relapses easily, and poor brace adherence is the main cause of relapse.

## 심화 해설

Bracing after Ponseti casting and tenotomy

The Ponseti method corrects clubfoot through serial manipulation, weekly casting, and usually a percutaneous Achilles tenotomy. However, the corrected foot retains a strong tendency to drift back into the equinovarus position. The foot abduction brace is not an optional accessory; it is the maintenance phase that protects the correction achieved during casting. Bracing adherence is the single most important factor in preventing relapse after initial correction. When parents ask how the brace will be worn, the nurse should explain both the schedule and the reason behind it.

The standard protocol after tenotomy and the final cast is to place the infant in a foot abduction brace consisting of shoes attached to a bar. During the first 3 months, the brace is worn full time, meaning 23 hours per day. This intensive initial phase maintains the stretch on the soft tissues while they remodel. After that, wear is reduced to nights and naps, typically continuing until about age 4. Key point! Stopping the brace too early, even if the foot looks straight, invites recurrence because the underlying soft tissue imbalance persists for years.

The rationale for this prolonged schedule is rooted in the pathophysiology of clubfoot. The deformity involves contracted medial and posterior soft tissues, and the remodeling of these tissues continues well beyond infancy. Relapse occurs most often when the brace is discontinued prematurely or worn inconsistently. Studies on bracing in clubfoot emphasize that the tendency to relapse remains a significant clinical problem, and the duration and consistency of brace wear directly influence long-term outcomes. The brace holds the foot in abduction and dorsiflexion, counteracting the deforming forces that would otherwise pull the heel into varus and the forefoot into adduction.

A common misconception is that once the child begins walking, the brace is no longer needed. This is incorrect. Walking does not maintain the correction; in fact, weight-bearing without brace support can allow gradual recurrence. Similarly, wearing the brace only at night for a few months is insufficient because the remodeling window is much longer. The correct answer is therefore full time for about 3 months, then nights and naps until about age 4.

| Phase | Duration | Wear schedule | Purpose |
| --- | --- | --- | --- |
| Initial maintenance | About 3 months | Full time (about 23 hours/day) | Hold correction while soft tissues remodel |
| Extended maintenance | Until about age 4 | Nights and naps | Prevent late relapse during growth |

Watch out! The most common reason for clubfoot recurrence is not failed casting or surgery, but poor adherence to the bracing protocol. Nurses should anticipate that parents may find the brace bulky or worry about the child’s comfort. Providing clear anticipatory guidance about the schedule and reinforcing that the brace is temporary but essential helps families persist through the challenging early weeks. Brace designs continue to evolve, with newer dynamic bars aiming to improve comfort and tolerance, but the underlying principle of consistent, prolonged wear remains unchanged.

## 임상 시나리오

Foot Abduction Brace After Ponseti CastingMaintenance bracing schedule and relapse prevention
After the final Ponseti cast and percutaneous Achilles tenotomy, the infant is placed in a foot abduction brace (shoes on a bar). During the first 3 months, the brace is worn full time, approximately 23 hours per day.

After the initial full-time phase, wear is reduced to nights and naps, typically continuing until about age 4. This prolonged schedule allows the contracted medial and posterior soft tissues to remodel over years.

CautionPoor brace adherence is the single most important cause of relapse. Even if the foot looks straight, stopping the brace early invites recurrence because the underlying soft tissue imbalance persists well beyond infancy.

## 핵심 개념

- **Ponseti method** — A nonsurgical clubfoot treatment using serial manipulation, weekly casting, and usually a percutaneous Achilles tenotomy.
- **Foot abduction brace** — Shoes attached to a bar that hold the corrected feet in abduction and dorsiflexion to maintain correction.
- **Percutaneous Achilles tenotomy** — A minor procedure to release the tight Achilles tendon, typically performed near the end of Ponseti casting.
- **Relapse** — Return of the clubfoot deformity, most often caused by poor brace adherence or premature discontinuation.
- **Equinovarus** — The characteristic clubfoot position of plantar flexion, inversion, and adduction of the foot.

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