I had intended to write two separate posts, one for parents and one for Babywearing Consultants. As I was typing, I realised that a lot of the info would feature in both, and that both parties may benefit from having all the info, the emotions, the background. So here it is, all in one. First, I will share our journey and some basics about the treatment in general. Then, I will look at using a baby sling or carrier at the different treatment stages. And finally, I will outline why babywearing should be considered part of the treatment for talipes.
Meeting the dude
During my pregnancy with Mr A, I made all sorts of plans. We were going to experiment with newborn back carries. We were going to give all sorts of “suitable from birth” slings a test run, take photos and share them for other parents to see. We were going to have lots of time for all of this while the older two were in school and I would actually enjoy maternity leave to the full for a change.
When I met him, soaking in his presence, showering him with kisses, big snow flakes fell slowly past the window. It was very early morning, all calm around us. Then the midwife pointed out his feet weren’t right. She’d call the peadiatrician to have a look. She came. Mr A had bilateral Talipes (clubfeet). There was mention of Temple Street Childrens’ Hospital and referral and staying overnight and starting treatment asap …
All was not so calm anymore. I held him, for 24 hours, our bodies one, skin-to-skin. Then the phsysio taped his tiny feet and legs. We needed to be extra careful from now on.
I brought him home that day in the Ring Sling, conscious not to disturb the tape, worried to compromise his treatment. That confidence that I ooze when working with other parents … knocked. All those plans I’d made … forgotten about.
On his fourth morning we went to Temple Street to start Ponsetti treatment. The first step of this treatment is casting. Every week, Mr A’s feet were stretched a little bit more and then held in full leg casts. If the cast got badly soiled or his little toes started swelling up, we had to take the cast off at home and travel to Dublin for re-casting. We live over an hour from the hospital and it happened late in the evening when the clinic was closed. He was out of the cast for over 12 hours, which could’ve meant going back to cast one. I was awake a lot that night, stretching his little feet every time he fed … Thankfully it only happened once!
All going well, after around 6 weeks of Ponsetti casting the feet are in an over-corrected position. Mr A was among the majority of patients who at that stage need a tenotomy (cutting the achilles tendons) to have full function in their feet. A day procedure, under local anesthetic. I wasn’t able to comfort him on the breast as I was during castings. Those 30 minutes between handing him over, awake, to having him back in my arms, asleep after exhausting himself crying, were the longest 30 minutes of my live…
The tenotomy is followed by another 2 weeks in casts. I couldn’t wait to get those casts off him. To be able to fit a cloth nappy on him. To be able to cuddle him for an hour a day, every day, without anything in the way. Little did I know I was going to wish those casts back …
After nearly 2 months in casts we got our first set of boots and bar. From now on, his feet were kept at a 70° angle shoulder-width apart by little boots attached to a bar. A heavy contraption hanging off his battered legs. All those weeks without light and air had left the skin on Mr A’s legs incredibly sensitive, raw in places. He was sore, very sore.
The bar was in the way for everything. I had to relearn how to handle my precious baby, how to lift him, how to change a nappy, how to position him for feeding, how to put him into the car seat. How to wear him. And he was sore. For 2 days, I carried him supporting his body as well as the weight of the bar to ease his discomfort. Taking the boots on and off was torture for him. So we didn’t. We only took them off every two days for the hour. After a fortnight his skin was healthier, the sensitivity gone. Now we could have an entire hour without the boots and bar every day … an hour goes incredibly fast!
Over the coming months we were able to gradually reduce the time in boots and bar according to the treatment plan. At 9 months we were down to sleep times only. At 20 months we are nearly at the half-way mark now and he is running after his big siblings, and from them, without the slightest bit of bother. We are still putting on the boots and bar when going to bed at night and once he sees my eyes opening in the morning he asks for them off, so he can go wake everyone else.
Slinging the Ponsetti Baby
The casts go all the way up the leg, just about leaving enough space for a nappy. Knees are cast in a neutral position. And while they are not terribly heavy (the biggest part is cotton wool and fibre glass), they do weigh. An M-position can’t be achieved with casts in a sling.
Any sling you are considering using with baby should comply to the TICKS rules and have an adjustable seat that will go
- wide enough to support cast up to knee
- flexible enough to support cast on one leg and spread-squat on the other for unilateral Talipes
- small and flexible enough to support the natural spread-squat when out of casts and bar
- small enough to support legs knee-to-knee once you move into boots and bar
Mei Tais, small buckle carriers or stretchy wraps work best for most people.
Woven Wraps and Ring Slings can work. Do take care when making the seat with those, as the edge of the cast at the groin can easily dig into the leg and compromise circulation. Keep an extra eye on baby’s toes to make sure they are not swelling up.
Because baby’s knees are cast in neutral, they will look overspread. With unilateral Talipes, this can make baby look lopsided, as one leg will be closer to optimal positioning (knee higher than bum, calf hanging freely) and the other sticking out.
Boots and Bar
I lay awake for hours once I knew about the boots and bar … trying to work out sling solutions. The thought of having to parent without slings paniced me. A lot! Our first sling moved into our house when I was 5 months pregnant with our oldest. I’d never been a slingless mum. Parenting three children without the option to sling the baby … impossible!
There are different types of boots and bars. We started off with Markell Tarso boots and Dobbs bar. They were heavy and fixed to the bar but the hinges gave us more flexibility of movement.
We then moved into Mitchell Boots and Click Bar. This combination is much lighter, you can see the heel in the boot and the bar comes off easily. The boots are flush with the bar though, with no room for movement.
The bar keeps the boots at a 50 – 70 degree abduction, with the heels at shoulder width. In the boots, the sole of the foot has to be flat on bottom of the boot, toes uncurled and heels down and secured in the heel of the boot.
For using a sling that means:
- the seat will be much narrower and more shallow than optimum positioning, ruling out carries that do require a deep seat for non-experienced wearers (kangaroo, simple ruck, ring sling etc)
- you need to take great care not to force the heel up in the boot by aiming for optimum positioning, as this can compromise treatment
- sitting, squatting down and reaching over obstacles can be harder or impossible with the bar in the way
- non-optimum positioning means non-optimum weight distribution for the wearer (but still a lot easier than in arms!)
- for non-click bars: you need to be able to fiddle the sling through the bar. It can be tricky to keep the taughtness in Mei Tai straps when fiddling them back through
- for click bars: it’s easier to unclick at least one side for tieing the sling. Do be mindful of the narrow seat though so that when you click boots back on, the baby’s knees don’t press into the fabric.
Most parents find buckle carriers easiest to work with, followed by Mei Tais or stretchies for click bars. I have used a front cross carry on occassion when we were still in the Dobbs bar.
In Ring Slings in hip carries, a lot of babies quickly figure out how to push the bar against the wearer to stand up and pop the seat. The Scootbaby works really well for hip carries with boots and bar.
For back carries, the easiest for most parents in terms of positioning and control is to position baby in the sling on their front and scoot the lot around onto their back. More experienced parents have also used straight leg carries in an Onbu.
Parents who have worn before will notice a difference in comfort and day-to-day babywearing. And once baby gets more bar-free time, parents who started wearing with casts/bar will notice that difference as well. I still remember being slightly cross with myself at wrapping Mr A in a front cross carry during bar-free time one day. The comfort and ease was amazing compared to using the same carry with bar… Having used slings with my first two little people, the lack of ease at times when carrying with boots and bar got to me. It was frustrating not being able to reach plugs, not being able to sit in the sand at the beach with him in a front carry, sitting on the floor with the others, having the bar bounce off me every step I took.
We were lucky though, Mr A was long (56 cm born, the length of an average 3 months old) and fitted into standard buckles very early on. His size, my experience and training meant I could move him onto my back in buckles very early, bringing some ease despite bar.
Babywearing as part of Talipes Treatment
There’s the obvious benefits: being able to comfort him after treatments, painful stretching, scary surgery, snuggled up in the sling. Not needing to bring a pram into a crowded out-patients department every week – slings make that possible. Plus, of course: free hands for the other two and chores, sleepy snuggles whenever he needed to … and slinging a Ponsetti baby is most definately handier than carrying in arms!
There’s more though!
As the wearer moves, muscle movement is initiated in baby too. This transfer of movement subjects baby’s muscles to pressure, pulling and vibration, thus activating baby’s leg muscles from the hip all the way down to the little toes. Feet that are immobilised in casts and boots are stimulated and muscle tension eased.
In the sling, baby responds to the wearer’s movement not just physically but also neurologially. Connections are being laid down in baby’s brain that map patterns of movement – a head start when more independent movement is possible once boots and bar time can be reduced.
In her presentation at the Dresdner Tragetage 2014 comparing sling use and various therapeutic approaches, Kienzle-Müller concludes: “Babywearing can have therapeutic benefits for children. Babywearing is a form of therapy.” In another presentation, she advocates for the use of ergonomic slings for specific presentations, including malformation of the feet.
At every visit we have with our consultant for Mr A’s feet, he remarks how incredibly smooth his treatment is going, how rare it is for things to go so well. He regularly gets junior doctors in to look at Mr A’s feet for them to see a successfull case. I am convinced that babywearing played a role in this success.
If you would like to explore wearing your baby during Ponsetti treatment, do get in touch. If you don’t have a Babywearing Consultant near you, I offer Skype Sessions and have boots and bar to use with my weighted demo dolls.
own experience as a Certified Babywearing Consultant (Trageschule UK) and mum of a baby with bilateral Talipes, who has unilateral Talipes herself
B. Kienzle-Müller: Tragen als Therapie – Therapie durch Tragen. Therapie, was heißt das eigentlich? In: Dresdner TrageTage, Tagungsband, 19. – 21. Juni 2014.
B. Kienzle-Müller: Von der Therapie auf dem Pferd lernen! Kann Tragen als Therapie ähnlich wirksam sein wie Hippotherapie? In: Dresdner TrageTage, Tagungsband, 19. – 21. Juni 2014.