The Iowa brace

The Iowa brace was designed by a team of specialists directed by Dr José Morcuende at the University of Iowa — the institution where Ignacio Ponseti developed the method itself1.

Its defining feature is what it does not let you do. The abduction angle is fixed at 60 degrees for the affected ankle, and the bar is not adjustable. It comes in three lengths instead: 8, 10 and 12 inches1.

The connecting bar is called the Flex Bar. It allows limited movement when the child moves the legs, and returns to the set position once the child relaxes1. That is a middle position between a rigid bar and a fully dynamic one like the Dobbs.

An adjustable brace can be adjusted wrong. Sixty degrees of abduction is what the protocol calls for on the affected side, and a fixed angle removes the possibility of it drifting between appointments — at the cost of needing the right bar length rather than adjusting the one you have1.

That trade is the whole design philosophy. It is the opposite of the argument behind dynamic bars, which prioritize what the child will tolerate.

The Iowa group is also the source of some of the most quoted findings about bracing itself.

A study of 20 children over an average bracing period of 33 months looked at whether the brace was doing harm as well as good. It found femoral anteversion on the affected side averaging 40.5 degrees and tibial external torsion 38.4 degrees, both within the normal range, with average ankle dorsiflexion of 27.5 degrees. The conclusion was that brace use did not produce pathological changes in femoral anteversion or tibial torsion2.

What that means. The common parental worry — that holding a baby’s feet turned out for years will twist the legs — was not borne out in that series.

What it might mean. Twenty children is small, and 19 of them were compliant, which is far above the roughly one-third non-compliance seen in larger cohorts3. A compliant sample may not tell you what happens in a typical one.