The Dobbs bar

The Dobbs bar, from D-Bar Enterprises in St Louis, allows a child to move both legs independently rather than having them fixed to one another1. It is a bar rather than a complete brace: it is compatible with Mitchell Ponseti or Markell shoes, or with a custom molded solid AFO1.

Two things are consistently reported about it. It is relatively expensive, and dorsiflexion can be difficult to achieve with it1 — which matters, because holding the foot dorsiflexed is half of what a foot abduction brace is for.

A series of 28 patients and 49 feet compared a dynamic abduction brace against a traditional Denis Browne. Non-compliance was 7.1 percent with the dynamic brace against 41 percent with the traditional one, and skin lesions 7 percent against 23.5 percent1. A separate report by Garg and Porter found the same direction: higher compliance, fewer recurrences and fewer skin complications with the dynamic design1.

What it means. If a family cannot keep a fixed brace on, a bar that lets a baby kick is a real answer, and two independent reports point the same way.

What it might mean. Twenty-eight patients is small. Families given a dynamic brace may differ from those who are not — in what they can afford, which clinic they attend, how much help they have at home. Compliance is usually parent-reported, and parents round their hours up.

What nobody knows. Whether the extra cost buys better feet, as opposed to easier nights. Correction was not the endpoint in these comparisons.

The brace holds abduction and dorsiflexion. On the Mitchell the dorsiflexion is built into a heel wedge; on a dynamic bar it is harder to hold1. Raise that directly with whoever fits it, because a comfortable brace that is not holding the correction has quietly stopped being treatment.

The maker of the Mitchell now sells a dynamic bar of its own, the MP-Move, on the same reasoning1. The comparisons above are of other dynamic designs, not of that bar.