The Steenbeek brace

The Steenbeek foot abduction brace was developed in Uganda and is built using local tools and materials1. That is the design brief: meet the requirements for bracing after Ponseti casting, and be producible where the children actually are.

The cost difference is not marginal. Made locally in Kenya the brace costs under ten US dollars, against roughly three hundred for a child-friendly commercial brace — a price out of reach for most affected families there2.

It is used in clubfoot programs across Africa and Asia, and teams in Tunisia and India have both reported excellent outcomes with it1.

A prospective series followed 38 feet braced with the Steenbeek. Correction was maintained in 36 of 38 feet. In two feet the Pirani score worsened after the brace was applied, and recurrence followed2.

Compliance in that study was defined as the protocol asks: the brace worn 23 hours a day for the first three months, then at nap times for the remainder2.

What it means. A brace costing a thirtieth of the commercial alternative held correction in about 95 percent of feet in that series.

What it might mean. Thirty-eight feet is small, and the follow-up is short against a four-year bracing protocol. Programs that adopt the Steenbeek usually have strong training and follow-up attached, so some of that result may belong to the program rather than the hardware.

What nobody knows. How it performs against a Mitchell or a Markell in the same population. That comparison has not been done.

Most writing about brace choice assumes a choice exists. For most families with a clubfoot child in the world it does not, and the Steenbeek is the reason bracing happens at all1.

In the US or UK you will almost certainly be given a Mitchell or a Markell. The Steenbeek is still worth knowing about, because it is the clearest evidence that the expensive parts of a brace are not the parts doing the work.