The Wheaton brace

Brace designs for clubfoot fall into three groups: abduction braces, ankle-foot orthoses, and Wheaton-type orthoses1. The Wheaton is its own category, and it is the one you are least likely to be offered.

It does provide some abduction of the foot, which is more than an ankle-foot orthosis manages1. But it reaches up to the thigh, and that is where its problems start.

The review lists them plainly1:

• Expensive, because it is custom-made.
• Frequent adjustments required.
• Muscle atrophy. Because it reaches the thigh, it can promote atrophy of both calf and thigh muscle — and calf muscle is already abnormal in clubfoot.
• No supporting evidence. In the authors’ words, to the best of their knowledge there is no evidence to support its efficacy, so it is not recommended for the treatment of clubfoot.

That last point is worth sitting with. Most of this cluster is about weighing one imperfect evidence base against another. This is the one device where the published position is simply that the evidence is absent1.

This is not a reason to refuse a device or to override a clinician who has examined your child. There may be a specific reason in a specific foot, and clubfoot is not the only condition a Wheaton is used for.

It is a reason to ask three things: why this rather than a foot abduction brace, what it is expected to achieve that an abduction brace would not, and what the plan is for the calf. Then ask what the evidence is, because the published answer for clubfoot specifically is that there isn’t any1.

The standard after Ponseti casting is an abduction brace — Mitchell, Markell, Steenbeek or another in that family. The comparison sets out all nine.