We’re now on the countdown till the end of full time wear of the boots and bar. Yippee!
Looking back almost three months I just can’t believe how quickly it has passed, and how much Harvey has grown. It’s not been an easy three months (but then it never is with a baby!) but it’s also not been as bad as we had sometimes imagined. It’s unavoidable, you get on with it, you learn to live with it. Getting used to the boots and bar was strange at first, but now I’m imagining how strange it will be without them.
The boots are bar are the final stage of the Ponseti treatment and are used when the foot has been straightened but needs to remain in that position. As babies bones are developing at a rapid rate, they need holding in the corrected position. A lot like teeth, braces to straighten and removable retainers to maintain correction. So, for three months the boots and bar are worn full time, then go down to part time wear for night time and nap times until the child is around 5.
There are a few types of boots and bar. We have strappy boots, and a standard ponseti bar. The boots hold the foot in the corrected position and the bar goes between the boots to also hold the correct angle. This means the feet are effectively bound together, which Harvey found tough to start with. There is a newer bar, a Dobbs bar, which allows the feet to move independently which is an option if the standard bar is not tolerated, but it is too new for substantial evidence into it’s effectiveness.
Getting Harvey free from his cast was amazing. Although it had become normal, seeing my perfect newborn in an unnatural cast was sad, as much as you know it’s for the best. Equally, there have been times over the past three months where I have cried for Harvey, got angry, frustrated, and the sense of unfairness has re-emerged. But, treatment is soon over, and the long term benefit more than outweighs the short term.
The first few days where the hardest. The weight of the responsibility was immense. During the casting stage, us parents had very little responsibility for his treatment besides taking him to appointments and keeping a close eye on his toes for cast slippage or circulation issues. Now, the success of his treatment was entirely down to us. His later ability to walk on a straight foot was down to us. Preventing an early relapse was our responsibility (relapses are rare and are sometimes unavoidable despite treatment adherence). Taking care of a newborn for the first time is a massive responsibility, and, at times, the extra weight caught up with me. But the weight of responsibility felt much lighter, much sooner than expected. The nurses showed me twice how to put the boots on correctly and let me practice. I left feeling confident, but, as soon as it came to putting them back on for the first time at home I don’t think it would have mattered how many times they had shown me. I was so anxious to put them on right. I felt I needed to be proficient at putting them on straight away and got frustrated when it took a few attempts to get his foot positioned in them correctly. Such a difference from now when I could probably do it blindfolded, nearly! For a few weeks we were obsessed with Harvey’s heel. When the boots are first fitted the heel isn’t quite all the way down at the back of the boot. There is a little viewing circle in the boots to check and I was looking in it multiple times an hour, comparing it to photos posted on facebook groups and worrying the boots weren’t on right. For any new talipes mums- the heel does drop after a few weeks but our consultant said as long as you can see the heel in the hole, a little gap is fine.
The day Harvey got his boots was the hottest day of the year. The worst possible day. We got about 2 hours of broken sleep that night and ‘woke up’ worried that this would be the norm- it isn’t, it gets better. The next day was almost as hot and my graduation day.
Poor Harvey was not happy. In fact this year’s long hot summer was very much not appreciated. Imagine spending all day in socks and boots when it’s too hot for clothes. That first night, facebook was full of parents on the talipes groups discussing leaving the boots off for just one night because of the heat. As it was Harvey’s first night this was not an option. We’re all so glad it’s much much cooler now. The one thing which helped a little was cutting the toes off of his socks to get a little air to them.
The first few days were tough. Harvey was inconsolable at times. It must have been so incredibly frustrating to not move his legs independently. Again, it got better quickly. The more we lifted and played with the bar the better it got. He now happily lies for ages with his legs right up in the air. An impressive feat when the boots and bar weigh 400grams- his tummy and leg muscles are now super strong! He loves nothing more than banging the bar down to make a loud crash. Fun for him, but painful if an arm or leg is caught in the danger zone! Yep, we’ve had a fair few bruises from Harvey’s feet!
He may be strong but he’s not as mobile as other babies his age. Before the boots he was happily rolling from tummy to back. Since boots, nothing. He’s shown no signs of rolling for three months. He can sit unaided with his boots on, without them, he’s like jelly on a plate on a trampoline. He has plenty of tummy time throughout the day but just shows no sign of mobility. This is really starting to frustrate him over the last few weeks. He’s 5 months and wants to get going. He’s super alert and everything captures his attention. This is quite demanding for us, and I’m always on the lookout for new ways to entertain. I’m sure pretty soon he’ll be off in the blink of an eye.
Boots and bar are tiring for him too. They are so heavy it must take such energy to lift them. This shows in him not being able to stay happily awake for very long. Even now he starts grizzling and rubbing his eyes after an hour of play. I’m militant about naps, making sure he gets enough sleep during the day to fully enjoy golden hour.
During full time wear they are allowed an hour a day of freedom. Golden hour. The best hour of the day. He loves it. Mummy loves it. Daddy’s desperate to get home from work in time so he doesn’t miss it. As soon as the boots are off he grins, gurgles, kicks and squirms. Then plays with his toes in wonderment. He loves nothing better than us blowing on the soles of his feet. I love nothing better than kissing his perfect, (cheesy!), tiny little feet. We have bouncing, standing, dancing. His toes curl under all the new textures as he explores.
Then the boots have to go back on. At first he would scream. We tried to remember to shut our back doors before boots on in the summer, but apologies to our neighbours for the screams at the same time every day! As soon as the bar clicked back in place, I kissed Harvey, Daddy scooped him up for a reassuring cuddle and he was fine. I often retreated into the garden for a little sob, he will never see me sad about his feet. Fortunately this stage didn’t last for too long. Routine really helped, golden hour, boots on, feed,book, bed. We also found it was much easier to put his boots on whilst he sat in his bouncy chair, playing with a toy and Dad. At first we sat him on Dad’s lap but I think this may have made him feel constrained, perhaps reminding him of cast changes. We’ve been fortunate in that Harvey has not suffered from blisters or sores which a lot of babies do due to rubbing. We used socks with grips and granuflex (adhesive padding) at the back of the heel and under the middle strap. At the first sign of any redness we also used mepilex border lite (spongy plaster) under the granuflex. Although he has recently had very dry skin on the front of his foot which sometimes bled when we took socks and dressings off. I think just from daily baths and dressing changes when it was so hot. A tiny bit of sudocrem and bathing less often has really helped.
So, we’ve nearly survived full time boots. I was dreading this stage but it was not as hard as I imagined. Yes, you have to get used to slightly different ways of carrying and holding them. But there are advantages for parents- nappy changes are easy with no flailing legs! Also the bar is useful for carrying a muslin with baby at all times- handy with a sicky reflux baby like mine!
Of course it’s been tough on Harvey, he has coped amazingly and we are incredibly proud of him. Such a happy, bouncy fella who will never know just how much he amazes us.
Here’s hoping part – time wear continues to be a road with few bumps.