Birth defect with
twisted foot
or feet

Research Project I Correct Appliance of Brace
Collaboration: Maxima Medisch Centrum (Veldhoven) I Target group: Children with Clubfoot
Group work I Size: 5 students
1/3 of time of 16 weeks, Spring 2018 I Eindhoven University of Technology
Clubfoot is a birth defect where one foot or both feet are rotated inwards and downwards
Most effective treatment for clubfoot is the Ponseti Method.
The method consists of two phases: The treatment phase and the maintenance phase.
> Treatment phase: Children undergo a series of casting, an achilles tenotomy followed by the last cast
> Maintenance phase: Wearing of the Ponseti brace 3-4 months for 23 hours a day then for 2-5 years during the night and naps.
(A picture of the Ponseti brace is displayed in the header of this project)

Board of the Dutch Clubfoot Association:

Parents see the brace as something negative. They think it hurts their child and are insecure about applying the brace. They might assume the brace is causing the child pain and when their child cries it often leads to removal of the brace. Frequent brace removal increases the risk of the recurrence of clubfoot. In addition to that, parents often do not know how to apply the brace correctly. Braces that are too loose can cause the feet to be able to move up and down causing redness and skin irritations.

Researcher MMC Veldhoven (hospital):

For the Ponseti method to be successful the brace has to be worn frequently and in the correct way. If the brace is not worn correctly the chance of relapse is bigger and this means that the treatment phase of the Ponseti method has to be done again.


They are often insecure about how they have applied the brace. They fear that they are hurting their child when tightening the straps of the brace, or that they have applied the brace too loosely. Sometimes others have to apply the brace as well, like caretakers at a daycare for example. They do not have as much experience as the parents with the brace, and never got explanation from a professional on how to apply the brace.

There is no feedback for the person who is putting the brace on, so knowing whether the brace is applied correctly is difficult
Main question:
How can pressure sensors be used to indicate correct appliance of a clubfoot brace?
> Where and how should the sensors be placed in the clubfoot brace?
> Can a range be computed from the obtained data which indicates correct appliance of the brace?

Novel Pressure Sensors

Placing of sensors - Orthopedic surgeon from
MMC Veldhoven verified these places

Step 1: Turn on the 4 sensors simultaneously, and place them in the brace.
Step 2: Let the parent apply the brace correctly according to them, while the child is laying on its back.
As soon as the brace is applied, the time starts.
Step 3: Measure with the sensors for 2 minutes, while the child is laying on its back and lays as still as possible.
Step 4: After 2 minutes, let the parents loosen the brace. The straps should be 3 holes looser.
Step 5: Measure with the sensors for 2 minutes, while the child is laying on its back and lays as still as possible.
Step 6: After 2 minutes, let the parents take off the brace.
Step 7: Remove the sensors from the brace, and disconnect the sensors.

Left: Placing of sensors in the Ponseti brace

Top: Test with child with Clubfoot

> The sensors can be used for measurements in a clubfoot brace. They are sensitive enough and you see a difference when the child moves in the brace or not and if the straps are looser or more tight. However the data doesn’t have a unit. Therefore it is very difficult to convert it into newton.

> It is not possible to calculate a range of data in which the brace is worn correctly for age categories. We have to use an individual range instead of this. Every foot is different and the children also have different weights. In addition to that is not every clubfoot deformity the same which could cause the foot to have more pressure at the different sensor locations.
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