POSITIONAL CLUB FOOT MANAGEMENT IN TERM NEONATES USING A NEOPRENE STRAP IN A LEVEL IV NEONATAL INTENSIVE CARE UNIT: A CASE SERIES

Purpose: Assess feasibility and analyze effects of the use of a flexible neoprene strap on ankle/foot alignment of two term infants with bladder outlet obstruction, renal dysplasia, and unilateral positional club foot in a Level IV NICU.

Case Description: Two full term-age participants (gestational ages 37w2d and 37w4d). Physical therapy evaluation confirmed positional club foot prior to fitting participants with a neoprene strap/Velcro fasteners in a pattern promoting eversion and dorsiflexion on day of life 22 or 42 respectively. For procedural consistency, bedside positioning plans/strap application teaching were developed for parents and nurses. Donning/doffing and skin checks were completed during routine nursing assessments. Parents were also coached on PROM and AROM activities for the foot and ankle. Data were analyzed via completion of a parent questionnaire using numeric rating scales and open questions. Pre-/post- alignment photographs were captured on a traditional camera with calculation using Angle Meter 360 app.
Outcomes: Resting foot alignment changes in the frontal plane with decreased inversion at a mean of 45.5 degrees of change were noted (SD 20.5). Parents reported satisfaction of outcomes (Mean 9.5/10 +/- SD 0.5) and ease of application (8/10 +/- 0).

Discussion: The facilitation of a neutral resting alignment supported continued muscular flexibility and movement opportunities with resultant change in resting position without adverse events. Family and nursing compliance with strap application, in addition to commitment to PROM/AROM activities, was critical for success of this intervention. Use of a neoprene strap was safe and feasible despite a changing NICU environment.