Monthly Archives: May 2012

UFOs, AFOs, IPOs (oh wait, that’s Facebook’s problem)

BRACE OF THE DAY:  RICHIE BRACE (BRAND NAME)/ARTICULATED AFO (GENERIC)

In 1996, a sports podiatrist, Doug Richie, named a foot brace after himself.  We’ll forgive him for this narcissism because his product has helped many people with pained lower extremities.  The Richie Brace, also known as an ankle-foot orthosis (AFO, not to be confused with UFO, though sometimes resembling the latter more than the former), is a custom-fit brace comprised of a plastic footbed, lateral plastic stays, hinges that allow front-to-back and back-to-front motion, and Velcro straps that keep the brace in place.  Functionally, the brace (which I will refer to as an “AFO” since I went the generic route) limits motion of the subtalar joint (primarily side to side) while allowing full motion of the ankle joint (flex and point).

The original Richie Brace.

Pros:  Reduced pain in subtalar joint because it is not moving.  Unrestricted motion of ankle joint allows for a normal gait, which bodes well for other parts of the musculoskeletal system.  Fits into a regular athletic shoe, saving the owner money and the annoyance of buying bulky, sometimes unsightly ortho shoes.  Looks athletic.  Velcro straps allow for some adjustment.  People will frequently ask wearer if she was in a skiing accident.

Cons:  Can be difficult to fit.  Plastic sole and stays can rub and cause skin irritation or mild bone bruising.  Velcro sticks to, and can ruin, some types of pants (yes, I just went there).

My Experience:  After three failed attempts at customizing an AFO that would fit my foot, my orthotist and his manufacturers have created a product that fits well and allows me to walk further than with regular orthotics.  I’m still in the honeymoon phase of the brace, and thus hesitant to give the brace a resounding “yes,” but all signs point towards a step in the right direction!

Overall Impression:  Less limiting, and therefore more versatile, than the Arizona brace.  The articulated AFO does have some drawbacks, but they are minor compared to the problems with the Arizona brace.  

Wearer tends to forget about all of the drawbacks (except for the bone bruising) when she realizes her mobility has increased at least 50% during brace use.  Gold star, articulated AFO.  And props to you, Dr. Richie.

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The Least Romantic Embrace

My right foot has been in a lot of things:  shoes with external coils, shoes with internal springs, shoes that aren’t cool enough for my grandma, walking boots, aircasts, various types of braces, deep sh*t…

The next few posts will discuss different types of ankle braces, the pros and cons to each, and my personal experience with them.  If you would like to read about shoes, please see the archives.

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BRACE OF THE DAY:  ARIZONA BRACE (CUSTOM FIT)

This brace hails from — you guessed it — Arizona.  It is a rigid brace with a leather exterior and a lace-up tying system that is eerily similar to a corset.  It prevents most foot motion by stabilizing the ankle, talocalcaneal, mid-tarsal, and subtalar joints while allowing the toes to wiggle.

Pros:  Reduced pain in affected joints because they are not moving.  Looks odd but tends to conjure up pleasant images of horseback riding and the Victorian era.  Durable.  Lace-up system is quick and effective.

Cons: Looks odd to people who are not familiar with the Victorian era (or who see no place for representations of it in the 21st century), which can lead to questioning or awkward stares.   The brace limits mobility to such an extent that after a short amount of time, the affected foot can start to ache.  Furthermore, the brace alters the user’s gait and subsequently can cause problems in other areas of the body, especially the opposite knee and the upper back.

My experience:  When I first received my Arizona Brace (AB), I was hopeful:  I could walk 8 or 10 blocks instead of the usual 4 or 5.  I had to purchase two new pairs of shoes (the brace is so bulky that it requires a larger shoe size…if anyone wants a 9 and a 9.5 of the same shoe, let me know), which was irksome.  The expense seemed worth it until I began to develop strain and pain in other parts of my body.  After a few weeks wearing the brace, my whole body was a wreck.  I realized that because I had to take out the shoe insole in order to accommodate the girth of the brace, my right foot was lower to the ground than the left one.  This mismatch explained the pervasive body aches.  A shoemaker used mega glue to adhere a Vibram sole to the right shoe.  While my feet are now at the same height, I still experience discomfort, though to a much lesser extent than before the shoe alteration.

Because the AB is so good at immobilization, the body must compensate for the lost motion.  But no matter how hard the knees and hips work to move the foot, the wearer ends up shuffling because it is impossible to bend enough for a natural step.  It is nearly impossible to go down a flight of stairs in this brace.  But it’s been done.  Many times.  Whether you land on your feet or ass at the end is debatable.

Overall impression:  A good brace to use intermittently for short periods of time.  Excellent to wear in a shoe when not weight bearing (for example, when typing up a paper or writing a blog post) because it prevents the user from the “micro movements” that result from mindless foot fidgeting.

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