The previous post in this series outlined the basics of the Richie Brace ankle foot orthosis. This post is intended to add further insights into the usage of the Richie Brace within the lower extremity biomechanical practice. Hopefully, this will serve as a reminder that a valuable, but sometimes overlooked treatment option is available in difficult cases where a standard foot orthosis or ankle brace alone may not suffice. The Richie Brace can be regarded as a custom foot orthosis with an ankle brace component, or an ankle brace with a custom foot orthosis component. The fact is, it is both, depending on the situation it is being used for.
The KevinRoot Medical website has resources to help clients educate themselves about the Richie Brace.
Richie Brace Products – KevinRoot Medical
Dr Richie also has many educational resources available in support of his iconic brace.
Three models of the Richie Brace are available on the KevinRoot Medical Richie Brace order form; Standard, Restricted Ankle Pivot and Dynamic Assist
The standard model is by far the most commonly used and features a hinge which allows full sagittal plane motion of the foot at the ankle joint. The restricted ankle pivot partially immobilizes the ankle joint in cases where additional protection or stabilization are required such as arthritis or medial or lateral instability. The dynamic assist features a spring loaded ankle hinge to assist ankle dorsiflexion in cases of anterior weakness or dropfoot.
Numerous modifications and customizations are also available, such as various posts, heel cup depths, lengths of the foot plate, and accommodations., similar to custom foot orthoses. Medial or lateral arch suspenders are available for additional support of either medial or lateral instability or weakness.
Richie Braces may be used whether unilaterally or bilaterally. Medicare and some private insurance patients may be eligible for coverage of the Richie Brace under durable medical equipment provisions. Billing and compliance information is available on the KevinRoot Medical website. Some patients may not want to wear their brace full time, or under certain circumstances, so encouraging them to also have standard custom foot orthoses to use not only on the opposite foot, but on occasions when the Richie Brace is not preferred on the affected limb.
Patients should be advised that the Richie Brace requires the use of a deep, supportive shoe, such as an athletic shoe. Accurate impressions of the foot and ankle is critical to success in the use of the Richie Brace. Marking prominences such as the medial and lateral malleoli, medial Navicular and base of the 5th metatarsal, as well as 1st and 5th metatarsal heads should be performed. Casting with plaster, an STS casting sock, or digital impressions may be used. The patient can be prone, supine or semi weight bearing while sitting with the foot resting gently on a soft pillow. A common complaint when using the Richie Brace is a tendency for the foot to abduct off the foot plate of the device. This can be mitigated while casting the patient by plantarflexing the first ray, which can be done in either prone or supine positions. Whatever technique is utilized, practicing and repetition is encouraged in order to gain accuracy and reproducibility in your impressions. Through trial and error over time, I found casting the patient in a supine position with an STS sock holding the sub talar joint neutral and plantarflexing the first ray offered my patients the most consistent and effective outcomes with their Richie Brace.
