PREFERRED BRACING OPTION

Posterior Tibial Tendon Dysfunction (PTTD) – also known as adult-acquired flat foot – is a painful flatfoot condition which affects adults, primarily over the age of 50. Also known as Adult Acquired Flatfoot, this pathology affects women more than men and is linked to obesity, hypertension and diabetes. Most people with PTTD have had flat feet all of their lives. Then, for reasons not fully understood, one foot starts to become painful and more deformed.

PTTD begins with a gradual stretching and loss of strength of the posterior tibial tendon which is the most important tendon supporting the arch of the human foot. Left untreated, this tendon will continue to lengthen and eventually rupture, leading to a progressive visible collapse of the arch of the foot. In the early stages, patients with PTTD will notice a pain and swelling along the inner ankle and arch. Many times, they are diagnosed with “tendonitis” of the inner ankle. If the foot and ankle are not properly supported during this early phase, the posterior tibial tendon can rupture and devastating consequences will occur to the foot and ankle structure. The progressive adult acquired flatfoot deformity will cause the heel to roll inward in a “valgus” or pronated direction while the forefoot will rotate outward causing a “duckfooted” walking pattern. Eventually, significant arthritis can occur in the joints of the foot, the ankle and even the knee.

Click to read article on PTTD written by Dr. Richie: Clearing Up The Confusion Over Posterior Tibial Tendon Dysfunction

The Richie Brace® has been successfully prescribed for over 20,000 patients with PTTD over the past 7 years. The custom contoured footplate and the orientation of the leg uprights of the Richie Brace® are ideally suited to control the abnormal pronation forces occurring with PTTD. Most patients find the lightweight, low-profile design of the Richie Brace® to be far more comfortable than traditional long leg solid shell ankle foot orthoses. Thus the Richie Brace® has now become the preferred method of non-surgical treatment of PTTD by foot and ankle specialists.

See video below of patient with PTTD – before and after using the Richie Brace®.

Dropfoot is a condition where a person has difficulty lifting the front part of the foot. If you have foot drop, you will tend to drag your toes across the ground during walking. You may compensate for this problem by lifting your knee higher. In mild cases of foot drop, you will hear and feel your foot “slap” on the ground during walking

Dropfoot is a sign of an underlying problem with nerves or muscles and can be the first indication of a serious medical problem. When dropfoot is discovered, medical evaluation is recommended immediately to determine the underlying cause. Foot drop or drop foot can be very effectively treated with the Richie Brace®.

Causes dropfoot:

• Nerve injuries
  The muscles which lift the front part of the foot to clear the ground during walking are located on the front of the lower leg. These muscles receive stimulation from the common peroneal nerve which runs down the back of the thigh as part of the sciatic nerve. The common peroneal nerve and the sciatic nerve can be injured from:
  • hip replacement surgery
  • knee surgery
  • sitting for prolonged periods with your legs crossed
  • squatting for prolonged periods
  • sports injury
• Spine, Brain and peripheral nerve disorders
  Nerve input to the muscles of the leg is often controlled at higher levels of the spinal cord and brain. Diseases or injuries of the brain or spinal cord can cause mild or severe forms of foot drop.
  • In the spinal cord, pressure from a herniated disc can cause foot drop and often can be accompanied by numbness on the front or side of the leg. The foot drop can be subtle, often noticed by the patient hearing their foot “slap” on the ground during walking.
  • A stroke can cause damage to certain parts of the brain which controls the muscles of the leg. Foot drop can sometimes be the first evidence that a patient has suffered a stroke.
  • Traumatic brain injuries can cause foot drop. Cerebral palsy, another form of brain injury commonly causes foot drop. Often the foot drop is due to severe spasticity of the calf muscles.
  • Multiple sclerosis is a disease of the nerve cells in the brain and spinal cord. This disease can cause muscle weakness and fatigue which can show up as a foot drop condition during walking.
  • Charcot-Marie-Tooth disease is a hereditary disorder which damages the nerves in the arms and legs. Patients with this disease often develop foot drop along with high arches and numbness in the feet.
  • Peripheral neuropathy is a general term describing disease of the nerves primarily in the lower legs and feet. Diabetes is a common cause of peripheral neuropathy. Muscle weakness from peripheral neuropathy can cause foot drop.
• Muscle diseases
  Less common, diseases of muscles can cause overall weakness of the legs. Depending on severity of the disease, and the affected muscle groups, foot drop may become a dominant problem during walking. Muscle diseases include muscular dystrophy, polio and amyotrophic lateral sclerosis (ALS).

Whether the condition is expected to be temporary or permanent, patients with foot drop are often prescribed an AFO (ankle-foot-orthosis) to improve stability in gait and prevent trips and falls.

See video below of patient with dropfoot – before and after using the Richie Brace®.

Heel pain is the most common condition affecting the feet of middle aged adults.  The location of heel pain, the anatomic structures involved and the treatment options vary considerably.  The Richie Brace® family of products can be very effective in treating various forms of heel pain.

Plantar Heel Pain
Pain on the bottom of the heel is most likely due to plantar fasciitis.  This condition begins as an inflammation of the plantar fascia which is a strong ligament connecting the heel to the toes of the foot.  The plantar fascia is an important arch-supporting structure.   In plantar fasciitis , the attachment of the plantar fascia becomes inflamed and then undergoes tearing and degeneration.  In later stages, the heel bone (calcaneus) itself becomes inflamed at the attachment of the plantar fascia and a spur will form.

The primary treatments of plantar heel pain focus on reducing strain in the plantar fascia.  This can be accomplished with custom foot orthoses which support the medial arch of the foot.  Stretching of the Achilles tendon also relieves strain on the plantar fascia.  These treatments are usually successful, however some patients will go on to suffer long term or chronic symptoms which may require immobilization of the foot and ankle using a walking boot.

In long term or chronic cases of plantar heel pain the new Richie AeroSpring Plantar Fascia Offloading System can provide effective treatment without the need for wearing a bulky walking boot.  This system combines a carbon fiber ankle-foot orthosis with a custom foot orthotic and heel lifts to provide a three-point strategy for relieving strain on the plantar fascia.

See this video of the AeroSpring Bracing System:

Take a moment to read a blog written by Dr. Richie on Plantar Heel Pain:
Plantar Heel Pain: An Urgency to Treat

Posterior Heel Pain

Pain on the back of the heel bone is usually caused by inflammation of the attachment of the Achilles tendon.  Often times, a bursa sac of fluid forms here as well as a bone spur.  The cause is usually a tight Achilles combined with overuse or improper footwear.

The Richie AeroSpring Achilles Offloading System offers an effective treatment as an alternative to traditional immobilization in a walking boot.  With this bracing system, the patient can wear regular shoes, ambulate normally and drive an automobile without restriction.

See this video of the AeroSpring Bracing System:

Degenerative joint disease (DJD) is a form of arthritis. Patients with DJD suffer from pain due to inflammation in their joint cartilage. Many times, the cartilage can be worn down completely and then lost.  The movement of the ankle becomes more weakened over time and mobility is difficult.

The ankle joint is a common location for degenerative arthritis which occurs after trauma. When DJD affects the ankle there are few options available other than debilitating surgery.  Fortunately, patients now have an alternative to surgery when they are afflicted with arthritis of the ankle joint or the subtalar joint which is located beneath the ankle.

The Richie Brace® can relieve symptoms of DJD affecting the ankle and subtalar joints.  Some of the most positive and life-changing experiences with the Richie Brace® have resulted from treating DJD of the ankle where no other viable treatment options have been available to the patient.

Here are a few testimonials from patients who have had their lives changed by wearing the Richie Brace® for treatment of severe arthritis:

I am 70 years old but very active, training and showing my border collies in obedience, agility and herding trials and running a small sheep farm. A teenage accident left me with almost no cartilage in my subtalar and the bone has seriously deteriorated. The pain was so intense, I was close to deciding on the radical surgery of bone fusion and my activities were seriously curtailed. Since I started wearing my Richie Brace all day, every day, the pain reduction has been close to 95% and thoughts of surgery are now shoved in a dark recess.

It is nothing short of amazing. I am eternally grateful.

Sincerely,

H.P.

Prior to using the Richie Brace, I spent two years with incapacitating continuous pain. Orthopedic surgeons had recommended an ankle fusion as my only hope, but I did not want to undergo that surgery. Thanks to the Richie Brace, I can walk normally again, with minimal pain.

L.M.

I fell and split my heel on my left side and tore up my ankle pretty bad. They were able to fix my heel but for some reason my ankle never did heal right and every time I walked, there was a severe pain, so I had a very bad limp. This really made me real depressed sometimes because I show my dogs in competition and you really have to walk and do a little running. I own a Pembroke Welsh Corgi and a German Shepherd and my new dog is a Belgian Malinois. This breed is very active and I did my best to keep up with her. But it kept me from doing all the things I really wanted to do well.

Dr. Richie made a mold and sent it off. In about 4 weeks it came back at first it made my foot hurt worse when I put it on but he worked with it and told me to go home and try it out for a while. I came back in about 3 weeks later and did some more work on it and then when I put it on, it was too loose, so he made another one and this time it worked great. I was getting to the point that nothing was going to work but the doctor said we have to find the right adjustment. Sure enough I left his office and only came back once to show him how it was working. It has now been almost a year, I have gone from limping and taking 5 pain pills a day to hardly any limp and maybe 2 pain pills at the most and that’s only when I have been on my feet all day. In fact I can wear my own shoes and no one knows I even have a brace on. I can’t wear dressy shoes or sandals with the brace but that is ok. In fact a lot of people noticed that I wasn’t limping anymore when I was showing my dogs.

So I have waited to write this letter to be sure it was working in cold weather also. It does, but when it is cold I do have a little limp, but that’s in the bone. I can put full weight on it which I could not do before. I showed my Belgian Malinois to her breed Champion. I can run and play with my grandchildren and hike in the mountains like I used to do. I’m 64 years old now; I can do all the things I did before I broke my foot. I can’t thank Dr. Richie enough. I sent someone else to him because she had a foot problem that was a little different from mine. I see her at the dog shows and she can’t believe it either because of this brace I have my life back the way it was before I broke my heel and when the brace is off, then I’m right back where I was a year ago. And so that brace is everything for me and the one nice thing about it is I don’t even know it’s on because it is so light weight. Thanks so much to you and the staff for giving me something back that I lost and thought I would never have again. Because surgery was out of the question, they couldn’t guarantee that the pain would go away. Sorry it took so long but I had to make sure this wasn’t just a dream.

A.B.
California

Dr. Richie and the Richie Brace® saved my ability to walk with comfort. I had a talus fracture, which is the bone above the heel bone, and this ruined my joint underneath the talus bone. I had a great deal of pain and disability doing my routines and had to more or less stop my active athletics except for swimming. I had tried a variety of braces and seen many surgeons for possible corrective surgery and was left with the possibility of pinning my heel bone to the talus bone to improve the pain. Unfortunately, this operation has a significant complication rate and some people do very poorly with it. I continued to look and found Dr. Richie.

Dr. Richie made me a brace that allowed me to use my injured foot in a way that didn’t put pressure on the joint that was injured. The Richie Brace® was modified to make it a little stiffer and I have been progressively improving over the five months that I’ve had the brace. I use it with a low-topped hiking shoe, a medium hiking shoe, and my ability to walk seems almost normal now.

Dr. Richie, I really appreciate your invention and look forward to being your patient for years to come.

Sincerely yours,
Robert Yoho, M. D. Pasadena, CA

Lateral ankle instability, also know as chronic ankle instability, is a condition which causes a patient’s ankle give out on the person, causing the outside of the ankle to bend down toward the ground, the same way ankles do when they are sprained.  Lateral ankle instability is prevalent during activities such as running, walking, and sometimes even just standing.

Lateral ankle instability is usually the result of multiple ankle sprains, or turning of the ankle.  For this reason athletes are prone to have chronic lateral ankle instability.  Every sprain weakens the ankle ligaments, causing the ankle to turn more often, however, due to the elasticity of the weakened tendons, a sprain does not occur.

Research has shown that patients with chronic ankle instability are at significant risk to develop disabling arthritis within 20 years of suffering their first ankle sprain.  Therefore, treating the unstable ankle is of critical importance early, rather than later.

Over the past 25 years, the Richie Brace® has been worn by thousands of active individuals with chronic ankle instability to prevent further sprains as well as enhancing the rehabilitation process.  The Richie Brace® has been worn by many professional and Olympic athletes during competition and training.  Athletes prefer the custom fitted Richie Brace® over other brace options due to :

1. Superior fit inside the shoe
2. Unrestricted natural motion of the ankle while protecting from inversion and eversion movement which causes the sprain
3. Lightweight, open design for breathability, comfort and support
4. Custom foot orthotic for maximum support

There are myths and controversies regarding bracing the ankle after a sprain.  Those myths, which are un-true include a fear of muscle weakness and a compromise of sports performance.  To learn the real truth and research showing the benefits of wearing an ankle brace to recover from an ankle sprain, see this article written by Dr. Richie: Ankle Foot Orthoses for the Athlete.

Also, to learn the foot orthotic benefits of the Richie Brace® in treating ankle instability, read this blog by Dr. Richie:
A Closer Look At Foot Orthoses For Chronic Ankle Instability

Patients with tendinopathy often experience tenderness and pain with movement of the injured tendon and/or the surrounding tendon area. The pain is sometimes experienced with touch only, and no movement. The pain may be acute or chronic. Acute pain is usually paired with inflammation of the tendon.

Depending on the type of tendinopathy, immobilization is often necessary for healing.

When a patient experiences an Achilles tendon rupture, there will be an immediate shock of pain in the rearfoot/ankle, as well as the base of the calf muscle. When this occurs, a “popping” sound is usually present, followed by pain and severe swelling.