Perth Podiatry Ankle foot orthosis (AFO) / Richie Brace treatment
There are times where functional foot orthotics can not manage your foot malalignment. Below are conditions where a special brace called Richie AFO (ankle foot orthotic) can help. Dr Naraghi has done primary podiatric medical residency and podiatric surgical residency in USA. He practiced for four years in California and was trained by the founder of the Richie Brace in casting and prescribing Richie Brace. Dr Naraghi has more than 20 years’ experience prescribing AFO braces for many different mechanical foot and ankle conditions. Below are examples of some of the common conditions treated with an AFO brace:
Adult acquired Flat foot deformity
Adult acquired flat foot deformity is a terminology used to describe adult onset flat foot deformity. Have you noticed your arch getting more and more flat as you age? There are number of causes for this such as unrecognized trauma, weight, corticosteroid use, and systemic arthritis such as rheumatoid arthritis. Once the cause of your flat foot deformity is determined we will tailor best treatment options in order to treat the cause and not just the symptoms. This may need a multidisciplinary approach to your management between a podiatrist, GP, your rheumatologist and or other specialists.
Adult acquired flat foot deformity is divided in 4 stages. In earlier stages (stage 1 and 2) treatment consists of NSAIDS, myofascial or physiotherapy, orthotics therapy and in some cases surgical intervention. In later stages (Stage 3 and 4) you may benefit from Riche AFO Brace. In later stages of adult acquired flat foot deformity the foot becomes more rigid and hence the purpose of the brace is more to resist any movement in order to splint those joints and prevent further compensation by healthier joints in the vicinity.
Lateral Ankle Instability
Do you experience your ankle giving out? Have you sprained your ankle many times? If that is the case you maybe suffering from lateral ankle instability. Your ankle is stabilized statically by ligaments and dynamically by the tendons crossing the ankle. When these structures fail, this can lead to Lateral ankle Instability. In most cases of lateral ankle instability, the ankle sprain is not managed properly and patient has not gone through appropriate rehabilitation. There are many causes of lateral ankle instability:
1. Lax, weak, partially or complete rupture of the ligaments
2. Weakened lateral muscle groups
3. Fixed inverted or outward position position of your heel bone
4. Hypermobility/Ehlers Danhos Syndrome/Marfan’s/Turner Syndrome
5. Osteochondral lesions
Richie brace AFO is one the devices we use when the ligaments and tendons around the ankle are not strong enough to hold the ankle stable. There are variety of AFOs that can be used depending on whether it is needed to completely restrict or control the motions around the ankle.
Ankle and Subtalar Arthritis
Trauma is probably the most common cause of arthritis in the ankle and subtalar joint. Other causes may include systemic conditions such as inflammatory arthropathies, tarsal coalition and late stage adult acquired flat foot deformity (see above). The goal of AFO in treating ankle and subtalar joint arthritis is restricting the motion at these joints and preventing compensation in the vicinity joints. AFO Richie brace can help and prevent future surgical interventions such as fusion of the affected joints.
Foot Drop
Foot drop is a general term used for trouble lifting the front part of the foot. If you have foot drop, the front of your foot might drag on the ground when you walk. Foot drop isn’t a disease. Rather, foot drop is a sign of an underlying neurological, muscular or anatomical problem. Therefore, careful history and physical examination is needed to assess the cause of your drop foot. When you have a foot drop in order for your foot to clear the ground, your other joints in your body such as knee and thigh have to compensate.
The most common cause of the drop foot is compression of the deep peroneal nerve which is responsible for innervation of the muscles that are responsible to lift your foot upward. Often this may occur after a knee and hip surgery or sometimes after prolonged staying in a below knee cast. Other times drop foot can occur as a result of neurological and or neuro-muscular conditions such as Charcot Marie Tooth disease, multiple sclerosis and Muscular dystrophy. Finally drop foot can occur post stroke and very rare conditions such as amyotrophic lateral sclerosis.
The key to successful treatment is to determine the cause of your drop foot and then we can help prescribing the right AFO brace for your condition. In some case only a simple device attached to your shoe (e.g. Dictus band) or simple AFO leaf spring.
For an up-to-date treatment guide for the various types of Ritchie braces and their clinic indication for various foot and ankle conditions please refer to –https://richiebrace.com/wp-content/uploads/2021/10/treatment-guide.pdf
