Braces

Braces are devices that are placed around a limb to support it. Unlike casts, braces are designed so they may be removed. Some of the common braces I use are below.

CAM Walker
A CAM Walker is a removable walking cast. It covers the foot and extends up to just below the knee. It is made of a rigid plastic with a cushioned liner that may have air bladders built into it. There is a front piece that is held on with several Velcro straps that wrap around the device. It has a “rocker bottom” that helps allow a rolling motion from heel to toe to when walking.

A Cam Walker is commonly used instead of a walking cast, when support is required for weight-bearing. It has the advantage that it can be removed when you are not walking. You may remove it in bed at night, for bathing, and in some cases to do motion exercises. You must wear it when you do any weightbearing.

Sometimes a CAM Walker is used as a removable splint when you should not be weightbearing. This is common after surgical treatment of calcaneus fractures. The CAM Walker provides support, but can be taken off several times a day to do motion exercises.

It may be similarly used if regular wound care is needed. The CAM Walker can be taken off to inspect and care for the wound, then replaced to provide support.

The air bladders built into the device can be inflated to provide a greater amount of support. You will be given a hand pump that fits onto the exposed valves, and can inflate the bladders variably. It is not necessary to use these, and you can experiment to see what feels best. Similarly, the Velcro straps can be tightened or loosened depending on what feels most comfortable.

Ankle Braces
There are a variety of ankle braces I use to treat ankle sprains, and ligament reconstruction.

The thinnest, low-profile brace is a Slip-On ankle support made of Ace bandage material. This gives the least amount of support, but will fit inside most shoes. This is useful in mild sprains, or when things are recovering, but only minimal residual support is needed.

An Aircast Stirrup Brace has supports that extend up along the inside and outside of the ankle, held together by a piece that fits under the heel. There are Velcro straps that hold it in place, wrapping around just above the ankle. This brace is used after ankle ligament reconstruction surgery. It prevents inversion of the ankle, but allows the ankle to dorsiflex and plantarflex. It can be used to protect acute ankle sprains.

An Ankle Lacer is made of canvas with rigid stays built into the medial and lateral sides. There are laces that weave up the front of the brace. These can be tightened to adjust the degree of support, and allow for swelling. Some of these also have Velcro straps, and some have incorporated elastic bands.

Ankle Foot Orthoses (AFO)
AFOs are braces that are custom made for long term use. They are used for a variety of conditions, including treatment of arthritis, tendon injuries or dysfunction, and muscle weakness. Long term posterior tibial, anterior tibial and Achilles tendon problems can be treated with these braces as an alternative to surgery. Patients with Charcot Arthropathy often have deformed feet, and custom molded braces can help salvage their feet.

A Polypropylene AFO is a hard plastic shell that extends from under the foot, behind the ankle and up to the posterior calf. Some are made with a hinge at the ankle. There is a Velcro strap that wraps around the calf to hold the brace on. It is designed to fit into a lace-up shoe.

An Arizona Brace is also custom fit to your ankle. It is made of leather that runs from the midfoot up to the lower leg. There are laces up the front that can be tightened or loosened to provide support. It is also designed to be used with a lace-up shoe.

A Double-Upright Brace is one that is built into a shoe. There are metal stays that are built into the inside and outside of the heel. At the level of the ankle there may be hinges to allow for ankle motion. When used to treat a flatfoot due to posterior tibial tendon dysfunction, an additional T-strap can be added to the inside by the ankle to add more support. This is the type of brace that was traditionally used for treating polio problems. It has the disadvantage of being limited to only one shoe.