Understanding and utilising the Richie Brace for ankle and midfoot Arthritis

The Richie Brace is a specialised tool that has shown to be exceptionally beneficial in managing conditions such as ankle and midfoot osteoarthritis and tibialis posterior tendon dysfunction, which is often related to rheumatoid arthritis. Despite its effectiveness, it remains underutilised in clinical practice.

In this weeks episode of the NK Active podcast Lead clinician Nick Knight speaks to Zoe Wilson from ZW Clinics to discuss about everything there is to do with the Richie Brace. To our knowledge she is the only podiatrist we know who is offering a course on this subject.

Introduction to the Richie Brace

Introduced by Dr. Doug Richie, an orthopedic surgeon from California, the Richie Brace is an ankle-foot orthosis (AFO) designed to treat a variety of foot and ankle pathologies conservatively. It’s a type of brace that is particularly useful for treating adult-acquired flatfoot, providing support and allowing patients to continue with daily activities while avoiding more invasive treatments like surgery and injections.

Usage and Indications for the Richie Brace

Professionals use specific assessment methods to determine if a Richie Brace is suitable for a patient. They evaluate:

• The position of the heel bone (calcaneus) relative to the supporting surface
• Forefoot abduction, which is the lateral movement of the front part of the foot
• The appearance of too many toes on the lateral side when viewing from behind, known as the’too-many-toes’ sign
• The integrity of the medial longitudinal arch
• The patient’s ability to perform certain movements like heel raises and inversion against resistance

Early intervention with a Richie Brace can lead to successful management in up to 90% of cases if the pathology is recognized early.

The Decision Between Orthoses and Braces

When choosing between an orthosis and a Richie Brace, the decision is based on the thorough clinical assessment mentioned above. Earlier stages of conditions may benefit from bracing which can be a temporary measure until the patient can transition back to regular orthotic solutions.