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.

Rationale for Fixed Hinge and Tamarack Hinges

Richie Braces can come with different types of hinges:

• Full Articulation Hinge Brace: This allows a natural up and down motion of the foot, restricting excessive pronation and supination which aggravates foot arthritis symptoms. This type is suitable for patients who have the normal range of motion at the ankle.
• Fixed Hinge: A rigid variant of the Richie Brace, the fixed hinge is appropriate for patients with limited ankle movement and acts as a splint.
• Dynamic Assist Tamarack Hinge: Aimed for patients with foot drop, this type provides a dynamic aid by promoting foot lift during the swing phase of walking.

Contraindications for Using the Richie Brace

There are scenarios when the Richie Brace is not advised, such as:

• Advanced cases of deformity, especially in the midfoot area.
• When there’s a rigid deformity present, which limits the brace’s functionality.
• Patients who may not be candidates for surgery due to various reasons yet have progressed too far for conservative management to be effective.

The Importance of Proper Casting

An accurate cast of the patient’s foot is essential for a custom-fit Richie Brace. Healthcare providers emphasize the importance of hands-on practice and experience for perfecting casting techniques. Tips for a successful cast include:

• Positioning the patient properly, typically lying on their front.
• Warming and mobilizing the foot to reduce contracture and achieve desirable angles before casting.
• Using non-permanent markers to indicate anatomical landmarks.

Access to Richie Brace Treatment and Education

Patients and podiatrists interested in this brace may face difficulty in finding local treatment providers, as the number of clinics offering this service is limited. A proactive approach includes:

• Searching online for expert podiatrists familiar with the Richie Brace
• Participating in educational courses that provide both theoretical and practical training on prescribing and casting for the Richie Brace

Conclusion

The Richie Brace offers a transformative approach for many patients suffering from arthritis and related conditions when used correctly. While the journey from novice to expert in its application is challenging, the results can be life-changing for patients, offering an alternative to more invasive procedures while allowing them to regain mobility and quality of life.

We thoroughly recommend speaking to Zoe if any of the above is of interest to you. Further infomation about her course and how to find out more about ZW Clinics can be found below.

Zoe’s links..

The course 

https://zwclinics.com/prescribing-the-richie-brace-course/

The ZW Website: https://zwclinics.com

X [Formally Twitter] @zoewilsonpod

Instagram @zwclinics

Facebook @zwfootandankle

Listen to the latest episode of the NK Active podcast here on your chosen platform – https://kite.link/nk-active or watch the YouTube video below.

And of course if you would like to speak to our team about how we can support you please do get in contact.