Douglas Richie, DPM, inventor of the Richie Brace, continues to push the boundaries of technology and design. He will soon add two pathology-specific braces to his existing line of ten models—one targeted to patients with Achilles pathology, another for those with diabetes who’ve had partial foot amputations.
“These patients have in common the loss of propulsive ability, and the new braces will seek to address that deficit while still providing protection,” Richie said.
It’s been an innovative twenty years for Richie. In 1996, after years of sports podiatry practice, he was frustrated by the challenge of fitting sport ankle braces to patients who also wore custom foot orthoses. The two products should have worked naturally together, but because neither was made with the other in mind, the result was often ungainly and uncomfortable.
“Podiatrists didn’t know much about ankle-foot orthoses at the time,” Richie said. “We weren’t taught about the devices in school, and when we were in clinical practice we didn’t have relationships with vendors who could supply them.”
The situation has changed, obviously. According to Richie, roughly 40,000 custom AFOs are now prescribed annually. One reason for the increase, of course, is the Richie Brace itself, which he developed and launched in 1996. Another innovation was the distribution network of established foot orthotic labs he put together.
“Those labs compete fiercely with each other, but they like our products and trust me,” Richie said. “The labs offer products and services I can’t, too. For example, about eighty percent of our prescriptions are for a unilateral brace, but many patients require a foot orthotic on the contralateral side, and it’s nice to have a distributor who can provide that.”
The original Richie Brace, which still accounts for 85% of the company’s sales, offers a nonoperative approach to pathologies such as chronic ankle instability and mild to moderate posterior tibial tendon dysfunction (PTTD).
“When doctors initially started saying they wanted to use the brace for PTTD and severe ankle deformities, I was skeptical, because I considered it a sport brace for athletes,” Richie said. “But I kept hearing how effective the brace was for PTTD, so I worked with several people, including certified orthotists, to improve the original design and develop new models for specific problems.”
The restricted-hinge variation of the basic brace is designed for patients with degenerative joint disease (DJD, typically osteoarthritis) of the ankle or rearfoot. It’s also used to treat dropfoot as long as the patient has a stable knee.
“Patients who’ve had severe ankle fractures often progress to arthritis,” Richie explained. “But for some patients, fusion isn’t a great option, and many of our best testimonials come from those who’ve achieved significant pain relief with our braces.”
Richie offers two other braces for dropfoot conditions: the Dynamic Assist (for patients with dropfoot without equinus, absent spasticity, with stable knees; as well as those with peroneal nerve injury, post-stroke, or post-CVA problems), and the Richie Solid AFO (for those with severe dropfoot with spasticity and/or unstable knees).
“In all bracing, the goal is to preserve joint motion,” Richie said. “Any orthotist would rather treat dropfoot using a device with a dynamic hinge. But if the patient has an unstable knee, you can’t let the ankle move; then you need a solid AFO. You also need a solid device in cases of spasticity or contracture, such as in MS or cerebral palsy.”
Richie offers Gauntlet and California AFO models for more severe problems such as severe joint disease, Charcot arthropathy, or Stage III and IV adult-acquired flatfoot. There are also two models that use straps to suspend the arch, medially or laterally, to provide support without bulk.
Richie sees two trends that may significantly affect how his braces, and similar products, are prescribed. The first is the ongoing development of foot and leg scanners that could make casting obsolete. Such devices are still prohibitive for podiatry practices, but Richie thinks that within a year they may become affordable, which would be a game changer. One problem, however, is that casting offers clinicians an opportunity to make corrections before fabricating the AFO, but there’s no equivalent in the new methodology yet.
“Fabricators or labs can correct varus and valgus easily if they have a plaster model,” he said. “But when you go to CAD/CAM, you’re no longer working with the three-dimensional model, so you have to find a way to balance for forefoot and rearfoot deformities.”
The second trend is likely to be increased scrutiny of insurance and Medicare reimbursement rates for AFOs. In response, Richie may develop a “library system” of off-the-shelf devices to complement the two it now offers.
Cary Groner is a freelance writer in the San Francisco Bay Area.
Article sponsored by Richie Brace.