Introduction to Lower Limb Corrective Bracing

By Mitchell Warner, CPO

Ortho Rehab Designs Prosthetics and Orthotics, Inc., Las Vegas Nevada,

Part One:  “Do I need corrective lower limb bracing?”

Corrective lower limb bracing is devoted to helping people whose lower limbs have deformities, injuries and/or are affected by various diseases that make it hard and/or painful for them to walk.

However, many people who seek to improve their walking with corrective lower limb bracing (CLLB) are often disappointed with the results. Their disappointment usually stems from the failure to determine and insist upon:

  • proper diagnosis
  • proper brace selection
  • proper brace fit

Inadequate attention to any of these elements can lead to disappointing CLLB results, but proper diagnosis is generally the most important – and hardest – element to get right.

There are three primary reasons that individuals need corrective lower limb bracing

  • deformity correction/compensation
  • trauma correction/compensation
  • disease compensation

Deformities are mostly the result of birth defects and CLLB for these usually starts at an early age, sometimes before children can talk or otherwise effectively communicate with their caregivers. This inability of patients to tell their caregiver what’s wrong can sometimes lead to misdiagnosis, but for the most part, deformities are easy to see and assess so there is relatively little misdiagnosis in this area.

Trauma is much the same. Car accidents, sports injuries and other such mishaps often require CLLB to aid in recovery – or to help patients compensate for loss of function when they don’t recover completely from their injuries.

Disease-related need for CLLB is much harder to diagnose, and misdiagnosis in this area is the proximate cause not only of many disappointing results, but the reason some people suffer years of frustration, pain and debilitation. Thus it’s extremely important to get a correct diagnosis of your disease from the very beginning in order to get the best results from corrective lower limb bracing.

Most disease-related need for CLLB comes from neuropathy, which is a disease or disorder that affects the nervous system. There are two principal types of neuropathy:

Hereditary neuropathy comes in three primary forms: Charcot-Marie-Tooth Disease (CMT); Dejerine-Sottas Disease; and Familial Dysautonomia.

Non-Hereditary neuropathy is caused by diabetes, deficiencies of vitamin B12 and other vitamins and minerals, tumors, strokes, and/or infections, to include HIV.

Your first question, of course, must be: “Is there neuropathy in my family history?” If the answer is yes, then learn – and, if possible document – all you can about your family neuropathy history, then see your doctor as soon as possible and bring everything you’ve learned with you. The information will be invaluable in helping your doctor properly diagnose your condition so that you can then select the proper brace for your needs.

If you have no neuropathy in your family history, you might still have CMT or other hereditary neuropathy, but before you go to your doctor, research possible causes for non-hereditary neuropathy.

Look first to diabetes. It’s the most prevalent non-hereditary cause of neuropathy, which generally results from diabetic microvascular injury to the blood vessels that supply nerves (vasa nervorum). Diabetic neuropathy is perhaps the most common non-hereditary form of neuropathy due to the explosion of non-hereditary Type II diabetes in this country (as of 2011, more than 25 million Americans had diabetes and 79 million more were diagnosed as pre-diabetic).

If you don’t have diabetes or any of its precursor physical or lifestyle symptoms, then look to some of the other listed non-hereditary neuropathy causes and learn if you have any additional symptoms related to those areas.

Then see your doctor if numbness persists in your extremities. If you don’t have family neuropathy history, ask to be tested for diabetes since that’s the “prime suspect” for non-hereditary neuropathy. The same goes for the other non-hereditary causes listed – “If there’s doubt, check it out.”

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Finally, be aware that you may not have neuropathy at all, even though you show similar symptoms. It is not at all uncommon for people to be misdiagnosed as suffering from some form of neuropathy when they have an entirely different condition causing their neuropathy-like symptoms. Before you go to your doctor, be sure to learn as much as you can about alternative diagnoses even when you’re certain you have neuropathy.

By now it should be clear: The key thing in determining whether you need corrective lower limb bracing is to figure out from the beginning exactly what’s wrong with you before you proceed to brace selection and fitting. As you can see, neuropathy is a large field and both you and your doctor could think you have one form of it when you have a different form – or no neuropathy at all!

One final note on proper diagnosis. Most people who experience numbness in their hands and/or feet do not go immediately to the doctor; they either shrug it off, or figure it’s a transitory problem that will go away. Then, when their symptoms get so severe that they’re forced to go to the doctor, they still have no idea what’s going on – and no database of observations and their own knowledge to share with their doctor.

That’s the reason for this “quick start” guide: to help you learn about and understand what may be happening with your body before you go to your doctor, so that when you do finally go, you can help your doctor more quickly and accurately diagnose your condition. If you do, it will save you a lot of pain and suffering and frustration and wasted time and money.

Next Post: Part Two: Proper Brace Selection

12 thoughts on “Introduction to Lower Limb Corrective Bracing

  1. I am so interested to hear if you have any patients that have foot drop due to MS and if the brace helped them.

    Gina Massingill MS patent, Austin,TX

  2. I am a 61 year old female with CMT2B. Over the past several years my symptoms have increased to a point that It was necessary to wear bracing full- time. I speak of this bracing very loosely. I was prescribed Toe-Off braces, which are an off-the-shelf, “one size fits all ” type of product. Within months of receiving the Toe-Off braces, they had a stress fracture at the ankle where they fit into the shoe. The company would not warrant the product and I was left with very expensive broken braces. The Toe Off braces did help me control some of my foot drop but did nothing to support me or assist with balance and correction of the underlying issue of the CMT. I suffered falls on a regular basis (at least 1-2 falls a week) and could barely walk at a speed that was safe to be out in the community. Fatigue was so overwhelming that daily tasks were becoming almost impossible to achieve. I had stabbing pain in my lower back and hips which required powerful medication to control, and at night muscle spasms hindered my ability to sleep. Essentially I was dropping out of my social life and things I would have looked forward to began to cause me trepidation and anxiety. How far would I have to walk? What would I do if I found myself having to stand somewhere without something to hold, dancing about and dipping to keep my balance? Worse yet would be the humiliation if I fell. I realized I was becoming a burden to others even though they assured me I was not. How could I not be when I needed constant assistance to keep up. I kept thinking there has to be something better, something that works, or at least someone who really understood and cared about people who cannot walk independently. At every turn there was the “Sorry, this is the best we can do.”
    I began to look for answers in publications that provide information and support to people with a variety of problems. Most led back to the solution of Toe Offs, Blue Rockers or some form of AFO. As I searched online I discovered a video of a young girl with CMT that walked very much like me. She was fitted with a brace called Helios made by Mitch Warner of Ortho Rehab Design in Las Vegas. I watched in amazement as she was able to achieve a normal gait and balance with her Helios on. Wow, was that real? It couldn’t be. Surely all the doctors I had seen would know about this,- but they didn’t. I read more about Mitch Warner, Helios and his success in getting people moving again. I cried over testimonials from people whose lives had changed due to their Helios braces because they had suffered the same issues as me.and we’re now getting their lives back. I had to take a chance and I called to make an appointment.
    I talked with Michelle, Mitch’s assistant. She was so cheerful, positive and organized, I felt comfortable from the start. She guided me through what I needed to do, I could not wait for my appointment.
    On December 17 I arrived at the office of Ortho Rehab Designs. That is the day my life changed. Mitch knew from the start what my issues were and I knew I was in the right place. Mitch is such a skillful craftsman and gifted with knowledge, experience and passion for helping people really live their life’s. My first prototype braces were so perfect I was ready to take them home, but Mitch assured me it was going to get better. When I put on my “real” braces they were even better. I walked up and down the hall. I stood alone, comfortably. In the video he made I looked almost normal. Amazing!
    Mitch worked with me to make sure the braces fit comfortably. I learned how to go up and down stairs. All the details.
    Then it was time to go home with my new braces to my new life. Was that me negotiating the airport alone?
    Oh Yeah! Thank you, Mitch!

    • Hi Susiegale,

      My name is Gina Massingill, 50 years old.

      I have also seen the video you speak of and have talked to mitchs office lady. I have footdrop because of my MS that has been around for 20+ years. Regular AFOs are not for me. My other issue besides my right foot dropping is that my right knee is hyperextending terribly. If I am going to walk far I wear what is called a spider knee cage to keep it from getting too irritated and am not sure if the 2 can work together. Also my balance is way off. I have started using a cane full time in the last 6 months because of the foot drop and the balance issue.

      I am wondering if you think this could help me?. Plus I am wondering how in the world a brace can cost $5000.00?
      Did you have any help with your insurance?

      I know I probably need to start with doing the video for Mitch and I will.

      Thanks for posting.

      Gina Massingill

      • Dear Gina,
        It was nice to hear from you but was sorry to hear about your troubles! I agree that you need to get a video off to Mitch. Michelle was so helpful with what you should include. He will be able o see all that you have going on and will tell you if he can help. Since he makes the braces, he will know if all issues can be addressed with one brace. These are not ” off the shelf” type braces”.

        Balance was a huge issue for me. The Helios really make me feel stable even when standing alone. My foot drop issue is totally solved. I don’t fear falling as my foot clears the floor easily. Tests my physical therapist did before and after my Helios show that I have nearly doubled my walking speed.

        As far as insurance, policies differ so much you will just have to go a few rounds with yours! Michelle is very knowledgable about insurance and will be extremely helpful to you. The cost ( insurance or not) is well worth it for what you get. These braces are made just for your needs, reinforced and constructed not only to last, but to get you mobile again. Mitch spends an entire week with you to make sure the fit is right and you regain maximal function. The time he spends with you is uninterrupted and personalized. By the way, he warrants the braces for 2 years.

        The Helios have truly been a miracle for me. They have changed my mental attitude as well as my physical ability. Everyone comments on how much more straight I stand. I hope you will go forward in contacting Mitch I believe that if anything can be done, Mitch will do it. He is awesome.

        Don’t know if this was helpful at all. Contact me anytime and please keep me posted on your progress. Hugs and prayers coming your way!

  3. I have CMT2 and was fitted with the Helios braces in January 2007. I found Mitch through his ad on the hnf-cure website and a nurse friend of mine went with me to Las Vegas. We had a fun week and I was fitted for the Helios. What a difference!Simply put “they gave me my life back” I am now 69 years old and do my own housework, cooking and also love to garden. We live in Northern Minnesota. I use a cane with a spike when there is snow and ice outside, but otherwise I don’t believe anyone realizes that I have issues unless I show them my braces. Thanks Mitch!

  4. My 75 y.o. husband has been treated for Spinal Dural AVF. There were three fistulas in his spine. Two were treated with embolization. The third required extensive back surgery in May, 2012. While it appears the treatment was successful, he has not recovered feeling in his legs. He can not walk unassisted and uses a walker or mobility scooter full time. His right leg is worse than the left, including more weakness. Both feet have barely any feeling and in the right leg, he has little feeling as high as the thigh.
    Before he was diagnosed, we were sure he had CMT. He has hammertoes, knock knees and the shape of his foot looks similar to those with CMT. It’s possible he has more than one condition, although he was not diagnosed with CMT. We looked into the Helios braces online at that time. Now, he’s pinning his hopes on you being able to help him walk unassisted.
    I don’t know if you’ve treated anyone with his condition before, but would look forward to your response.

  5. Hi JeriG,

    I have not yet encountered a patient with CMT that also has the spinal problem that you are explaining about your husband.
    The Helios Brace treatment would focus on the lower limbs, and help restore a patients balance and alignment, for greater stability and mobility. I would be glad to review a videotape of your husband walking.

  6. I too have CMT and have visited Mitch and Michelle for the Helios Braces. Before I purchased them I too used a cane most of the time for ambulating and standing freely. I tried several different types of braces that did not work and when the guy I am dating found these braces on line and the videos of individuals’ successes; I researched them and the company and made one of the most intelligent decisions I have made in my lifetime….to make a trip to Las Vegas and purchase these braces. I did not realize the effect that my disability and inability to ambulate without fear of falling had on my attitude. Since my purchase of these braces in October of 2012, I can now walk and stand freely and am mastering uphill and stairs much better. I am working on curbs still but I think my problem with them is more my sciatic nerve that hurts when I put weight on my foot to raise myself up.

    These braces have changed my life so drastically and individuals who do not know me do not realize that I have a problem with ambulation. I also think that they have a string to my mouth because my temperment is much better because I feel so much better about myself and can funciton in my full-time job (which requires a great deal of walking and bending) without problems. I can go through the line at SubWay and actually carry my food, drink, and pay for my meal without worrying about falling down or dropping something while holding on to my purse, cane, and food items.

    Thank you so much Mitch and MIchelle…you were wonderful to work with and put up with me and my desire to wear normal shoes, which I do now by the way. This is the most wonderful gift I have ever received and the cost cannot be measured, it is truly a life-changing experience that I recommend to all who want to walk again without a cane or walker or whatever they need to hold on to. At work they laugh because I can walk as fast as they do now and they don’t have to wait on me… in fact sometimes I go so fast that they tell me to slow down.

  7. Pingback: Introduction to Lower Limb Corrective Bracing – Part Two | Helios: Balance for Life

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