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The advantages of simple metal braces are that they are quick, easy, and cheap to make. They often last longer, and, if used with sandals or clogs, in hot weather they are cooler than plastic. However, they also have disadvantages: because a shoe, sandal, or wood ‘clog’ must be built or attached to the brace, there is additional work and cost. Also, they are heavy, clumsy, and more noticeable. In hot or wet weather, leather or cloth, or even the metal starts to rot. Shoes or boots which the child cannot change, even when they get wet, begin to stink.
METAL ROD BRACES* using ‘re-bar’ (reinforcing rod for use in cement building construction)
For a brace shorter than 50 cm. (20 inches) you can use rod that is 5 mm. thick. For a longer brace, the rod should be thicker—up to 8 mm.
Bend the rod like this.
Half ring slightly bigger than leg.
|TOP RING COVER
Rivet and glue the leather.
These flat-bottomed soles make walking more difficult
BACK KNEE STRAP
soft leather inner pad
thick, strong leather
This clog is not as good a design as the one in the box on the right.
|These improved clog designs make walking smoother.
strong rubber sole (car tire)
soft sponge rubber (or nothing)
*Much of the information on metal braces, on this and the following pages, is taken or adapted from Poliomyelitis by Huckstep, and Simple Prosthesis Manufacture by Chris Dartnell.
- 1 SHOES AND CLOGS FOR METAL BRACES
- 2 HOW TO CONTROL UP AND DOWN MOVEMENT OF FOOT
- 2.1 CONTROLLING FOOTDROP AND TIPTOE DEFORMITIES
- 2.2 Making a backstop
- 2.3 Toe-raising spring
- 2.4 CONTROLLING FOOT-RISE AND UNWANTED KNEE-BEND
- 2.5 KNEE HINGES
- 2.6 Hinges on a round-rod brace
- 2.7 A hinge for flat metal bar
- 2.8 BRACES THAT FOLLOW THE SHAPE OF THE LEG
- 2.9 ADJUSTABLE BRACES
- 2.10 Hip Bands
- 2.11 Hip band without lock
- 2.12 Hip band with lock
- 2.13 KNEE PIECES (Use this design.)
- 2.14 ANKLE STRAPS
- 2.15 RAISED SOLES OR ‘LIFTS’ for one leg that is shorter
SHOES AND CLOGS FOR METAL BRACES
|High-top leather shoes often work best, especially in communities where children usually wear shoes.||Shoes are easier to put on when the whole top can open wide. It may help to cut off the front part of the shoe.||Leaving the toes open to ‘breathe’ is also important if a child is not likely to wear (or wash) stockings.|
For adding thicker soles and making other changes, it helps to buy shoes with soles that are sewed on. (Today, many shoes have plastic or rubber soles that are glued on or molded with the shoe. These are much harder to work with.)
Unfortunately, leather shoes are costly. Also, they may not last long in rain and mud. So, you may want to make simple, low-cost wooden-soled shoes, or clogs. This design is from Simple Prosthesis Manufacture.
(can be made of old car tire)
|strap clog||lace-up clog|
|1. Draw around the foot on a piece of wood about 2½ cm. thick. Be sure to use a wood that is not likely to split.|
|2. Leave extra space as shown (to allow for child’s growth). Cut out the piece of wood.|
Put nails here.
Drill hole for brace ⅓ of the way up clog.
|3. Carefully draw this shape on a piece of paper, using the length of the clog as a guide. Then cut it out.|
|4. Now draw both sides of the leather top. Between the 2 sides add the width of the clog.|
In communities where most children go barefoot, a disabled child may prefer more open clogs. This design is adapted from Huckstep’s Poliomyelitis, and the ‘Jaipur Sandal’.
Note: These open clogs are hard to fit on deformed feet or feet with tiptoe contractures. In such cases, high-top clogs or boots work better. Or use plastic braces molded to fit the foot.
HOW TO CONTROL UP AND DOWN MOVEMENT OF FOOT
CONTROLLING FOOTDROP AND TIPTOE DEFORMITIES
|A child with ‘footdrop’ or a floppy foot that hangs down so that she has to lift her leg high with each step,||needs a brace that holds the foot up. Use a plastic brace,||or a metal brace with a backstop that lets the foot bend up, but not down.|
Making a backstop
Cut a thin plate of steel.
Screw it to the heel piece.
Put in a lining to protect foot.
|A child with spasticity whose foot pushes down hard may need a longer plate to keep it from working loose.|
Toe-raising springAnother way to help prevent footdrop is with a toe-raising spring.
This is a more complicated design.
piece of car tire inner tube
This is a simpler design.
CONTROLLING FOOT-RISE AND UNWANTED KNEE-BEND
A child who walks with knees bent and feet bent up,
|may (or may not) be helped by a brace that prevents the foot from bending up as much. If possible, use a stiff plastic brace.||Or use a metal brace with a stop placed in front of the upright bars.||A strong stop with a long plate will be less likely to work loose or damage the clog.|
A child whose weak leg bends at the knee when he tries to put weight on it,
may need an above knee brace.
|But sometimes a below-knee brace that stops the foot from bending up will help push the knee back enough so that the child can support his weight on it.
The brace can be of stiff plastic, or metal with stops to prevent foot-rise.
|If a brace with an ankle joint is used to prevent the ankle from bending up, the base piece will need a long, strong, forward plate.
The joint can be adjusted to allow only the desired range of motion.
Braces with locking knee hinges permit the child to bend her knees for sitting or squatting.
|Non-bending knees are satisfactory for most children. The child can sit with her leg straight.||
|However, in some communities, a child may ‘fit in’ better if he can squat.
However, hinged braces have disadvantages: they are more costly and take longer to make. A child outgrows them quickly—unless they are adjustable. So use your judgment.
The knee hinge locks for walking and unlocks for sitting or squatting.
Hinges on a round-rod brace
Child pulls up tubes to bend knee.
thin metal rod
tubes for locking knee
thin metal tube
A BETTER HINGE
metal tube that fits rod
Tube fits closely over hinge.
Cut rod ends to form smooth fit.
|A simpler hinge such as the ones above for a round rod can also be used on a flat rod.|
A hinge for flat metal bar
squared metal ring
side pieces welded or riveted
The ring must fit closely to keep the joint firm.
Head of pin sticks out so ring cannot slip farther down.
BRACES THAT FOLLOW THE SHAPE OF THE LEG
Flat metal bar can be bent to fit the shape of the leg more closely. This is not always necessary but if done well the brace will fit better—especially when the bar is used with molded plastic.
See instructions for bending and fitting the rod.
As the child grows, a brace made like this can be lengthened. Teach family members how to do this.
Braces with a hip band may be needed for the child:
|whose leg (or legs) is so weak at the hip that it flops or turns far out to one side.||or whose legs tend to twist too much inward (or outward).||Put hinges at height of hip bone.|
|A common problem with hip bands is that the low back bends forward and the butt sticks out. This can cause back problems, and hip contractures.||A hip band that dips down in back to push in the butt helps prevent this problem.
If necessary, add an elastic strap here.
|The back of the hip band can be made of thin metal lined with leather, or of strong plastic.|
|On plastic braces the side bars and hinges can also be made of thick, strong plastic. This adds some flexibility, which will be better for some children but not provide enough support for others.|
|A child who tends to flop forward at the hips, may need a hip band with a locking hinge. You can use this design.||
metal ring lock
Pull up to bend for sitting.
Braces with plastic hip band and locking plastic hip hinges. (PROJIMO)
Hip band without lock
Hip band with lock
leather hip belt
nut and bolt with washers
Tighten enough so it will resist a little, but can bend for sitting.
flat metal bar
Bend to fit hips.
|For a young child whose feel turn in a lot, a night brace to hold the feet (and hips) turned outward may help. It can be made from a thin metal bar or from wood.
KNEE PIECES (Use this design.)
|A child with a weak leg that straightens normally,||needs a slightly loose strap behind the knee,||
and a firm, comfortable knee piece.
|A child with a leg that does not quite straighten,||needs a knee piece that firmly pulls the knee back.|
|A child with a knee that bends backward,||needs a firm strap behind the knee that lets the knee go back only a little.|
(A front strap may also be needed.)
|For children with a severe back-knee problem, it is often better to use a plastic brace that distributes pressure over a wide area above and below the knee. (This is more comfortable than a behind-the-knee strap that presses only on a small area.)|
|A leg that bends in at the knee,||A leg that bends out at the knee,|
|needs a knee piece that pulls the knee outward,||needs a knee piece that pulls the knee inward,|
|and also one that pulls the knee back (as shown above).||and also one that pulls the knee back.|
one in back
one in front
and one to the side
|For an ankle that bends out, use a strap that pulls the ankle in.|
|A sole raised on the outer side may also help.|
|For an ankle that bends in, use a strap that pulls the ankle out.|
|A sole raised on the inner side may also help.|
RAISED SOLES OR ‘LIFTS’ for one leg that is shorter
|For a child who has one leg shorter than the other:|
|Measure the difference in leg length.||
amount of lift needed
difference in leg length
|Make the ‘lift’ of the sole about 1 cm. shorter than the difference in leg length.|
Note: Almost all children have one leg that is a little shorter than the other, and this does not usually affect how they walk. Raised soles (‘lifts’) are usually not needed if the difference in leg length is less than 2 cm.
However, a child who drags a foot because his hips tilt down on that side may be helped by a small lift on the other side—even if that leg is the same length or longer.
Material used for lifts should be as lightweight as possible. You can use cork or a light, porous rubber. If the material is heavy but strong, to make it lighter you can drill holes through it. Put a thin, strong sole on the bottom.
|A child with a mild to moderate ‘backknee’, may be helped by a heel that extends backward. This helps push the knee forward when the child puts her weight on her foot.|
For a more severe back-knee, the child may need a long-leg brace (See "Evaluating a Child's Needs for Aids and Procedures" and "Knee Pieces".)
Design from Simple Prosthesis Manufacure, by Dartnell.
height of lift
Ask a local shoe or sandal maker to teach you how to fasten on the soles and lifts.