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Metal Braces

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HealthWiki > Disabled Village Children > Chapter 58: Braces (Calipers) > Metal Braces


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.

Metal rod bent to make a brace.
Bend the rod like this.
Bent metal bar for brace on leg.
Half ring slightly bigger than leg.
BELOW KNEE
Bent metal bar for brace on leg.
ABOVE KNEE
TOP RING COVER
Rectangle with holes and thick strap.
soft leather
thick strap
Model of above knee brace made of bars with knee piece and shoe at bottom.
ABOVE-KNEE BRACE
Rivet and glue the leather.
These flat-bottomed soles make walking more difficult
Thin rectangle with holes.
BACK KNEE STRAP
Two bars, 2 small leather squares, one with a hole in it.
KNEE PIECE
soft leather inner pad
thick, strong leather
ABOVE-KNEE BRACES
2 types of full leg brace made of bent rod, one below-knee brace made with bent rod.
BELOW-KNEE BRACE
This clog is not as good a design as the one in the box on the right.
These improved clog designs make walking smoother.
A thin, long rectangle rounded out on one side.
wood
strong rubber sole (car tire)
soft sponge rubber (or nothing)
or
Thin, long rectangle rounded out on one side and with wedge cut on other side.
wood
car tire


*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.


SHOES AND CLOGS FOR METAL BRACES


High-top leather shoes often work best, especially in communities where children usually wear shoes. high top leather shoe strapped into metal brace. 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. arrow pointing to cut off toe of shoe.
side view of brace-shoe combo with removed toe area.
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.

wood clog with leather sides attached to a metal brace with arrows pointing to different aspects of the contraption.
rivet
leather top
rubber sole
(can be made of old car tire)
buckle
eyelets
wood base
leather sides of clog, one with buckles and one with holes for laces.
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.
pencil outlining the foot on a piece of wood, piece of wood shown with cutting outline with space left around the foot outline.
2. Leave extra space as shown (to allow for child’s growth). Cut out the piece of wood.
a paper lined up with the length of the clog cut in the shape of a square with one corner cut off so that the top line is the width of the ankle and the bottom line is the length of the clog.
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.
two of the cut out shapes with the long ends next to 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’.

pieces of an open clog needed for assembly.
leather straps
sponge rubber
¼ inch or 1 cm. water-resistant plywood or hardwood
light, strong wood (drill holes to make lighter)
strong rubber sole (car tire)

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,
foot with ankle all the way extended so the toe drops straight down.
needs a brace that holds the foot up. Use a plastic brace,
molded below the knee plastic brace.
or a metal brace with a backstop that lets the foot bend up, but not down. metal brace and an open clog with a heel closure.


Making a backstop

piece of thin steel with two holes punched out, steel bent so that foot fits in it, piece of steel mounted on wood sole,clog with steel inserted and lining protecting the foot.
Cut a thin plate of steel.
Bend it.
Screw it to the heel piece.
Assemble clog.
Put in a lining to protect foot.
DVC Ch58 Page 545-5.png
A child with spasticity whose foot pushes down hard may need a longer plate to keep it from working loose.


Toe-raising spring

Another way to help prevent footdrop is with a toe-raising spring.
spring attached to below the knee strap and to heel strap on brace by leather straps.
wire spring
This is a more complicated design.
car tire inner tube stretched from under mid foot to the below the knee strap on brace.
piece of car tire inner tube
This is a simpler design.


CONTROLLING FOOT-RISE AND UNWANTED KNEE-BEND

young unhappy boy walking with difficulty with his knees and ankles bent.
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.
young boy standing taller and walking more easily with plastic braces on.
Or use a metal brace with a stop placed in front of the upright bars.
metal brace with heel stop in place.
A strong stop with a long plate will be less likely to work loose or damage the clog.
DVC Ch58 Page 545-11.png


child holding his weak leg that is bent at the knee.
A child whose weak leg bends at the knee when he tries to put weight on it,
child supporting himself on a straight leg with a full leg metal brace.
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.
child supporting himself with a below the knee plastic leg brace.
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.
DVC Ch58 Page 545-15.png

The joint can be adjusted to allow only the desired range of motion.

KNEE HINGES

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.
child sitting with her leg out straight with a non bending brace on.
NON-HINGED BRACE
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.
child goes to the bathroom in a squatting position with both knees bent and a hinge leg brace on.
HINGED BRACE
The knee hinge locks for walking and unlocks for sitting or squatting.



Hinges on a round-rod brace

metal brace locked with tubes around the hinge, metal brace bent with tubes slid down from the hinge, close up view of the tube slid around the hinge and both pieces of metal.
Child pulls up tubes to bend knee.
thin metal rod
tubes for locking knee
thin metal tube
pin

A BETTER HINGE

DVC Ch58 Page 546-4.png
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




metal ring is away flat metal bar hinge.
OPEN
squared metal ring
side pieces welded or riveted
bent metal joint.
ring on hinge keeping it locked.
The ring must fit closely to keep the joint firm.
Head of pin sticks out so ring cannot slip farther down.
LOCKED

BRACES THAT FOLLOW THE SHAPE OF THE LEG

metal brace following the shape of the leg.
Bend around knee.

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.

ADJUSTABLE BRACES

As the child grows, a brace made like this can be lengthened. Teach family members how to do this.

metal brace with multiple screw hole so it can be lengthened.
screws

Hip Bands

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. child with foot turned outward with braces and crutches but no hip belt. or whose legs tend to twist too much inward (or outward). child wearing full leg braces with knees and toes turned inward. happy child with a hip belt attached to his full leg braces making his legs and feet properly aligned. Put hinges at height of hip bone.
WITHOUT
HIP BAND
WITHOUT
HIP BAND
WITH
HIP BAND


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. child with hip band above the butt with his butt pushed out and lower back dipping. A hip band that dips down in back to push in the butt helps prevent this problem.

If necessary, add an elastic strap here.
child with a hip band that goes across his rear end keeping his back straight. The back of the hip band can be made of thin metal lined with leather, or of strong plastic.
hip band and brace made of metal and 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.
child bent at the hips leaning forward on crutches. A child who tends to flop forward at the hips, may need a hip band with a locking hinge. You can use this design. child standing straight with locked hip joints preventing him from flopping forward.
adjustable locked hip joint with a movable ring.
metal ring lock
Pull up to bend for sitting.
DVC Ch58 Page 547-10.png
Braces with plastic hip band and locking plastic hip hinges. (PROJIMO)



Hip band without lock

Hip band with lock

hip belt attached to leg braces.
leather hip belt
nut and bolt with washers
Tighten enough so it will resist a little, but can bend for sitting.
flat metal bar
weld
hip joint bar, bent in a curve shape with locking mechanism.
Bend to fit hips.
lock
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.
two wood attached to metal bar in the shape of correct foot alignment.

KNEE PIECES (Use this design.)


A child with a weak leg that straightens normally, DVC Ch58 Page 548-1.png needs a slightly loose strap behind the knee,
child with a full leg brace that has a strap behind and in front of the knee.
and a firm, comfortable knee piece.
A child with a leg that does not quite straighten, DVC Ch58 Page 548-4.png
child with a full leg brace with a strap only in front of the knee.
needs a knee piece that firmly pulls the knee back.
A child with a knee that bends backward, DVC Ch58 Page 548-6.png needs a firm strap behind the knee that lets the knee go back only a little.
child with a full leg brace that has a strap only behind the knee.
(A front strap may also be needed.)
full leg brace with long plastic plates above and below the knee.
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,
knee bent inward, knee with brace and strap on the inside of the knee preventing it from bending inward. needs a knee piece that pulls the knee outward, DVC Ch58 Page 548-9.png needs a knee piece that pulls the knee inward,
knee strap. knee strap.
and also one that pulls the knee back (as shown above). and also one that pulls the knee back.
When necessary you can use 3 knee pieces:
full leg brace with three knee pieces.
one in back
one in front
and one to the side


ANKLE STRAPS


bent out ankle
For an ankle that bends out, use a strap that pulls the ankle in. brace with strap going from outside of foot to inner metal rod.
shape of ankle strap
A sole raised on the outer side may also help.
strap extending from sole of shoe to top of shoe with straps that wrap around the ankle.
inward bent ankle.
For an ankle that bends in, use a strap that pulls the ankle out. brace with strap going from inside the foot to the outer metal rod.
A sole raised on the inner side may also help.

RAISED SOLES OR ‘LIFTS’ for one leg that is shorter

(See instructions for measuring leg length difference and for homemade measuring instruments.)


For a child who has one leg shorter than the other:
Measure the difference in leg length.
boy holding a yard stick to that it is parallel to the ground standing with his shorter leg on stacked cardboard.
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.

child with a lift tied on one of their shoes.
Tie on a temporary lift with string, tape, or a loop of inner tube.
IMPORTANT! Before putting a permanent lift on a shoe or sandal, test it by tying or taping on a temporary lift. Watch the child walk and ask how he likes it. You may want to try several heights before deciding on the one that works best.
foot shaped lift with holes in it and a rubber sole on the bottom.

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.

porous lift with slopped in bottoms attached to a below the knee plastic brace.
For a lift with a stiff-ankle brace, the child can often walk more smoothly with a ‘rocker‑bottom’ sole.
Back slopes in for a softer heel strike.
rounded in front for easy ‘roll over’ at the end of a step
flat middle section for firm standing


child with slight backward bending knee.
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.
plastic below the knee brace attached to a foot lift with a sole that extends backwards.


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".)

A high lift, when needed, can be built into a bar brace.
a bar brace made of metal bars and a sheet of thinner metal for the foot rest.
Design from Simple Prosthesis Manufacure, by Dartnell.
front view of the brace showing the different components.
washer
bolt
nut
side view of the brace showing the different components.
bolt
height of lift


Ask a local shoe or sandal maker to teach you how to fasten on the soles and lifts.



This page was updated:19 Jan 2018