Metal Braces

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

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In this chapter:

 

In this chapter:

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) *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.

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. BELOW KNEE

ABOVE KNEE

TOP RING COVER soft leather thick strap	ABOVE-KNEE BRACE Rivet and glue the leather. These flat-bottomed soles make walking more difficult
BACK KNEE STRAP		KNEE PIECE soft leather inner pad thick, strong leather

ABOVE-KNEE BRACES 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. wood strong rubber sole (car tire) soft sponge rubber (or nothing) or wood car tire

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.

rivet leather top rubber sole (can be made of old car tire) buckle eyelets wood base
	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.	3. Carefully draw this shape on a piece of paper, using the length of the clog as a guide. Then cut it out.
4. Trace the shape onto both sides of the leather top, adding the width of the clog between the 2 sides.
5. Cut the leather and nail it onto 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.

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,

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. Bend it. Screw it to the heel piece. Assemble clog. 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 spring Another way to help prevent footdrop is with a toe-raising spring.

wire 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.

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.

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.

HINGED BRACE 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 pin	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 OPEN 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. LOCKED

BRACES THAT FOLLOW 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.

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.		or whose legs tend to twist too much inward (or outward).			Put hinges at height of hip bone.
WITHOUT HIP BAND		WITHOUT HIP BAND			WITH HIP BAND

A common challenge 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. 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 weld	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.

KNEE PIECES (Use this design.)

A child with a weak leg that straightens fully,		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 severe back-knee, 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.

When necessary you can use 3 knee pieces:

one in back one in front and one to the side

ANKLE STRAPS

	For an ankle that bends out, use a strap that pulls the ankle in.		shape of ankle strap
	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

(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.	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.

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.

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.

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

A child with a mild to moderate “back-knee”, 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".)

A high lift, when needed, can be built into a bar brace.
Design from Simple Prosthesis Manufacure, by Dartnell.		washer bolt nut
		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:04 Apr 2024