Inappropriate Use of AFOs, Particularly the Richie Brace, for Flat Feet in Children

The use of the Richie Brace, a type of Ankle-Foot Orthosis (AFO), has become increasingly common among podiatrists treating pediatric flat feet. While AFOs are highly effective for conditions like posterior tibial tendon dysfunction and severe ankle instability, their application for flat feet in children is often unwarranted. Custom-made orthotics are a more appropriate and less restrictive treatment, offering comparable benefits without the drawbacks of AFOs.

Flat feet in children, or “pes planus,” is a common condition where the arch of the foot is lower than normal. In most cases, flat feet do not cause significant problems and can be managed with simple, non-invasive treatments. When intervention is necessary, custom-made orthotics are generally sufficient to provide the support needed to correct foot posture and relieve symptoms .

The Richie Brace, while highly effective for conditions like posterior tibial tendon dysfunction and chronic ankle instability, is overkill for most cases of pediatric flat feet. The brace provides unnecessary levels of support and restricts movement in ways that are not needed for flat feet correction. Custom orthotics, which are designed to support the arch without restricting ankle movement, are just as effective and far less cumbersome for children .

AFOs like the Richie Brace are significantly more expensive than custom orthotics, which can place an undue financial burden on families. Additionally, wearing a visible, restrictive brace like the Richie Brace can cause psychological distress for children, who may feel self-conscious or embarrassed, particularly in social or school settings .

For most children with flat feet, custom-made orthotics are a sufficient and cost-effective treatment option. The use of AFOs like the Richie Brace should be reserved for more severe or complex cases involving significant instability or deformity. Parents should be aware that while the Richie Brace is marketed as a gold standard for certain conditions, it is not necessary for pediatric flat feet.

Bibliography:

 1. Jafarnezhadgero A, Madadi-Shad M, Alavi-Mehr SM, Granacher U (2018). The long-term use of foot orthoses affects walking kinematics and kinetics of children with flexible flat feet: A randomized controlled trial. PLoS ONE 13(10): e0205187. https://doi.org/10.1371/journal. pone.0205187

 2. Amir Ali Jafarnezhadgero, Morteza Madadi Shad, Mahdi Majlesi (2017). Effect of foot orthoses on the medial longitudinal arch in children with flexible flatfoot deformity: A three-dimensional moment analysis, Gait & Posture, Volume 55,2017, Pages 75-80, ISSN 0966-6362, https://doi.org/10.1016/j.gaitpost.2017.04.011.