Ankle Braces, Ankle Splints, Ankle Sprain, Foot Splints,Hip Splints,Sports Ankle

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Splints

Braces and splints

Braces and splints for musculoskeletal conditions

Braces and splints can be useful for acute injuries, chronic conditions, and the prevention of injury. There is good evidence to support the use of some braces and splints; others are used because of subjective reports from patients, relatively low cost, and few adverse effects, despite limited data on their effectiveness. The unloader (valgus) knee brace is recommended for pain reduction in patients with osteoarthritis of the medial compartment of the knee. Use of the patellar brace for patellofemoral pain syndrome is neither recommended nor discouraged because good evidence for its effectiveness is lacking. A knee immobilizer may be used for a limited number of acute traumatic knee injuries. Functional ankle braces are recommended rather than immobilization for the treatment of acute ankle sprains, and semirigid ankle braces decrease the risk of future ankle sprains in patients with a history of ankle sprain. A neutral wrist splint worn full-time improves symptoms of carpal tunnel syndrome. Close follow-up after bracing or splinting is essential to ensure proper fit and use.

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Family physicians often must make decisions regarding the use of braces or splints in the management of musculoskeletal disorders. Bracing can be useful for acute injuries, and also for chronic conditions and in the prevention of injury. The purpose of braces and splints is to improve physical function, slow disease progression, and diminish pain. They can be used to immobilize an unstable joint or fracture, to unload a portion of a joint and improve pain and function, to eliminate range of motion in one direction, or to modify range of motion in one or more directions. They do not replace a good rehabilitative program, and the entire spectrum of treatment options should be explored and used as needed.

Accurate diagnosis of the injury is important in determining whether a brace or splint is indicated. Generally, splints are for short-term use. Excessive, continuous use of a brace or splint can lead to chronic pain and stiffness of a joint or to muscle weakness. However, long-term use of some braces, such as a knee unloader brace, can help prevent progression of pain attributable to osteoarthritis of the knee.

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Given the limited evidence on the use of braces and splints, it is particularly important to use a patient-centered approach, with consideration for individual patient's expectations and concerns and an understanding of the nature of their activity. For example, for high school and collegiate athletes, there are specific rules on the types of protective equipment, splints, and braces that may be worn during competition. (1) Close follow-up after bracing or splinting is essential to ensure proper fit and use.

The most common types of braces and splints used in primary care and the quality of evidence to support current recommendations are discussed in the following. Braces and splints recommended for common musculoskeletal conditions are listed in Table 1.

Knee Braces

Knee braces have been developed to unload the medial compartment for patients with varus osteoarthritis, to treat anterior knee pain, and to immobilize the knee.

UNLOADER (VALGUS) KNEE BRACE

Unloader, or valgus, knee braces have been proposed as one treatment option for patients with medial compartment osteoarthritis of the knee. These braces are designed to apply an external valgus force, thereby reducing the load on the medial compartment and decreasing related pain (Figure 1). Improved joint proprioception also may play a role in reducing pain. (2,3) Indications for this type of brace include radiographic evidence of unicompartmental osteoarthritis (medial compartment) and varus malalignment.

[FIGURE 1 OMITTED]

Relatively few studies on bracing have been published, and most are not randomized controlled trials. A Cochrane systematic review (4) identified only one randomized controlled trial. (2) In this study, 119 patients who had osteoarthritis associated with varus deformity of the knee were randomized to receive usual treatment, unloader knee brace, or neoprene sleeve to evaluate the effect of these therapies on functional status and quality of life. (2) Although both the sleeve and the brace reduced pain and improved function, greater benefit was found with the unloader brace. In a randomized crossover trial, 12 patients with varus osteoarthritis were given a simple hinged brace or an unloader brace during two six-month periods. Because patients acted as their own controls, it was possible to identify statistically and clinically significant benefits for the unloader brace that were greater than those of the hinged brace despite the small number of patients involved in the study. (5) The American Academy of Orthopaedic Surgeons recommends unloader braces for the reduction of pain in patients with osteoarthritis of the knee. (6) This conservative option is thought to extend the time before patients need to undergo knee arthroplasty; it also can be considered for those who are not candidates for surgery.

ANTERIOR KNEE PAIN BRACE

Anterior knee pain, also called patellofemoral pain syndrome (PFPS), is a common complaint among young, active patients. Its etiology is multifactorial and controversial, and the treatment can be frustrating for the physician and the patient. Braces have been developed to address the most commonly accepted etiology: malalignment of the patellofemoral joint. Typically, these braces are made of neoprene or a similar elastic material, with additional straps or a buttress for patellar support. The buttress can be circular, C-shaped, J-shaped, or H-shaped to help maintain tracking of the patella in the femoral groove. These braces are reasonably priced, and off-the-shelf models are adequate (Figure 2).

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