Functionality and Outcomes Following Utilization of an Arizona Brace for Non-Operative Foot and Ankle Care

CATEGORY: Ankle Arthritis; Hindfoot INTRODUCTION/PURPOSE: The Arizona ankle foot orthotic (AFO) is a popular custom-molded orthotic stabilizer often used to treat posterior tibial tendon dysfunction, chronic Achilles tendonitis, ankle trauma and other pathologies. In the case of ankle injury or deformity, a resulting proprioceptive deficit may result in functional instability. There exists little evidence demonstrating the effectiveness of an Arizona brace in the course of non-operative treatment with regard to alleviation of pain and a return to standard daily activity. Previous analysis has shown Arizona bracing to be a viable treatment for posterior tibial tendon dysfunction, but is yet to incorporate a larger spectrum of pathologies. Furthermore, patient satisfaction with the brace, and continued use of the brace to aid in function in the longer-term has yet to be assessed. METHODS: Patients who were prescribed an Arizona ankle brace as a means of non-operative treatment at our institution from 2017-2018 were eligible for retrospective study for follow up of 2-4 years. Pre-bracing diagnosis was noted. Eligible patients were contacted via email to complete survey assessments. Patients were asked to use a 5-point Likert scale (0-4) to rate their overall satisfaction with the brace as a treatment device. Patients were also asked to report if they eventually proceeded to surgical intervention, how often they still wear the brace throughout the day, how long they wore the brace if they'd discontinued use, whether the brace was easy to wear, and - if no - what made the brace difficult to wear. Patients also completed two VAS pain rating scales - one when walking with the brace, one when walking without - and the FAAM-ADL subscale to evaluate their level of function. RESULTS: Surveys were completed by 118 patients with average age 63.2 years and average BMI 31.9 kg/m(2). Patients reported an average satisfaction of 2.1/4, with 61 (51.7%) stating they were 'satisfied' or 'very satisfied' with the brace. At the time of survey, 74 patients (62.7%) reported that they no longer use the brace at all. Sixty responded that the brace was easy to wear, while 58 (49.5%) stated that the brace was difficult to wear, with the most common reason being that the brace was too bulky and difficult to wear with shoes on. Pain rating was significantly lower when walking with the brace versus without (44.6 vs. 63.6, p=0.003). Patients braced for valgus ankle deformity (n=11) had higher FAAM-ADL scores at follow-up than those with ankle arthritis (n=45) or tendonitis (n=36). CONCLUSION: The Arizona ankle brace is a worthy first-line nonoperative treatment for a number of ankle pathologies, as it may help to avoid the need for surgical intervention. The brace may be more adept in correcting broad foot/ankle deformities as opposed to bony or tendinous irregularities, and patients should be counseled with regards to the varying patient satisfaction and comfort while wearing the brace. Larger cohort studies are indicated to further investigate diagnostic significance and bracing efficacy.