The Markell brace

Symmetrical leather shoes made to work with a Denis Browne bar. In the one study that compared them directly, the Markell had about half the pressure sores of the Mitchell, and that is the only head-to-head figure that exists.

Written by Heath, who has lived it: casts from birth, a fusion at sixteen, the US Army, and distance running.

What it is

The older design, and still the reference one

Markell shoes are symmetrical in shape and designed to work with a Denis Browne bar 1. They are supplied in the UK through C-Pro Direct, and the related Horton Click system comes from the MJ Markell Shoe Company in New York, using a shoe that clicks into the bar and permits internal and external rotation of the foot1.

Every foot abduction brace in use today descends from the orthosis Denis Browne described in 19311. The Markell sits close to that original: a straightforward leather shoe on a fixed bar, without the molded lining or quick-release of the Mitchell.

One cohort, five numbers

What 247 children in braces actually went through

Every figure below comes from one review of 247 children and 374 feet at an Australian hospital, across all the brace types used there. Tap through them.

Sores that meant pausing the brace

43 children developed them. Pressure sores in the cohort first appeared at a median age of 4.8 months.

That is a figure for bracing in general, not for one shoe. The comparison between shoes is the last tab.

The heel lifting in the shoe

Recorded in roughly one child in four.

A heel that lifts is a foot no longer being held dorsiflexed.

Families not keeping to the protocol

About one family in three, in a cohort where somebody actually counted.

Children who needed recasting

Nearly a third of the cohort needed recasting at some point.

Markell against Mitchell, on sores

Pressure sores in 12.6 percent of children braced in a Markell and 22.9 percent in a Mitchell: a relative risk of 1.82, with a confidence interval from 1.03 to 3.20.

The lower end of that interval sits barely above 1.0, and the study counted sores. It did not measure how the feet ended up.

The evidence

Fewer pressure sores than the Mitchell

A review of 247 children and 374 feet at an Australian hospital found pressure sores in 12.6 percent of children braced in a Markell against 22.9 percent in a Mitchell. A relative risk of 1.82 favoring the Markell, with a confidence interval from 1.03 to 3.202.

What it means. On this one complication, the simpler shoe did better.

What it might mean. That interval nearly touches 1.0, the point where a difference stops being distinguishable from chance. It is retrospective and from a single center, and children are not assigned a brace at random. If a clinic reaches for one design for the harder feet, the harder feet carry their complications with them.

What nobody knows. Whether either shoe produces better-corrected feet. Nothing in that study measured correction.

For scale, across the whole cohort 43 children, 17.4 percent, developed sores that meant pausing the brace, and sores first appeared at a median age of 4.8 months. Non-compliance ran at 33.2 percent, heel lifting at 25.1 percent and recasting at 31.2 percent2.

Context

Where it sits among the alternatives

The trade across the designs is roughly comfort against simplicity. The Mitchell was built to be more wearable and reports more skin trouble. The Dobbs bar lets the legs move independently and reports better compliance, but costs more and can make dorsiflexion harder to hold1. The Steenbeek is cheaper by an order of magnitude and is what most of the world actually uses1.

Markell brace

What is the Markell brace?

Symmetrical leather shoes designed to work with a Denis Browne bar, supplied in the UK through C-Pro Direct. The related Horton Click system, from the MJ Markell Shoe Company in New York, uses a shoe that clicks into the bar and allows the foot to rotate.

Is the Markell better than the Mitchell?

On pressure sores, in the only direct comparison, yes: 12.6 percent against 22.9 percent, a relative risk of 1.82. But the confidence interval runs from 1.03 to 3.20, it is one retrospective study at one hospital, and it measured sores rather than how the feet turned out.

How common are pressure sores in bracing generally?

Across 247 children in that review, 43 of them, 17.4 percent, developed sores that meant pausing the brace. Sores first appeared at a median age of 4.8 months.

Is the Markell an old design?

It is closer to the original Denis Browne orthosis from 1931 than the newer shoes are. Older is not the same as worse, and on the one complication anybody has measured, it performed better.

Can Markell shoes be used with a Dobbs bar?

Yes. The Dobbs bar is compatible with Mitchell Ponseti or Markell shoes, or with a custom molded solid AFO.

Sources

Where this comes from

1 Current concepts on bracing in the Ponseti methodMasquijo JJ, Allende V. Revista de la Asociación Argentina de Ortopedia y Traumatología, 2023;88(2):218 to 223 2 Pressure sores and bracing complications in idiopathic clubfootKollias CM et al. Prosthetics and Orthotics International, 2026. PMID 42149778 3 Foot abduction braceIgnacio Ponseti Foundation

Figures on this page are quoted from the studies cited above and are not this site’s own measurements. Series are small and mostly retrospective, so treat them as a starting point for a conversation with your clinic rather than a verdict on any brace.

If you are working out the schedule rather than the hardware, the bracing guide covers the hours. Most rubbing is solved by what goes under the boot, and the full comparison puts every design side by side.