The Denis Browne bar

Every foot abduction brace currently marketed is an evolution and adaptation of the orthosis Denis Browne described in 19311. The original is a dorsiflexed foot brace attached to leather boots, with openings at the toe and heel so the foot can be checked for being plantigrade1.

The bar is still the reference point. Markell shoes are designed specifically to work with a Denis Browne bar1, and when studies compare a new brace against “traditional” bracing, the Denis Browne is usually what they mean.

The basic arrangement, two shoes held on one bar, is simple enough to spot in an old family photo. The ones below are mine, from before the Ponseti method was standard, so the shoes and the schedule are not what a clinic hands out today.

Most brace comparisons are retrospective. One is not. A randomized controlled trial allocated 60 feet in 38 patients to either a foot external rotation above-knee brace or a Denis Browne, and followed them for 24 months2.

Final Pirani scores were comparable: 0.42 against 0.57, a difference that did not reach significance (p = 0.411). Parental compliance was better with the newer brace — 86.7 percent rated good or intermediate against 66.7 percent — but that difference also did not reach statistical significance (p = 0.118)2.

What it means. The authors concluded both braces achieved good comparable outcomes. On the thing that matters most, how the feet ended up, the ninety-year-old design held its own.

What it might mean. Thirty-eight patients is small, and a small trial can miss a real difference as easily as it can invent one. Neither result being significant means neither brace was shown to be better, which is not the same as showing they are the same.

Set against that, a separate series reported non-compliance of 41 percent with a traditional Denis Browne against 7.1 percent with a dynamic brace, and skin lesions of 23.5 percent against 7 percent1. That is a much larger gap than the trial found, from a weaker study design. Both things are in the literature and they do not agree.

The honest summary is that the case against the Denis Browne rests on comfort and compliance in retrospective series, and the one randomized comparison found the feet came out the same2.

Some authors have concluded that newer and more expensive designs did not deliver better compliance than the Denis Browne at all1. If you have been handed one, you have not been handed an inferior brace.