The Markell brace

Markell shoes are symmetrical in shape and designed to work with a Denis Browne bar1. 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.

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 serious enough to stop bracing, 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.

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.