The Cunningham Brace is the brainchild of Jerald Cunningham who runs his own clinic in Maine, USA. Jerald graduated cum laude from Cornell University with a degree in Physics and Cognitive studies. He is a guest lecturer at the University of New England’s Ph.D. Physical Therapy programme.
Jerald started developing the brace at the request of the orthopaedic surgeon he worked with. The consultant felt that whilst the Boots and Bar offered a successful treatment, they often caused a lot of distress to the child and parents. They can be difficult to put on, keep in place and children can find it difficult to sleep.
Jerald has worked on it for over a decade, continuously making development changes based upon the evidence provided by the in-brace x-rays taken after every patient fitting.
The Cunningham Brace (also known as the Dynamic Torsional KAFO or DTKAFO) is a flexible brace that is only fitted to the affected leg and allows movement for all of the normal activities such as crawling, rolling, standing and even walking.
The brace is always gently stretching the baby into the correct position so it is acting as though the therapist is always there manipulating and correcting the foot. In the case of a unilateral (single) club foot, because each leg is treated separately only the affected foot is involved (with the boots and bar approach, both feet have to be attached to the bar regardless.)
The end result is a very effective treatment protocol that has reduced treatment times to about a third of other treatments, and which typically requires only two braces during the two years that it is worn.
After a brief period, the baby is not even aware of the presence of the brace. This really improves comfort and compliance (and decreases stress for parents).
The big difference is that the Cunningham Brace is flexible and only fitted to the affected leg. This allows for the sort of dynamic movement you’d expect in babies, such as crawling, rolling and standing. Greater activity helps build a more developed muscular system – particularly calf muscles. Anecdotally we’ve seen a lot more symmetry in calf muscles using the Cunningham Brace than boots and bar. And because it’s a different kind of mechanism we don’t have to strap the feet up so tightly, which reduces issues such as blistering on the legs.
The Cunningham Brace is made from a series of measurements that we can either take in the clinic or help you to take during a virtual appointment. We hold a range of Cunningham braces in stock that we can adapt to the correct size and foot type of your baby. This process normally takes a few hours unless your child has a size that is out of the normal range or we do not have it in stock.
It depends on your child and the complexity of their case. On average, though, we’ll be looking to review your baby’s progress once a month over the course of treatment.
Treatment lasts about two years – this is around one-third of the time other methods require. In the first year, your baby will wear the brace for 23 hours a day – compared with boots and bar which can only be done for three months. This means we can help correct your baby’s foot while their tissue and bones are at their softest and most compliant. Once your baby is standing, they will only wear the brace during nighttime and naps.
The exact number will depend on your child and their condition, but typically a child will only need to wear two to three braces over a two-year period. The first for about six months, then a year each for the second and third.
Very often parents contact us before their baby is even born, having discovered the club foot on a scan. However, they first need to go through the Ponseti method with their consultant and then be triaged by a specialist physiotherapist before we can start treatment.
For six-year-old Sophie, life has always carried unique challenges. LOC orthotist, Alan Hews, has been working with Sophie and her family since she received selective dorsal rhizotomy (SDR) surgery for cerebral palsy at the Portland Hospital aged three ... continue reading ...
LOC has been treating Lilac since 2018 following her SDR surgery for cerebral palsy. Her extraordinary progress has been possible thanks to her own courage, her family’s determination in fundraising through Just4Children and the targeted intervention of a number of professionals including our own team at LOC ... continue reading ...
For 10-year-old Aran, the ability to walk independently is becoming reality with the help of the Elaine Owen Clinic, which is run at our Gait Laboratory in Kingston upon Thames. Aran has diplegia cerebral palsy, which manifests itself in tense muscles and spasms ... continue reading ...
With a diagnosis of cerebral palsy, little Sofia has more to contend with than the average four-year-old! But her positive outlook, combined with her family’s support and determination plus orthotics and physiotherapy, is helping her on the way to a bright future ... continue reading ...
LOC has recently begun treating five-year-old Esme to help her regain strength and independence of movement following SDR surgery for cerebral palsy. Esme’s mum, Charlotte, is already seeing significant improvement in Esme’s mobility since her bespoke AFOs were fitted ... continue reading ...
Five-year-old Austin has a diagnosis of cerebral palsy and underwent SDR surgery in November 2018. In July 2020, Austin’s parents brought him to LOC’s OSKAR Clinic, hoping that we could help him to walk independently and with more confidence ... continue reading ...
Working with LOC and Elaine has been a great experience – they really take the time to look at your child and understand their individual challenges and needs. For parents who are in the same position that we were, I would say do your research – see what clinics are available near you and what the costs are, but my feeling is it’s worth every penny.
After 10 years of daily physiotherapy and swimming, not to mention SDR, hamstring and tendon lengthening, we have finally achieved independent walking – it was a mother’s day gift that would take some beating.
LOC’s video vector technology measures exactly where Austin’s weight is being distributed, how his hips are moving and how his legs are moving. It’s those insights that have made his new AFOs so effective. Even within a few days, LOC’s splints have had more impact on his independence of movement than anything else we have done.
Since his new orthoses, his change has been remarkable. He is more mobile and can walk independently. Jason is now walking indoors and outdoors and is unrestricted. He is now properly enjoying the summer sunshine for the first time in a few years with no complaints of pain.
It has been a breath of fresh air – LOC’s ability to accommodate Sophie’s circumstances and manufacture her orthotics so quickly has taken a huge amount of potential stress away. Alan talks to Sophie as well - she looks forward to seeing him. He has even been able to fulfil her request to have her SMOs decorated with unicorns! It makes her feel special and much happier about wearing them.
Amelia was always looking for something to hold on to, now she runs around. Sam really puts in that extra effort to make the clients happy. I’d recommend LOC because they have all the equipment and extremely professional staff who have been trained by world-renowned physiotherapist Elaine Owen.
Lilac just flits about now. Every day she's getting stronger and our expectation now. We are absolutely with The London Orthotics Consultancy for the long haul now. We’ve found a business that can provide what we need and who we trust, and it’s the trust that's the most important thing to us.
Multidisciplinary teams in business will sit down together and discuss a project with all parties concerned, each adding their particular expertise and insight. This is what it is like at London Orthotic Consultancy (LOC) but on a more personal level: Teamwork is evident. The camaraderie and mutual respect are undeniable. The attention to the smallest achievement is uplifting.
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