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 ...
Luca was diagnosed with moderate to severe brachycephaly, a condition where the head is unusually wide and flat. Here, Mum Lauren tells us his story.
From debilitating challenges with foot drop to conquering mountains... New carbon-fibre Ankle Foot Orthoses (AFOs) help this Charcot-Marie-Tooth patient climb Mount Kilimanjaro.
Vacuum bell therapy and custom rib bracing helped to improve Charlie's pectus excavatum chest shape, reducing his sternum indentation from 40mm to 10mm.
Among 14 to 17-year-old cricket players, there is an increased risk of pars stress fracture, or spondylolysis, which can cause lower back pain and reduced mobility. These athletes are at high risk due to their still-developing bones, which struggle to cope with the repetitive stress of fast bowling.
Apprentice orthotist Catherine Hendy’s journey into the world of prosthetics and orthotics began in an unconventional way. After completing a degree in art, she then trained as an orthotics technician, before taking up an apprenticeship to become a clinician. Now, she’s been nominated for the British Association of Prosthetists and Orthotists (BAPO) Student of the Year 2024.
Amelia was diagnosed with tightness in her neck by her GP before her plagiocephaly diagnosis. Clinician Jo Drake treated her with a LOCband Lite cranial remoulding helmet, which improved her overall head shape and asymmetry.
What are lower limb orthotics, and how can they improve mobility and reduce pain? We've put together this summary of the different kinds of lower limb orthotics, from AFOs and KAFOs to more complex orthotics like RGOs, and how they can help patients with their mobility goals.
Barney's very severe flat head syndrome (plagiocephaly) and diagnosis of torticollis led to successful helmet therapy with the LOCband, significantly improving his head shape, going from 27mm asymmetry to 12mm.
