What Are Braces and Orthotics?
Braces and orthotics are external support devices that protect, stabilize, and reduce stress on joints affected by arthritis or injury. When properly fitted, they can reduce pain, improve function, and potentially slow joint deterioration.
Braces typically refer to devices for knees, wrists, and ankles. Orthotics usually refer to shoe inserts and footwear modifications.
Knee Braces for Arthritis
Types of Knee Braces
Compression/Sleeve Braces
- Provide warmth and mild compression
- Improve proprioception (joint position sense)
- Best for mild pain and swelling
- OTC availability, $20-$60
- Examples: Bauerfeind GenuTrain, Copper Fit
Hinged Braces
- Add lateral stability
- Protect against giving way
- Good for moderate arthritis with instability
- OTC or prescribed, $50-$200
- Examples: DonJoy Playmaker, Breg Freestyle
Unloader/Offloader Braces
- Specifically designed for knee OA
- Shift weight away from damaged compartment
- Most effective for unicompartmental arthritis
- Prescription required, $400-$1,500
- Examples: Össur Unloader One, DonJoy OA Adjuster
Patellar Stabilizing Braces
- Focus on kneecap tracking
- Help with patellofemoral arthritis
- Reduce kneecap pain during movement
- OTC or prescribed, $30-$150
Evidence for Knee Braces
Unloader Braces:
- Multiple studies show pain reduction (20-50%)
- Most effective for medial (inner) knee OA
- Work best in conjunction with other treatments
- Compliance is challenging (bulky, uncomfortable)
Compression Sleeves:
- Modest evidence for mild symptom relief
- May improve proprioception and stability
- Placebo effect possible
- Low risk, low cost option
Choosing a Knee Brace
Consider:
- Location of arthritis (medial, lateral, patellofemoral)
- Severity of symptoms
- Activity level and needs
- Ability to put on/remove independently
- Insurance coverage
- Comfort and fit
Hand and Wrist Braces
Types of Hand Braces
Thumb Spica Splints
- Stabilize thumb base (CMC) joint
- Most common location for hand OA
- Worn during activities or at night
- $15-$50 OTC; $50-$200 custom
Wrist Splints
- Limit wrist movement
- Reduce stress on hand joints
- Often used for carpal tunnel and arthritis
- $15-$40 OTC
Finger Splints
- Support individual finger joints
- Oval-8 splints popular for DIP/PIP arthritis
- Silver ring splints combine function with aesthetics
- $5-$30 OTC; $100-$300 silver
Evidence for Hand Braces
- Thumb splints show consistent benefit for CMC arthritis
- Best worn during aggravating activities
- Night splinting may reduce morning stiffness
- Custom splints offer better fit but higher cost
Foot Orthotics
Types of Orthotics
Over-the-Counter Insoles
- Mass-produced arch supports
- Cushioning and mild support
- Good starting point
- $15-$50
- Examples: Superfeet, Powerstep, Dr. Scholl’s
Semi-Custom Orthotics
- Heat-moldable or kiosk-fitted
- Better fit than pure OTC
- $50-$150
- Often available at specialty running stores
Custom Orthotics
- Made from mold of your feet
- Prescribed by podiatrist or orthopedist
- Address specific biomechanical issues
- $300-$800
- Insurance may cover with medical necessity
Lateral Wedge Insoles
Specifically for knee osteoarthritis:
- Wedge under outer heel
- Theoretically shifts knee loading
- Mixed research results
- OARSI guidelines recommend against routine use
- Some individuals may benefit
Evidence for Orthotics
For Foot/Ankle Arthritis:
- Custom orthotics help redistribute pressure
- Can reduce pain from ankle and foot OA
- Rocker-bottom shoes reduce ankle motion
For Knee Arthritis:
- Lateral wedge insoles: uncertain benefit
- Shock-absorbing insoles may help some patients
- Proper footwear as important as insoles
Proper Fitting
Why Fit Matters
- Poorly fitted braces can worsen symptoms
- Wrong size may not provide support
- Improper alignment can cause skin problems
- Incorrect use negates potential benefits
Getting Properly Fitted
For OTC Braces:
- Measure according to package instructions
- Try multiple sizes if between sizes
- Test during intended activities
- Return if uncomfortable after break-in period
For Prescription Braces:
- Fitted by certified orthotist
- Adjustments made for optimal function
- Follow-up to ensure proper fit
- Training on proper application
Insurance Coverage
Medicare Coverage
Medicare Part B covers braces when:
- Medically necessary for your condition
- Prescribed by a physician
- Provided by a Medicare-approved supplier
- Meets specific coverage criteria
Coverage Details:
- 80% of approved amount after deductible
- Prior authorization may be required for expensive braces
- DME (Durable Medical Equipment) rules apply
Private Insurance
- Coverage varies by plan
- Often requires prescription
- Prior authorization common for custom/unloader braces
- Check in-network suppliers
- May have annual DME benefit limits
Tips for Coverage
- Get a prescription from your doctor
- Verify coverage before ordering
- Use in-network suppliers when possible
- Appeal denials with medical documentation
- Keep receipts for HSA/FSA reimbursement
Limitations of Bracing
Braces Won’t:
- Cure arthritis
- Regrow cartilage
- Replace need for other treatments
- Work for everyone
Common Challenges:
- Discomfort, especially in heat
- Difficulty with clothing
- Compliance (many stop wearing)
- Skin irritation
- Muscle weakness if overused
Combining Braces with Other Treatments
Bracing works best as part of a comprehensive approach:
- Physical therapy: Strengthen muscles for long-term stability
- Weight loss: Reduces joint stress regardless of bracing
- Injections: May reduce inflammation that bracing can’t address
- Activity modification: Bracing supports but doesn’t replace smart activity choices
Questions to Ask Your Healthcare Provider
- Would bracing help my specific type of arthritis?
- Do you recommend an OTC brace or should I be fitted for a custom one?
- How many hours per day should I wear it?
- Will wearing a brace weaken my muscles?
- What activities should I wear it for?
- Is this brace covered by my insurance?
- Should I see an orthotist for proper fitting?