'The Orthopaedic Sleeve', developed by The Orthopaedic Sleeve Society (TOSS), is a biomechanically advanced, adjustable brace designed to optimise recovery for heel-related and ankle pathologies, including calf tears, Achilles tendinopathy/enthesopathy, Sever’s disease, plantar fasciitis, and anterior ankle impingement. By modulating electromyographic (EMG) signals, reducing tendon and fascial tension, redistributing workload, and limiting ankle dorsiflexion, it aligns with pathophysiological healing stages to accelerate recovery, normalise gait, and minimise complications such as retrocalcaneal bursitis, Kager’s fat pad irritation, or fibrosis. Below is a concise guide for healthcare practitioners to effectively integrate 'The Severs Sleeve' into evidence-based rehabilitation protocols.

Key Benefits and Mechanisms

1. Pathology-Specific Support

- 'The Orthopaedic Sleeve' targets specific structures (plantar fascia, Achilles tendon, calcaneal apophysis, anterior tibiotalar joint) to reduce tensile and compressive stress, protecting injured tissues and promoting healing without restricting uninjured areas.

- Clinical application: In plantar fasciitis or Sever's disease, 'The Orthopaedic Sleeve' offloads the enthesis of the Achilles and plantar fascia on the calcaneus; in anterior ankle impingement, 'The Severs Sleeve' minimises synovium/capsule compression.

2. Biomimetic Design:

- 'The Orthopaedic Sleeve' mimics natural heel and ankle biomechanics, reducing compensatory pain patterns (e.g., limping, forefoot striking) that strain secondary joints (e.g., metatarsophalangeal, knee, hip joints).

- Supports symmetrical gait, enhancing functional recovery across conditions like Sever’s disease or Achilles tendinopathy.

3. Adjustable Tension for Healing Phases:

- 'The Severs Sleeve' features a patented tension system with high (maximum offloading), moderate, and low (progressive loading) settings to align with inflammatory, proliferative/dysrepair, and remodelling/chronic phases.

- Acute Injury Phase: High dial tension minimises the EMG activity and muscle stress, reducing edema and inflammation. Such as during the first four weeks of plantar fasciitis and the first six weeks for Sever’s disease.

- Semi-Acute Phase: Moderate tension introduces controlled loading to stimulate collagen alignment and tissue repair. Such as weeks four to twelve of Achilles dysrepair.

- Return-to-Activity Phase: Low tension encourages functional adaptation and strength. Such as weeks 12–24+ for degenerative tendinopathy.

4. Stress Shielding for Tissue Protection:

- 'The Severs Sleeve' redistributes workload to the brace as a synergistic muscle and connective tissue, supporting secondary injury prevention and early ambulation without overloading damaged structures.

- The brace reduces: Achilles tendon tension, muscle stretch during activation with tears, plantar fascia eccentric straining in fasciitis, anterior joint compression in impingement, neovascularisation, fibrosis and microtears.

5. Reduction of Kinesiophobia:

- 'The Severs Sleeve' provides stable, pain-reducing support through lightweight, breathable materials and an ergonomic, adjustable fit, boosting patient confidence in weight-bearing and movement.

- The brace encourages adherence to rehabilitation by alleviating fear of reinjury, critical for athletes or active children with Sever’s disease.

6. Restoration of Normal Movement:

- 'The Severs Sleeve' limits dorsiflexion to reduce retrocalcaneal compression (e.g., bursitis, Kager’s fat pad irritation) and anterior joint stress, restoring stride length and cadence.

- Clinical example: In Achilles enthesopathy, dorsiflexion control minimises retrocalcaneal bursal inflammation, enabling influence on retrocalcaneal structures.

7. Patient Autonomy and Long-Term Outcomes:

- Easy-to-adjust tension settings empower patients to tailor support to their recovery stage, fostering independence and compliance.

- Supports long-term function by preventing recurrence through education on load management, footwear, and maintenance exercises.

Practical Implementation

- Initial Use: Start with 1–2 hours daily, increasing by 1 hour/day until fully tolerated, ensuring comfort and skin integrity.

- Complementary Interventions: Pair with heel lifts (5–10 mm) for enthesopathy or Sever’s disease, custom orthotics for plantar fasciitis, or footwear adjustments for anterior impingement to enhance biomechanical support.

- Exercise Integration: Combine with condition-specific exercises (e.g., isometric heel raises for Achilles tendinopathy, intrinsic foot strengthening for plantar fasciitis, eccentric loading for calf tears) to align with brace tension settings.

- Monitoring: Use validated outcome measures (e.g., VISA-A for Achilles, Foot Function Index for plantar fasciitis, FAOS for ankle impingement) and imaging (ultrasound, MRI) to assess healing and adjust brace settings.

- Contraindications: Avoid low-tension settings or excessive dorsiflexion in early phases to prevent tissue irritation. Monitor for complications (e.g., compartment syndrome in calf tears, microfractures in Sever’s disease).

Clinical Considerations

- Individualisation: Tailor tension and dorsiflexion limits based on pathology stage, patient factors (e.g., age, activity level, comorbidities), and biomechanics (e.g., overpronation, tight calf muscles).

- Interdisciplinary Collaboration: Coordinate with physical therapists, podiatrists, and orthopedists for complex cases, such as degenerative tendinopathy or chronic impingement with osteophytes.

- Patient Education: Instruct on brace use, load management (<10% weekly activity increase), and maintenance exercises to sustain recovery and prevent recurrence.

Conclusion

'The Severs Sleeve' is a versatile, patient-centred tool that bridges pathophysiology and biomechanics to optimise recovery across heel and ankle pathologies. By providing adjustable, pathology-specific support, the brace supports a healing environment, normalises gait mechanics, and empowers patients to transition from pain to performance. Healthcare practitioners can confidently integrate 'The Severs Sleeve' into rehabilitation protocols to achieve faster, more sustainable outcomes.

From Pain to Performance

The Orthopaedic Sleeve Society (TOSS)