Patent Publication Number: US-9414950-B1

Title: Rear entry ankle brace with medial and lateral access

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of co-pending application Ser. No. 13/908,959, filed Jun. 3, 2013, which is a Continuation-In-Part of application Ser. No. 13/413,098, filed Mar. 6, 2012, now U.S. Pat. No. 8,454,545, which is a continuation of application Ser. No. 13/364,236, filed Feb. 1, 2012, now abandoned, which claims priority from U.S. Provisional Patent Application No. 61/439,115, filed Feb. 3, 2011, all of which contents are hereby incorporated by reference in their entirety. 
    
    
     FIELD OF THE INVENTION 
     This invention relates generally to ankle braces, and more particularly to improvements in such braces enabling ease and rapidity of application to the wearer&#39;s ankle. 
     BACKGROUND 
     Ankle sprains in the general population typically occur as a result of either excessive inversion or excessive eversion. An inversion ankle sprain is the internal rotation of the ankle joint; i.e., rolling the foot inward or medially, and overstretching and usually injuring the outer ligaments in the ankle. This accounts for about 90 percent of all ankle sprains. An eversion ankle sprain is the external rotation of the ankle joint; i.e., rolling the foot outward or laterally. 
     The ankle is an assembly of bones held together by a number of soft tissues such as muscles, ligaments, tendons, and cartilage. In the typical ankle injury, a traumatic impact or force causes the foot to invert or evert relative to the lower leg. When the off-centered force induces inversion or eversion of the foot relative to the lower leg in excess of the natural limits of the soft tissue structures, that soft tissue is damaged. The injury may include stretching or tearing of the soft tissues and, if severe enough, damage or fracture to the bones in the ankle joint, lower leg, and foot. 
     Ankle braces and supports are prescribed as a treatment for an ankle sprain or fracture, or to prevent further injury to the weakened joint. It should support and stabilize the ankle and foot to limit inversion and eversion, but should not overly limit the flexion motions associated with the foot motions of the wearer walking, running, lunging, pivoting, etc. If the injured ankle is substantially immobilized by the ankle brace, rehabilitation is delayed and a stiff ankle may result, which opens the possibility for re-injury. 
     Injuries to ankles typically require the application of ankle braces, which must be repeatedly applied and removed at short intervals during the rehabilitation period. Thus, ease and rapidity of application and removal are important to the wearer. The ankle brace cannot be complicated so that it is easy for the wearer to physically put on and take off, and should also be comfortable to wear. 
     SUMMARY OF THE INVENTION 
     An ankle brace with medial-, lateral-, or rear-entry access by the wearer into and out of the brace, comprising a foot and ankle holder preferably made from a sheet of soft fabric without a rigid frame or skeleton, defined by a foot portion transitioning to an upper ankle portion with opposed first and second sides, wherein the upper ankle portion includes an open back and an open front. A rear portion or posterior panel discrete from the foot and ankle holder removably attaches to the upper ankle portion to at least partially enclose the open back. In the preferred embodiment, the rear portion or posterior panel includes opposed first and second panels that, independently, removably attach to the first and second sides, respectively, of the upper ankle portion. An optional padded tongue is located at the open front of the ankle holder. Means for binding is provided, overlying the tongue, to bind the first and second sides of the upper ankle portion together. At least one elongated support strap is connected to the ankle holder and extends under the foot portion and then extends generally upwardly and rearwardly for removable retention to at least one of the first and second sides. 
     At least one retention strap, preferably including an elastic material, is connected to the holder, and extends around the holder to at least partially overlie and to removably connect to the support strap. Accordingly, one of the first and second panels may be independently detached from the respective first and second sides of the upper ankle portion for lateral, medial, and rear access by the wearer into and out of the ankle brace, via the open back of the foot and ankle holder. As such, the means for binding, preferably a lacing system, does not need to be untied (after the initial adjustment) so that the wearer can conveniently and quickly withdraw his or her foot from ankle brace. The same for wearing the ankle brace—the tied lacing system does not need to be undone, adjusted, and tied again for the wearer to insert his or her foot back into the ankle brace and return to normal activity. The is highly attractive feature to athletes, the elderly, those with limited mobility or range of movement. 
     The means for binding the first and second sides of the upper ankle portion together may be a system of laces and eyelets or loops, straps, buttons, snaps, zippers, latches, hooks, hook-and-loop fasteners (Velcro), and the like, or any combination thereof. 
     The ankle brace optionally includes a rigid heel support disposed at the foot portion. In a preferred embodiment, the rigid heel support is a U-shaped strip that extends from the medial side, underneath the heel, to the lateral side. The rigid heel support strip is stitched, cemented, or sewn onto or into the foot portion and supports the wearer&#39;s heel in a stirrup fashion. In an alternative embodiment, the rigid heel support is made from multiple pieces joined by pivots to accommodate ankle movement. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a side elevational view of a preferred embodiment rear entry ankle brace with medial and lateral access. 
         FIG. 2  is a rear or posterior view of the ankle brace of  FIG. 1 . 
         FIG. 3  is a side elevational view of the foot and ankle holder of the ankle brace from  FIG. 1 . 
         FIG. 4  is a front or anterior elevational view of the foot and ankle holder of  FIG. 3 . 
         FIG. 5  is an internal view of the rear portion of the ankle brace from  FIG. 1 . 
         FIG. 6  is a back, exterior view of the rear portion of the ankle brace, showing the entire length of the elongated support straps. 
         FIG. 7  shows a first flap of the rear portion in an open position, with the ankle brace worn on the right foot, allowing entry into the ankle brace from the medial side of the right foot. 
         FIG. 8  shows a second flap of the rear portion in an open position, with the ankle brace worn on the right foot, allowing entry into the ankle brace from the lateral side of the right foot. 
         FIG. 9  is a perspective view showing the ankle brace of  FIG. 1  worn on the right foot, with the rear portion attached to the foot and ankle holder, and the straps just prior to applying them to the ankle brace. 
         FIG. 10  is a perspective view showing the ankle brace of  FIG. 9  worn on the right foot, with the rear portion attached to the foot and ankle holder, and the straps wrapped around the foot and ankle and attached to the brace. 
         FIG. 11  is a front view of an alternative embodiment foot and ankle holder with a tongue and a speed lace. 
         FIG. 12( a )  shows an alternative embodiment foot and ankle holder with a rigid heel support with pivots embedded in the foot portion of the foot and ankle holder;  FIG. 12( b )  shows an alternative embodiment rigid heel support without pivots; and  FIG. 12( c )  is an end view of the rigid heel support of  FIG. 12( b ) . 
         FIG. 13  is an alternative embodiment ankle brace with a secondary closure attached to the anterior of the ankle brace. 
         FIG. 14  shows an alternative embodiment ankle brace with the first and second complementary attachment means. 
         FIG. 15  shows an alternative embodiment ankle brace with eyelets to receive laces therethrough. 
         FIG. 16  shows an alternative embodiment ankle brace with lace loops for the secondary closure. 
         FIG. 17  shows an alternative embodiment ankle brace with eyelets to receive laces. 
         FIG. 18  shows an alternative embodiment ankle brace in a cross-sectional view taken across the sagittal plane with a foot plate. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       FIG. 1  is a side elevational view of a preferred embodiment stabilizing ankle orthosis, support, or brace  10  for prophylactic and chronic sprains. The exemplary ankle brace  10  limits inversion/eversion while not restricting plantar and dorsiflexion. The ankle brace  10  is a rear-, medial-, or lateral-entry design, and in the preferred embodiment, is constructed preferably from a foot and ankle holder  12  and a separate, detachable rear portion or posterior panel  14 . 
     The foot and ankle holder  12  and the rear portion  14  are preferably made from one or more thin layers or sheets of a soft and flexible fabric. The fabric may be ballistic nylon, spacer fabric, durable mesh knit nylon, suede, leather, denim, or vinyl, or any combination thereof or like materials. In the preferred embodiment, the fabric of the foot and ankle holder  12  and rear portion  14  do not have any internal or external rigid supports or skeleton. Accordingly, the foot and ankle holder  12  with the attached rear portion  14  is highly flexible and is generally shapeless when not being worn, similar to a crumpled bath towel. This flexibility gives the wearer tremendous comfort and joint mobility, especially prized by an athlete. The lack of rigid internal or external supports also reduces the overall weight of the ankle brace  10 , another important consideration for the athlete. 
       FIG. 2  is a rear elevational view of the ankle brace  10  showing the foot and ankle holder  12  attached to the rear portion  14 . In the preferred embodiment, the side panels/sides  28 ,  30  of the rear portion  14  at least partially overlap, and independently attach to and detach from the respective side panels  22 ,  24  of the foot and ankle holder  12  via, preferably, hook and loop fastener patches. This feature is indicated by the arrows in  FIG. 2 . 
       FIG. 3  is a side elevational view of the preferred embodiment foot and ankle holder  12  only, and  FIG. 4  is a front elevational view of the foot and ankle holder  12  only. The foot and ankle holder  12  has a foot portion  16  that transitions into an upper ankle portion  18 . As seen in  FIG. 2 , the sole area of the foot portion  16  is preferably seamless to reduce irritation under the wearer&#39;s foot. Also in  FIG. 2 , the rear portion  14  optionally includes a soft patch  50  to gently engage the Achilles tendon of the wearer. 
     As best seen in  FIG. 3 , the foot and ankle holder  12  has an open posterior area or open back  20  that enables the wearer to insert his or her foot into the brace  10 . The open back  20  further provides a large heel opening for the wearer&#39;s comfort. 
     The foot and ankle holder  12  has opposed first and second side panels or sides  22 ,  24 . As seen in the front view of  FIG. 4 , the foot and ankle holder  12  also has an open anterior or front  66  where the wearer&#39;s forefoot and toes protrude from the foot portion  16 . The upper areas of the open front  66  as seen in  FIG. 4  can be pulled together by the wearer tightening the means for binding  26 , here cinching the laces and tying a knot as shown. Thus, the anterior or front edge of the sides  22 ,  24  are bound and held together by the means for binding  26 . In various alternative embodiments, the means for binding  26  may be laces as shown, or may be a wire strand, straps, buttons, snaps, zippers, hooks, claws, hook-and-loop (Velcro) fasteners or patches, and the like, or any combination thereof. As shown in  FIGS. 3 and 4 , the laces  26  pass through speed loops or optional eyelets at the front of the foot and ankle holder  12  that can be easily cinched and then tied at the top as shown. 
     In the preferred embodiment, the foot and ankle holder  12  does not require a tongue residing underneath the laces  26  where the front leading edges of the first and second sides  22 ,  24  meet, as in  FIG. 4 . The underside interior of the front portion of the foot and ankle holder  12  beneath the laces may be padded. The front leading edges of the foot and ankle holder  12  are pulled together and closed by the tightened laces  26 . The laces  26  do not directly press against the wearer&#39;s foot so the tongue is unnecessary. The present invention design thus proceeds against conventional wisdom of having a tongue in an ankle brace. 
     Omitting a tongue simplifies construction and simplifies the procedure for the wearer when putting on or taking off the ankle brace  10 ; attaching the brace and removing the brace are accomplished quickly. This is advantageous to athletes and those who have daily exercise-related routines requiring that the ankle brace be worn and removed frequently. No tongue also means no shifting of internal parts that touch the wearer&#39;s foot during use, which may be uncomfortable or a nuisance to adjust. 
       FIGS. 5 and 6  are various isolated views of the detachable rear portion or posterior panel  14 , shown attached to the foot and ankle holder  12  in  FIGS. 1 and 2 . Rear portion  14  has opposite first and second panels  28 ,  30  extending from a middle portion  56 .  FIG. 5  is an interior view of the detached rear portion  14  showing the surface that engages the wearer&#39;s lower calf and Achilles area. Complementary portions of hook-and-loop fasteners  58  may be applied to the interior of the first and second panels  28 ,  30  for attachment to the exterior sides  22 ,  24  of the foot and ankle holder  12  as illustrated in  FIG. 1 . Overall, the rear portion  14  is preferably made from one or more thin layers or sheets of flexible fabric.  FIG. 6  is an exterior view of the rear portion  14 . As best seen in  FIG. 6 , there are preferably two elongated support straps  32 ,  34  attached to the exterior surface of the rear portion  14 . There may be fewer or more support straps. 
     The elongated support straps  32 ,  34 , preferably two of them, made from inelastic nylon or high strength webbing, are used to wrap and compress the wearer&#39;s foot and ankle area. Each strap  32 ,  34  circumscribes the ankle and the midfoot area in opposite directions. The long support straps  32 ,  34  give the wearer the option to wrap with multiple turns the specific area of the ankle that requires the greatest amount of support. 
     As seen in  FIG. 6 , also attached to the rear portion  14  are a pair of retention straps  36 ,  38 . The retention straps  36 ,  38  include an elastic material. The retention straps  36 ,  38  are shorter than the support straps  32 ,  34  and are not meant to circumscribe the wearer&#39;s foot of ankle as with the support straps. Rather, the retention straps  36 ,  38  are stretched and attached to the lateral and medial sides of the foot and ankle holder  12  using hook and loop fasteners. The oppositely extending straps  36 ,  38 , applying circumferential tension as with a cuff, help secure the ankle brace  10  to the wearer while minimize shifting or slippage even during physical activity by the wearer. 
       FIG. 7  is a perspective view seen from the medial side of the ankle brace  10  as applied to a wearer&#39;s right leg  40 . The ankle brace  10  also partially covers the wearer&#39;s right foot  42  allowing the forefoot and toes to extend out into the open. The wearer is shown optionally wearing a sock. The foot and ankle holder  12  generally wraps over the front and side portions of the ankle, midfoot, and lower leg, while the rear portion  14  covers the rear portion of the wearer&#39;s ankle and lower leg, and overlaps with the foot and ankle holder  12  at the sides  22 ,  24 . As seen in  FIG. 7 , the wearer has already threaded, adjusted, tightened, and tied the means for binding  26 . Also at this stage, the elongated support straps  32 ,  34  have not been applied or have been removed. Likewise, the retention straps  36 ,  38  have not been applied or have been released. 
     A medial side opening  44  in the ankle brace  10  is created when the first panel  28  is independently detached from the first side of the ankle holder  12 —independently detached because, although hidden from view in  FIG. 7 , the lateral side of the wearer&#39;s right leg  40  is still covered by the foot and ankle holder  12 . As such, the second side  24  remains attached to the second panel portion  30  of the foot and ankle holder  12 . This connection maintains structural support of the ankle brace  10  even though the medial side is opened as shown. The support and retention straps  32 ,  34 ,  36 ,  38  still in place ensure that the ankle brace  10  does not accidentally slide or fall off of the wearer&#39;s foot, making the putting-on-taking-off routine complicated for the wearer. Consequently, the opening  44  enables the wearer to insert or remove his or her right foot  42  into or out of, respectively, the ankle brace  10  from the medial side. 
     Beneficially, this same ankle brace  10  can be worn on the left foot, although not shown. Similar as seen to  FIG. 7 , if worn on the left foot, a space  46  can be created by lifting the second panel  30  and moving it away from the second side  24  of the foot and ankle holder  12  thus allowing the wearer to remove her foot or insert her foot into or out of the ankle brace  10  from the medial side for the left foot. 
       FIG. 8  shows the ankle brace  10  partially applied to the wearer&#39;s right leg  40 . Looking at the lateral side of the right leg  40  in this view, it can be seen that when the second panel  30  is detached from the second side  24 , a lateral opening  46  is created allowing the wearer to insert or withdraw his or her foot  42  into or out of the ankle brace  10 . The medial side of the ankle brace  10  has the first side  22  of the holder  12  still attached to the first panel  28  of the rear portion  14  thus giving structural support to the ankle brace  10  even though opening  46  is created. In the  FIG. 8  view, the elongated support straps  32 ,  34  and retention straps  36 ,  38 , are not yet in use and not bound. 
       FIG. 9  shows the rear portion  14  attached to the foot and ankle holder  12  on both the medial and lateral sides. Again the ankle brace  10  is shown worn on the right leg  40 . With the holder  12  and rear portion  14  attached together, the means for binding (preferably laces)  26  may be further cinched up and tied for a precise fit. Alternatively, the overlapping side panel attachments  22 ,  24 ,  28 ,  20  of the foot and ankle holder  12  and the rear portion  14  may be adjusted relative to each other, thus making fitment of the brace  10  looser or tighter for the wearer. If desired, the overlapping side panels  22 ,  24 ,  28 ,  30  allow for gross adjustment of the fitment, and the laces allow for more precise adjustment of the fitment on the patient. 
     Next, the wearer takes each support strap  32 ,  34  starting on one side at the back of the ankle, then passes it by or circumscribes the ankle at about the malleoli, then proceeds underneath the midfoot and sole, and may wrap over the instep, then extends upward to the opposite side of the ankle, and finally attaches the end to the upper ankle portion  18 . The second strap is applied in the opposite direction. The wrapping description is only provided here to illustrate a use of the present invention ankle brace; the exact technique will be given to the patient by the treating physician, orthopedist, or physical therapist. Once applied, the straps  32 ,  34  help support and stabilize the ankle for treatment of ankle sprains, post injury rehabilitation, etc. 
     The wearer then applies the elastic retention straps  36 ,  38 . The retention straps  36 ,  38  are pulled forward and stretched, then locked down by hook and loop fasteners, claw hooks, etc. at or near the ends. The retention straps  36 ,  38  are thicker than the inelastic support straps  32 ,  34 , and wrap around the lower leg just above the malleoli, and overlie the retention straps  36 ,  38 . Aside from keeping the ankle brace  10  in place on the wearer&#39;s ankle and foot, the elastic retention straps  36 ,  38  act as a cuff compressing and stabilizing this area, and improving the support for the ankle joint. 
       FIG. 10  shows the ankle brace  10  worn on the right leg  40  with all of the straps in place.  FIGS. 9 and 10  show the ankle brace  10  worn on the wearer&#39;s right leg  40  and provide a medial point of view. The ankle brace  10  may likewise be worn on the left foot, although not shown.  FIGS. 7-10  thus show that when the ankle brace  10  is worn on the wearer&#39;s right leg, it is possible to access the ankle brace  10  medially as seen in  FIG. 7  or laterally as seen in  FIG. 8 . Similarly, if the ankle brace  10  is worn on the left leg, medial and lateral access to the ankle brace  10  are likewise possible. 
     Another advantage with the medial and lateral access via the overlapping side panels  22 ,  24 ,  28 ,  30  is that the wearer does not need to work with the laces  26 . Oftentimes, a more obese or elderly patient might not have the range of motion or reach to access the laces to cinch them down, and to tie or untie them. Sometimes, the patient will not be able to bend over to apply a conventional ankle brace or remove it from his ankle. On the other hand, with the present invention ankle brace  10 , the patient can cross his left or right leg with the injured ankle while seated comfortably on a chair, then open the medial side of the ankle brace, and insert his foot through the medial opening  44 . Removing the ankle brace  10  involves the same procedure; sitting in a chair, crossing the leg with the injured ankle, detaching the medial panel from the foot and ankle holder to reveal the medial opening  44 , and withdrawing the foot from the brace. The patient also has easy access to the support and retention straps while in the seated, leg crossed position. Therefore, the medial and lateral access of the present invention ankle brace alleviates hardship for many wearers who lack range of motion. 
     For athletes and highly active individuals who have an ankle injury, the overlapping side panel access gives the wearer much quicker on or off capability than tying and untying the laces in the front, which becomes a chore if performed frequently. To be sure, once the laces  26  are adjusted, cinched up and tied, they do not need to be untied to release the foot from the ankle brace  10 . Rather, the wearer simply detaches either the medial or lateral retention strap  36 ,  38 , then detaches either the first or the second side panel  28 ,  30  from the foot and ankle holder  12  and pulls his foot out from the medial opening  44  or the lateral opening  46 . The entire rear portion  14  can also swing fully open as in a car door so the wearer can withdraw his foot directly rearward. When the wearer returns to using the ankle brace again, he simply inserts his foot through the rear, medial or lateral openings  20 ,  44 ,  46 , swings the rear portion  14  to close whichever opening  20 ,  44 ,  46 , and reattaches the side panel  28 ,  30  to the side or sides  22 ,  24  of the foot and ankle holder  12 . The detached retention strap  36 ,  38  is now stretched and reattached, and the ankle brace  10  is in position and ready. Furthermore, in the foregoing process, the support straps  32 ,  34 , depending on how they are wrapped around the wearer&#39;s ankle brace  10 , do not necessarily have to be disturbed or removed from their wrapped and bound state. This makes the ankle brace on or off procedure ever faster and easier. 
     Retention straps  36 ,  38  are preferably elastic and include Velcro fasteners at the ends. The retention straps  36 ,  38  are stretched by the wearer and then locked down by attachment of the Velcro fasteners to the exterior surfaces of the rear portion  14 . The elasticity in straps  36 ,  38  apply a compressive force to the lower leg area. The elongated support straps  32 ,  34  may be elastic, but is preferably inelastic, and similarly have Velcro patches at the very ends to attach to the exterior of the foot and ankle holder  12  or the rear portion  14 . As seen in  FIGS. 1 and 2 , optional finger loops  48  may be provided at the ends to allow the wearer for easier gripping and tightening of the elongated support straps  32 ,  34 . 
     On advantage is the present invention ankle brace  10  may be worn on either the left or right foot without requiring two mirror image configurations be stocked by the orthopedic supplier. This saves a lot of money in terms of inventory costs and storage space. Further, regardless of which leg the ankle brace  10  is worn on, the wearer can insert or remove his or her foot into or out of the ankle brace  10  from the medial side, the lateral side, or from the rear of the brace by flipping open one or more of the side panels  28 ,  30  of the rear portion  14 . 
     The ankle brace  10  has a low profile design as seen in  FIG. 10 , which enables an easy fit in athletic shoes, work boots, and the like. The low profile design further allows the user to wear athletic socks, work socks, or stockings, yet still fit within his or her everyday shoes. The large opening  20  in the back of the ankle brace ( FIG. 2 ) permits the heel to protrude, which improves wearer comfort. 
       FIG. 11  is a front view of an alternative embodiment foot and ankle holder  68 . The ankle holder  68  has a front or anterior opening  66  that includes a tongue  64  stitched at its sides to the foot and ankle holder  12 . The tongue  64  is made from a stretchable, padded material. Some patients have a wider foot, and use of the tongue  64  in the ankle brace thus accommodates those wider sized feet. Also, the means for binding in this embodiment includes a wire strand  60  and shoe lace loops  72 . The wire strand speed lace  60  is a thin cord with a circular cross-section. Because of its thin diameter, the lace can be cinched through the shoe lace loops  72  faster because of less drag against the loops. A pushbutton, spring-based clamp  62  locks the ends of the speed lace  60  together in lieu of a knot to maintain tension. 
       FIG. 12( a )  shows an alternative embodiment foot and ankle holder  70 . The shoe laces and foot portion have been removed, and the foot and ankle holder  70  has been laid open to reveal the interior. The foot portion  16  is at the center and the first and second sides/side panels  22 ,  24  are spread apart. The top of the foot and ankle holder  70  depicted in  FIG. 12( a )  is the front/anterior while the bottom is the posterior/back. For clarity of the illustration, the tongue  64  is depicted in phantom/dashed lines and has been folded and flipped downward from its normal position, which is flipped up and located adjacent the binding means  72 . The binding means  72  in this embodiment are loops  72  and laces  60  shown in  FIG. 11 . Of course, shoe lace eyelets can be used in place of loops  72 . 
     In the  FIG. 12( a )  embodiment, the soft fabric of the foot and ankle holder  70  has been reinforced with a rigid heel support  76 , shown in dashed lines. The rigid heel support  76  is laid flat and inserted into the foot portion  16 . By this arrangement, when the present invention foot brace is worn, the rigid heel support  76  acts as a stirrup supporting the wearer&#39;s heel while the heel support is situated inside the shoe, sneaker, or boot. The rigid heel support  76  when laid out has a thin rectangular strip shape as shown, and may optionally be made in multiple segments or pieces so that the discrete segments  80 ,  82  are connected to the main portion  84  with pivots  86 . These segments  80 ,  82  may further extend into the upper sides  22 ,  24  of the foot and ankle holder  70 . The segments  80 ,  82  function as side walls supporting and stabilizing the medial and lateral sides of the ankle, and the segments  80 ,  82  may extend up to and include the medial and lateral malleoli. The pivots  86  allow the rigid heel support  76  to flex along with the wearer&#39;s ankle during physical activity. 
       FIG. 12( b )  shows an alternative embodiment rigid heel support  78  that is made from a thin, flat, continuous strip of rigid plastic. It is polymer molded to preferably have a free-standing U-shape, as seen from an end view in  FIG. 12( c ) . Once inserted into the foot and ankle holder  70  of  FIG. 12( a ) , the molded U-shape tends to flex the fabric of the foot portion  16  and sides  22 ,  24  into a U-shape to partially surround the wearer&#39;s heel as in a stirrup. 
     The plastics used for the rigid heel support is preferably HDPE or nylon, and other materials such as aluminum and rubber are contemplated. Such materials have the rigidity and strength even in a thin strip form to sufficiently stabilize an injured ankle, but are still lightweight so as to easily fit inside an athletic shoe without impeding comfort or mobility. The pivots  86  can be a simple hinge, such as a boss or hook on one piece fitted into a receiving hole on another piece; or a rivet or a pin that enables the segments  82  to swivel independently from the main portion  84 . The rigid heel support  76 ,  78  can be inserted into a pocket inside the fabric foot and ankle holder so that it can be removed by the user as an option, stitched or sewn to a surface of the fabric, cemented to a surface of the fabric, permanently embedded within the fabric as shown, or the like. 
     In various alternative embodiments, the foot and ankle holder  12  and/or the rear portion  14  is made from a non-stretchable cotton fabric. Heavy gauge ballistic nylon, non-stretchable nylon fabric, cotton velour, or the like, may be used in alternative embodiments, and each of the materials may be used individually or in combination. The expanse of cotton fabric may be further reinforced with cross-stitched thread  52  (indicated by partial cross-hatching in the drawings). Padding may be inserted into key locations of the foot and ankle holder  12  and the rear portion  12  to improve comfort. Optional semi-rigid inserts or stays can be placed inside optional medial or lateral pockets  54  in key areas such as side panels  22 ,  24  of the holder  12 , or in the panels  28 ,  30  of rear portion  14 , to increase stability and support for the ankle. The stays may be stackable inside a pocket for extra rigidity and support. The stiffeners can be made of aluminum, steel, or plastic material that conforms to the shape of the ankle surface. 
     In still other alternative embodiments, the retention straps  36 ,  38  are made from non-stretchable, non-fraying nylon. The retention straps  36 ,  38  may be made from an elastic material such as Neoprene, rubber, etc. 
       FIGS. 13-18  show alternative embodiments of the ankle brace disclosed above, including adding a secondary closure, using complementary first and second attachment means to fasten the respective side panels of the foot and ankle holder to the rear portion, and the addition of a foot plate. 
       FIG. 13  shows the ankle brace  10  described above with a secondary closure  101 . The secondary closure  101  in the preferred embodiment has a plurality of wire, string, rope, or like laces  102  terminating at attachment pads  103 . The laces  102  are threaded through lace loops  104  formed in or stitched to the rear portion  14 , as seen in  FIG. 16 . As preferably fitted to the ankle brace  10 , the laces  102  are threaded through the loops  104  in the rear portion  14  and overlie the open front  66  and are anchored to the first and second panels  28 ,  30  of the rear portion  14  by attachment pads  103  that have hook and loop fasteners thereon. The laces  102  also preferably overlie the means for binding  26  the foot and ankle holder  12 . The laces  102  may be short in length as shown in  FIG. 13  so that they only wrap partially across the front of the ankle brace and anchor to the panel  28 ,  30  opposite to the panel having the lace loops  104 ; or the laces may be very long to circumscribe most of the ankle brace and attached to the same panel as the lace loops  104 . In various alternative embodiments, the laces may have attachment panels at opposite ends so the lace loops may be omitted, or the laces and loops are used in combination where the laces are threaded back and forth through the loops and the ends of the laces have attachment pads for anchoring to the first and second panels  28 ,  30 . 
       FIG. 13  also depict first and second complementary attachment means  106 ,  108  that are disposed on the side panels  22 ,  24  of the foot and ankle holder  12  and the side panels  28 ,  30  of the rear portion  14 . The first and second complementary attachment means  106 ,  108  may be pushbutton button snaps, zippers, rivets, screws, hooks and D-rings, hook and loop fasteners, eyelets and laces, and like fasteners known in the art. The preferred embodiment ankle brace has a plurality of complementary attachment means  106 ,  108  disposed on the side panels  22 ,  24 ,  28 ,  30  so there is adjustability in the attachment points. If snaps are used, for example, the attachment of the rear portion  14  to the foot and ankle hold  12  is performed by the patient by aligning one or more pushbutton snaps with the respective bosses while adjusting the fitment. Once this is done, the patient has custom fit the brace to his or her ankle. Furthermore, the ankle brace may then be removed from the medial or lateral side while the snaps on the opposite side remain attached so that the brace may be reapplied to the ankle without further adjustment by the patient to the unopened side. The first and second complementary attachment means  106 ,  108  further bolster the relative positions of the foot and ankle holder  12  to the rear portion  14  when worn for more vigorous activity, for example, so there is less likelihood of the two components shifting or detaching from each other. 
       FIG. 15  shows eyelets  110  formed into the side panels  28 ,  30  of the rear portion  14 . The eyelets  110  receive the laces  102  from the secondary closure  101  and may replace the lace loops  104  of  FIG. 16  or be used in combination with them.  FIG. 17  shows an alternative embodiment foot and ankle holder  12  with complementary attachment means  106  that are in the form of eyelets. Not shown are the complementary laces that are threaded through the eyelets to attach the foot and ankle holder  12  to the rear portion  14  via their respective side panels  22 ,  24 ,  28 ,  30 . 
       FIG. 18  shows a preferred embodiment foot plate  112  to be located in the foot gauntlet or foot portion  16  of the foot and ankle holder  12 , which is shown in cross-section along with the rear portion  14 . The foot plate  112  is preferably made from a semi-rigid plastic sheet, a rubber sheet, or a more rigid metal sheet having a general silhouette of the sole of the patient&#39;s foot, or may be a partial silhouette thereof such as the forefoot or heel. The foot plate may have contours such as a raised arch area, or ribbing or stippling on its surface, as with a shoe insole. Because the foot plate  112  has some rigidity, it provides additional support of the patient&#39;s foot not contained by the foot and ankle holder  12 . The foot plate  112  may be used in combination with or in lieu of the rigid heel support  76  shown in  FIG. 12 . 
     One or more straps  114  with hook and loop fasteners are stitched, glued, attached, or molded into the foot plate  112 . To apply, the patient first places his or her foot on the foot plate  112 , then inserts the foot into the foot and ankle holder  12  and uses the straps  114  to attach the foot plate  112  to the foot and ankle holder  112 , encloses the ankle with the rear portion  14 , and makes the final adjustments. 
     Unless otherwise described herein, conventional materials and manufacturing methods may be used to make the present invention. Additionally, various modifications may be made to the present invention without departing from the scope thereof. Although individual features of embodiments of the invention may be shown in some of the drawings and not in others, those skilled in the art will recognize that individual features of one embodiment of the invention can be combined with any or all of the features of another embodiment.