AFOs

• An orthosis is an external device that facilitates or inhibits movement.
• Ankle devices will address weak or absent dorsiflexion, mediolateral instability, or weakness of ankle plantar flexors.
• Knee devices will address hyperextension and stance collapse.
• AFOs will control and/or assist ankle motin via limiting PF, DF, or mediolateral instability.
• AFOs will influence the knee due to biomechanics and kinematics.
• Free orthoses devices provide no control of anatomical joint motion.
• Assist orthoses devices will assist the patient into DF through a loaded spring.
• Stop LE orthoses devices will prevent motion in a specific direction.
• Lock LE orthoses devices will completely restrict all joint motion.
• A large anterior trimline will increase mediolateral stability.
• Solid AFOs are one piece, and may also be known as rigid.
• Articulating AFOs have a joint.
• Rigid AFOs improve stance stability and toe clearance in swing. They may also prevent PF contractures.
• The disadvantages of rigid AFOs are limited late stance phase and push-off. They are very limiting in motions, and not accommodating to limb volume changes.
• If the patient has a lot of swelling, they need a double-adjustable ankle joint.
• Double-adjustable ankle joints are indicated if the patient needs variability in the components, or if they need help with toe clearance.
• The disadvantage of double-adjustable ankle joints is that they are custom, heavy, and ugly. They also will tear up shoes.
• Articulating AFOs are modifiable.
• Articulating AFOs are indicated if the patient can handle natural movement and have some mediolateral stability.
• The disadvantages of articulating AFOs are that they are custom and can be heavy.
• Plantarflexion stops will prevent excessive knee hyperextension in stance.
• Dorsiflexion stops will prevent excessive knee flexion in stance.
• Posterior leaf spring AFOs are indicated if the patient has DF weakness. They will assist with swing and toe clearance.
• Posterior leaf spring AFOs are available off the shelf.
• The disadvantage of posterior leaf spring AFOs is that it does not control mediolateral instability.
• Dynamic AFOs are indicated if the patient needs a subtle dorsiflexion assist. You can also add an anterior shelf to help with stance control.
• The disadvantages of dynamic AFOs are that they are expensive and that they do not control mediolateral instability.
• Ground reaction or floor reaction AFOs have an anterior shell to assist with stance control. These are not appropriate if there are contractures at the knee or hip.
• Ground reaction AFOs are indicated if the patient needs assistance with stance control.
• The disadvantages to ground reaction AFOs are that they are bulky, there are lots of contact areas, and that they are custom.
• KAFOs provide knee and ankle instability.
• KAFOs provide stability for difficult gait, but are very heavy and limit true mobility at the knee and ankle.
• Air casts will control only for mediolateral instability. They are good for safety with transfers.
• Ace wraps control for DF and some eversion. They are for quick-in-the-moment fixes. They do not work well with spasticity or severe contractures.
• Turbomed XTERN is worn exteriorly. it will assist with swing and is similar to the metal adjustable AFO.
• Foot up braces are quick trials for those who may have very slight limb clearance deficits.
• FES targets the common fibularis nerve thus affecting the tibialis anterior.
• FES only assists with DF during limb swing. There is no stance assist.
• FES can be worn with any shoes or barefoot, but they are very expensive and only appropriate for certain individuals.
• An immediate effect is testing without a device then immediately re-testing after putting the device on.