Foundations for Ankle Foot Orthoses: Difference between revisions

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* Increase stability  
* Increase stability  
* Patient Needs
* Patient Needs
== Commonly Used Ankle Foot Orthosis ==
# Flexible A.F.O.
# Rigid A.F.O.
# Jointed A.F.O.
==== Design/ Manufacture ====
• Custom made  
• Mostly manufactured from a plaster model • Polypropylene/ lamination/ Carbon Fibre • 3 point force system
=== 3 point force system ===
• Stabilizes a joint or segment
• Reduces angular rotation
• Medio-lateral or antero-posterior
• Longer the lever arm the greater the force
• Pressure= Force /Area
=== Foot/Ankle Position ===
=== Casting Procedure ===
=== Prescription Criteria For A Flexible A.F.O. ===
o Drop foot
o Mobile foot/ankle
o No tendency to valgus or varus
=== Common conditions include ===
• CVA
• Nerve injury/dysfunction
• Paediatrics
== 1. Flexible AFO ==
=== OTS AFO ===
=== OTS AFO ===
== 2. Rigid A.F.O. ==
==== Prescription Criteria For A Rigid A.F.O. ====
o Tightness in T.A.
o Tendency to valgus
o Tendency to varus
o Excessive dorsiflexion
o Slight tendency to flexion at knee
==== Common Conditions ====
• CP, NTD, Stroke, Trauma, Pain
==== Rigid AFO +/- Anterior Shell ====
o Tightness in T.A.
o Tendency to valgus
o Tendency to varus
o Excessive dorsiflexion
o Crouch/ Flexion at knees
(Ries 2019)
==== Muscle Tightness- Dynamic/Fixed ====
Crouch/ Equinus Gait Hyper-extension/ Escape Valgus
==== Valgus Deformities ====
o Rocker Bottom Foot o Hyper-mobility o Escape Valgus
==== Escape Valgus ====
o Compensatory movement
o Driven by tight TA
o Can alter foot structure  
o Can result in long term issues
==== Varus Deformities ====
o Correctable deformity o Difficult to control o Accommodate deformity
==== Varus Deformity ====
Crouch/Excessive Dorsiflexion
==== Tuning/ Optimising AFOs   ====
o There is evidence that tuning  AFOs can significantly improve  gait and their effect at the  proximal joints.  
(Owen 2002, Stallard 2003, Butler 2007,  Jagadamma 2009)  
Tuning/ Optimising AFO’S - AFOFC
== 3. Jointed A.F.O. ==
==== Prescription Criteria For A Jointed A.F.O. ====
o ROM in ankle joint
o Tendency to valgus
o Tendency to varus
o Tendency to Crouch
==== Jointed AFO ====
Prescription criteria for a DAFO/SMAFO
o Hyper mobile foot/ankle
o Ankle to plantargrade
o Medio-lateral instability
In Conclusion
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:Physioplus Content]]
[[Category:Physioplus Content]]

Revision as of 13:10, 30 April 2022

Original Editor - Carin Hunter based on the course by Donna Fisher
Top Contributors - Carin Hunter, Jess Bell, Kim Jackson and Tarina van der Stockt

Introduction[edit | edit source]

Types of AFO[edit | edit source]

  • AFO - Ankle Foot Orthosis
  • GRAFO - Ground Reaction Ankle Foot Orthosis
  • DAFO - Dynamic Ankle Foot Orthosis
  • SMAFO- Supramalleolar Ankle Foot Orthosis
  • Custom Made
  • Off the shelf

Orthotic Assessment  [edit | edit source]

Passive Assessment:

  • Range of Motion (ROM)
  • Muscle Power
  • Proprioception
  • Sensation
  • Leg Length
  • ROM Foot/Ankle

Active Assessment:

  • Level of mobility
  • Gait Pattern
  • Compensation Mechanisms o Instability
  • Risk of injury
  • Pain

Gait Cycle[edit | edit source]

Normal Gait Cycle:

Pathological Gait Cycle:

  • Pain
  • Joint ROM limitations
  • Muscle weakness/ paralysis
  • Neurological deficit
  • Sensory deficit
  • Leg length  

Pathologies[edit | edit source]

  • Paediatrics:
    • Neural Tube Dysfunction??? / Spina Bifida
    • Cerebral Palsy
    • Muscular Dystrophy
  • Cerebral Vascular Accident – Early intervention
  • Multiple Sclerosis – Progressive
  • Polio  
  • Neuropathy
    • HMSN
    • Diabetes
    • Tumor
  • Trauma
    • Nerve injury
    • Pain
    • Instability

Goal setting/ Prescription[edit | edit source]

  • Positioning
  • Provide Support
  • Prevent contractures
  • Improve mobility
  • Increase stability
  • Patient Needs

Commonly Used Ankle Foot Orthosis[edit | edit source]

  1. Flexible A.F.O.
  2. Rigid A.F.O.
  3. Jointed A.F.O.

Design/ Manufacture[edit | edit source]

• Custom made  

• Mostly manufactured from a plaster model • Polypropylene/ lamination/ Carbon Fibre • 3 point force system

3 point force system[edit | edit source]

• Stabilizes a joint or segment

• Reduces angular rotation

• Medio-lateral or antero-posterior

• Longer the lever arm the greater the force

• Pressure= Force /Area

Foot/Ankle Position[edit | edit source]

Casting Procedure[edit | edit source]

Prescription Criteria For A Flexible A.F.O.[edit | edit source]

o Drop foot

o Mobile foot/ankle

o No tendency to valgus or varus

Common conditions include[edit | edit source]

• CVA

• Nerve injury/dysfunction

• Paediatrics

1. Flexible AFO[edit | edit source]

OTS AFO[edit | edit source]

OTS AFO[edit | edit source]

2. Rigid A.F.O.[edit | edit source]

Prescription Criteria For A Rigid A.F.O.[edit | edit source]

o Tightness in T.A.

o Tendency to valgus

o Tendency to varus

o Excessive dorsiflexion

o Slight tendency to flexion at knee

Common Conditions[edit | edit source]

• CP, NTD, Stroke, Trauma, Pain

Rigid AFO +/- Anterior Shell[edit | edit source]

o Tightness in T.A.

o Tendency to valgus

o Tendency to varus

o Excessive dorsiflexion

o Crouch/ Flexion at knees

(Ries 2019)

Muscle Tightness- Dynamic/Fixed[edit | edit source]

Crouch/ Equinus Gait Hyper-extension/ Escape Valgus

Valgus Deformities[edit | edit source]

o Rocker Bottom Foot o Hyper-mobility o Escape Valgus

Escape Valgus[edit | edit source]

o Compensatory movement

o Driven by tight TA

o Can alter foot structure  

o Can result in long term issues

Varus Deformities[edit | edit source]

o Correctable deformity o Difficult to control o Accommodate deformity

Varus Deformity[edit | edit source]

Crouch/Excessive Dorsiflexion

Tuning/ Optimising AFOs  [edit | edit source]

o There is evidence that tuning  AFOs can significantly improve  gait and their effect at the  proximal joints.  

(Owen 2002, Stallard 2003, Butler 2007,  Jagadamma 2009)  

Tuning/ Optimising AFO’S - AFOFC

3. Jointed A.F.O.[edit | edit source]

Prescription Criteria For A Jointed A.F.O.[edit | edit source]

o ROM in ankle joint

o Tendency to valgus

o Tendency to varus

o Tendency to Crouch

Jointed AFO[edit | edit source]

Prescription criteria for a DAFO/SMAFO

o Hyper mobile foot/ankle

o Ankle to plantargrade

o Medio-lateral instability

In Conclusion

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