Foundations for Ankle Foot Orthoses
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]
- Flexible A.F.O.
- Rigid A.F.O.
- 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
