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:
This can be dues to:
- Pain
- Joint ROM limitations
- Muscle weakness/ paralysis
- Neurological deficit
- Sensory deficit
- Leg length
Pathologies[edit | edit source]
- Paediatrics:
- Neural Tube Defect / 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
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
Commonly Used Ankle Foot Orthosis[edit | edit source]
- Flexible A.F.O.
- Rigid A.F.O.
- Jointed A.F.O.
1. Flexible AFO[edit | edit source]
Design/ Manufacture[edit | edit source]
- Custom made
- Mostly manufactured from a plaster model
- Polypropylene/ lamination/ Carbon Fibre
- 3 point force system
Foot/Ankle Position[edit | edit source]
Casting Procedure[edit | edit source]
Prescription Criteria For A Flexible A.F.O.[edit | edit source]
- Drop foot
- Mobile foot/ankle
- No tendency to valgus or varus
Common conditions include[edit | edit source]
- CVA
- Nerve injury/dysfunction
- Paediatrics
OTS Flexible AFO[edit | edit source]
2. Rigid A.F.O.[edit | edit source]
Prescription Criteria For A Rigid A.F.O.[edit | edit source]
- Tightness in T.A.
- Tendency to valgus
- Tendency to varus
- Excessive dorsiflexion
- Slight tendency to flexion at knee
Common Conditions[edit | edit source]
- CP
- NTD
- Stroke
- Trauma
- Pain
Rigid AFO +/- Anterior Shell[edit | edit source]
- Tightness in T.A.
- Tendency to valgus
- Tendency to varus
- Excessive dorsiflexion
- Crouch/ Flexion at knees
(Ries 2019)
Used for[edit | edit source]
- Muscle Tightness- Dynamic/Fixed
- Crouch/ Equinus
- Gait Hyper-extension/ Escape Valgus
- Valgus Deformities
- Rocker Bottom Foot
- Hyper-mobility
- Escape Valgus
- Compensatory movement
- Driven by tight TA
- Can alter foot structure
- Can result in long term issues
- Varus Deformities
- Correctable deformity
- Difficult to control
- Accommodate deformity
- Varus Deformity
- 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]
- ROM in ankle joint
- Tendency to valgus
- Tendency to varus
- Tendency to Crouch
Prescription criteria for Jointed AFO and DAFO/SMAFO[edit | edit source]
- Hyper mobile foot/ankle
- Ankle to plantargrade
- Medio-lateral instability
In Conclusion