Types of Ankle Foot Orthosis

Ankle foot orthotics provide critical support for patients with a variety of foot, ankle, and gait issues. There are many types of orthotics that your physician may recommend for your condition. Understanding some of the options can help you identify which brace is best for your needs.

What Are Ankle Foot Orthotics Used For?

walking down stairs in converse black and white

Image via Flickr by Daniel Max

An ankle foot orthotic (AFO) is a device that helps control instabilities in the lower limb. AFO orthotics help the patient by:

  • Keeping the joints in proper alignment.
  • Stabilizing the gait.
  • Compensating for muscle weakness.

An AFO orthotic is most commonly recommended as a treatment for foot drop. Foot drop is the inability to raise the foot on one side of the body. This causes the toes to dangle and often drag on the ground when walking. Foot drop may be caused by:

  • Multiple sclerosis.
  • Cerebrovascular accident or stroke.
  • Traumatic brain injury.
  • Poliomyelitis.
  • Cerebral palsy.
  • Sciatica.
  • Muscular dystrophy.
  • Neck or spinal cord injury.
  • Lower leg (peroneal) nerve injury.
  • Peripheral nerve trauma.
  • Diabetes.
  • Spinal stenosis.

AFO devices can also help patients who are recovering from a sprain or fracture, dealing with the discomfort of arthritis, or facing other similar issues.

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Types of AFO Braces

There are many different ankle-foot orthosis types. Your physician will typically recommend the best AFO types for your individual needs. However, it’s helpful to have an understanding of the different options so you can properly evaluate your physician’s recommendation and determine which AFO brace types are best for you.

Articulated AFO

An articulated, or hinged, AFO features a hinge at the ankle and plantarflexion stop that allows for controlled movement. The hinge is adjustable, so your physician can adjust the range of motion that’s provided by the orthotic. The orthotic must be worn with a laced or velcro-closure shoe for added stability.

An articulated AFO is often a good choice for medial/lateral instability, CVA, and stress fractures. It’s not an appropriate option for patients with diabetes or fluctuating edema.

Rigid AFO

A rigid or solid AFO provides full coverage along the back of the leg and does not allow for any movement. This orthotic enables toe clearance as the foot swings and provides complete stability for the whole foot and ankle.
Rigid AFOs are typically used for children with cerebral palsy who have less than 10 degrees of ankle dorsiflexion when the knee is fully extended. This brace is also used for ankle stability in nonambulatory children with CP.

Dynamic AFO

A dynamic AFO (DAFO) is typically made from thin thermoplastic that’s custom fit to the patient’s foot. This plastic is more flexible than what you’ll find in many other types of AFOs. The DAFO helps the patient maintain neutral alignment and circumferential control of the foot. This type of orthotic is only appropriate where the foot and ankle deformities can be corrected passively with minimal force.

Posterior Leaf Spring AFO

A posterior leaf spring AFO offers flexibility at the ankle that allows for passive ankle dorsiflexion. This means that the patient enjoys a smoother knee to ankle motion while walking. The brace supports the foot at plantargrade as it’s swinging so that it can clear the ground, but it doesn’t provide the rigid support of other types of orthotics.

The flexible posterior foot plate of this orthotic stores energy with each step, which provides a small spring that helps propel the patient forward, making it easier to walk. These braces are typically made from carbon composites, copolymer polypropylene, or Ortholen. This orthotic is best for patients with mild spastic equinus.

Carbon Fiber AFO

Carbon-fiber AFOs are an intriguing alternative to the more traditional plastic design. The carbon-fiber AFO typically features a flat foot plate attached to a full-length orthotic. This type of device provides energy return at the toe-off, which facilitates efficient forward movement. The carbon-fiber AFO also allows the calf muscles to fire. Studies indicate that this type of orthotic is best suited to patients with:

  • Minimal coronal plane deformity in the ankle.
  • Minimal fluctuating edema.
  • Minimal equinus contracture.
  • Low to no spasticity.

Ground Reaction AFO

A ground reaction AFO (GRAFO), also known as a floor reaction AFO (FRAFO), is a custom fabricated support made from molded plastic. The anterior shell of this AFO redistributes the extension and ground reaction forces closer to the knee than other orthotics. This gives the brace more leverage than other similar designs.

This type of AFO is typically used for patients with spina bifida, brain or spinal cord injury, post-polio paralysis, cerebral palsy, PTTD, osteoarthritis, and adult acquired flatfoot.

How to Choose the Right Type of AFO

There’s a lot to consider when you’re comparing different types of orthotics. Your doctor’s recommendation is the best guidance you’ll find for your individual situation. However, you may find that there are two or more options available and the final choice is up to you. As you’re comparing AFOs, you may want to consider:

  • How it is worn: Some AFOs act as full boots and surround the foot completely. Most are worn with socks and shoes. You will probably want an AFO that fits comfortably with your wardrobe and is easy to put on and take off.
  • Replaceable parts: If you’re going to be wearing your AFO for a permanent condition, you should think ahead to potential wear and tear. Over time, some parts may need replacing, such as hinges or straps. It’s best to have an orthotic that’s easy to get new parts for so you don’t have to replace the entire brace.
  • Comfort: The construction of your orthotic can have a big impact on its comfort. You want a device that provides the support that you need without causing any additional pain or chafing. If you find a particular device uncomfortable, speak with your doctor to determine how you can adjust the device or discuss what alternatives are available.

The right ankle-foot orthosis will be comfortable and effective. You should be able to walk much more easily with this device and find relief from some of the symptoms of your condition. Our team at Scheck & Siress can help you navigate your options for different orthotics effectively to find the right fit for your needs.

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