Saturdays News - AFO (or Drop-Foot)

Definition: Drop-Foot or Ankle-Foot Orthosis (AFO).

Orthotics From Wikipedia, the free encyclopedia.

Orthotics (Greek: Ορθός, ortho, "to straighten" or "align") is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis (plural: orthoses) is "an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system".

(SSTattler: We will consider only ankle-foot orthosis mechanic device this week. Next week we will describe the various electronic devices called Functional Electrical Stimulation ... )
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Ankle-Foot Orthosis (AFO)

An ankle-foot orthosis (AFO) is an orthosis or brace (usually plastic) that surrounds the ankle and at least part of the foot. AFOs are externally applied and intended to control position and motion of the ankle, compensate for weakness, or correct deformities. This type of orthosis is believed to cause chronic joint weakness if over or improperly worn. They control the ankle directly, and can be designed to control the knee joint indirectly as well. AFOs are commonly used in the treatment of disorders affecting muscle function such as stroke, spinal cord injury, muscular dystrophy, cerebral palsy, polio, multiple sclerosis and peripheral neuropathy. AFOs can be used to support wasted limbs, or to position a limb with contracted muscles into a more normal position. They are also used to immobilize the ankle and lower leg in the presence of arthritis or fracture, and to correct foot drop; an AFO is also known as a foot-drop brace.

Ankle-foot orthoses are the most commonly-used orthoses, making up about 26% of all orthoses provided in the United States. According to a review of Medicare payment data from 2001 to 2006, the base cost of an AFO was about $500 to $700. An AFO is generally constructed of lightweight polypropylene-based plastic in the shape of an "L", with the upright portion behind the calf and the lower portion running under the foot. They are attached to the calf with a strap, and are made to fit inside accommodative shoes. The unbroken "L" shape of some designs provides rigidity, while other designs (with a jointed ankle) provide different types of control.

Obtaining a good fit with an AFO involves one of two approaches: 1. Provision of an off-the-shelf or prefabricated AFO matched in size to the end user, 2. custom manufacture of an individualized AFO from a positive model, obtained from a negative cast or the use of computer-aided imaging, design, and milling. The plastic used to create a durable AFO must be heated to 400°F., making direct molding of the material on the end user impossible.

The International Red Cross evidently believes there are four major types of AFOs:
Flexible AFOs: may provide dorsiflexion assistance, but give poor stabilization of the subtalar joint.
Anti-Talus AFOs: block ankle motion, especially dorsiflexion; do not provide good stabilization for the subtalar joint.
Rigid AFOs: block ankle movements and stabilize the subtalar joint; may also help control adduction and abduction of the forefoot.
Tamarack Flexure Joint: provide subtalar stabilization while allowing free ankle dorsiflexion and free or restricted plantar flexion, depending upon the design; may provide dorsiflexion assistance to correct foot drop.

The International Committee of the Red Cross published its manufacturing guidelines for ankle-foot orthoses in 2006. Its intent is to provide standardized procedures for the manufacture of high-quality modern, durable and economical devices to people with disabilities throughout the world.

YouTube: Introduction: AFO for Foot Drop

Howard Orthopedics Inc. 

Patient with Foot Drop walking with and without his custom molded AFO. AFO stands for Ankle Foot Orthosis.

YouTube: Drop Foot Brace & AFO Ankle Brace Solution

 Insightful Products LLC

Insightful Products LLC has recently introduced the Step-Smart AFO drop brace solution for Foot Drop which has received praise as the best drop foot brace from those that have tried other solutions.

BioMechanically, the Step-Smart design is more energy efficient than the competitive designs. It's more desirable than the stiff design, since it allows for good plantarflexion at heel strike. It's more desirable than the flexible designs, since it is preloaded. The benefit of a preload on the system is critical to shock absorption. Also, the Dorsi Flexion assist joints allows the best clearance at swing phase.

(SSTattler: I tried it for 1+ week and it works for me i.e. it raises my toe instead of tripping occasionally.  It cost $220 Cdn on the internet and it is very light).

Gait Efficient Drop Foot Ankle Brace

With drop foot, however, it is not desirable to have a design with free plantarflexion. Naturally, our bodies control the deceleration at heel strike with an eccentric contraction of the dorsiflexors. This combined with a slight flexion moment at the knee is what creates the best shock absorption. With other flexible solutions, there is too much plantarflexion at heel strike causing foot slap. The result is trauma and pain to the calcaneous. The reason that the Step-Smart design is superior to the others is that it provides resistance to plantarflexion the instant the heel hits the ground. Some other designs need to be plantarflexed before the resistance is high enough to be effective. By then it is too late. The shock of hitting the ground has already damaged the foot and ankle. The new Step-Smart provides a pre-load that controls deceleration at contact.

The Step-Smart drop foot brace has come closest to providing the right amount of deceleration (dictated by pre-load). It is appreciated and considered the best drop foot brace by the medical community because patients feel better during ambulation.

===> Step-Smart Drop Foot

===> Gait Analysis Drop Foot

===> Foot of the Week - Episode 9 - AFO Shoe combination

From Insightful Products 

In this weeks vblog, we demonstrate the AFO strategy used by Insightful to attach the AFO or ankle brace to the shoe using velcro. The foot and ankle brace is attached to the shoe using hook and loop pile. By attaching the ankle brace to the shoe, the unit becomes one. All of Insightful's bracing is designed to work with a shoe and not without a shoe. Fastening the brace to the shoe makes it easier to don the brace or to put the brace on but also keeps the brace placed back in the heel of the shoe. This keeps the brace from creeping forward in the shoe and using up space in the shoe.

===> Foot of the Week - Episode 22 - AFO Brace Donning

From Insightful Products 

In this episode, a patient shows us his unique method for donning the Step-Smart AFO brace for drop foot. In most instances, Insightful suggests attaching the AFO brace into the shoe first and donning the shoe brace combination at once. In this example, the patient finds it easier to don the AFO brace first and then he slides the foot brace combination into the shoe.

YouTube: Advanced Orthopedic Design

At Advanced Orthopedic Designs we provide comprehensive orthotic and prosthetic care. Our goal is to provide the best possible service in a caring and thoughtful manner. We strive for 100% patient satisfaction and back all of our custom-made orthoses with a money back guarantee. If, for any reason, you are unhappy with the device or the care you receive, you may return the device for a full refund, no questions asked. We believe in our products, our company, our service, and our skill, and are unafraid to offer this unconditional guarantee.

===> AFO: Casting

Kevin demonstrates the method and reasoning of our AFO casting technique. We recommend that our CFAB customers use this casting technique for best results.

===> AFO: Fitting Part 1

Kevin Matthews Fits Our Variation Of The Floor-Reaction AFO. Part 1 Of 2. See The Patient Walk With And With Out The Brace And Hear An Explanation Of The Design.

===> AFO: Fitting Part 2

Kevin Matthews Fits Our Variation Of The Floor-Reaction AFO. Part 2 Of 2. See The Patient Walk With And With Out The Brace And Hear An Explanation Of The Design.

===> AFO: Malleoli, Arch, & Calf Pads

Justin shows a method for padding an AFO without hinges. In this case, one of our TURBO, floor reaction, AFOs.

YouTube: Carbon Fiber - Ankle Foot Orthosis

MMAR Medical Group Inc. 

===> Ankle Foot Orthosis Differences & Applications

Understand the differences in construction and support between a variety of Matrix brand AFO braces. AFO, or ankle foot orthosis, braces are often prescribed to people suffering from a variety of common foot and ankle conditions. Commonly used in the treatment of disorders that affect muscle function such as stroke, spinal cord injury, muscular dystrophy, cerebral palsy, polio, multiple sclerosis and peripheral neuropathy, as well as many other conditions.

===> Fitting the Matrix AFO Brace

How to fit the Matrix & Matrix Max Carbon Fiber AFO drop foot braces to a patient.