Ankle foot orthosis

Primary goal
- The most prescribed device used to control the LE during each phase of the gait cycle for individuals
with neuromuscular or musculoskeletal impairments.
- Provide enough external support for stability in stance phase and clearance in swing with minimal
compromise of forward progression through the heel and ankle.
- Control the alignment and motions of the joint of foot and ankle.
Categories
- Static: inhibit motion in all type of the plane.
- Dynamic: allows some sagittal motion of degrees (ankle plantar flexion, and ankle dorsiflexion).
Materials
- Metal
Pre-fabricated
Aluminum (usually)
Stainless steel (for durability)
Nowadays it is in combination with leather or plastic
Stirrups -> responsible in attaching metal uprights
- Plastic
Most commonly used in AFO
It is lighter than metal and metal-plastic design
More favored especially when used for children
Made of thermoplastics and thermosetting
Basic on function
- Ankle stops
Set in the ankle joint to allow for any predetermined ROM depending on the gait disturbance.
It will try to stop a specific sagittal motion:
Plantarflexion stop
Because the dorsiflexors cannot eccentrically active to permot the foot to make contact with ground,
the ground reactive force remains posterior to the knee after heel strike, which creates a flexion
moment at the knee
Restrict plantarflexion but allows unlimited dorsiflexion -> posterior stop
Indication: plantarflexion contracture, to control plantarflexion spasticity
Dorsiflexion stop
Restrict dorsiflexion by allows plantarflexion -> anterior stop
Used for weak plantarflexors
Used to substitute for fix of gastoc-soleus complex
Set at 5 degrees of dorsiflexion
Tries to promote plantarflexion -> assists push up
Assist the knee into extension (because weak calf muscle allows the ankle to enter dorsiflexion and
creates a knee flexion moment after heel strike)
To assist weak quadriceps
Limited motion stop
 Restricts in both directions
Often prescribed if there is extensive involvement of the ankle musculature
Put ankle in neutral position
Indication: patient with flaccidity
- Ankle joint assists
Dorsiflexion assist
Substitutes concentric contraction of DFs to prevent flaccid foot drop toes off.
indication: px with flaccid, common peroneal nerve injury
Aka Posterior leaf spring
Plantarflexion assist
Substitutes concentric contraction of PFs
Dorsiflexion-plantarflexion assist
Substitute or promotes contraction of both PFs and FDs
- Types of ankle-foot orthosis
Thermoplastic AFO
Introduction of thermoplastic AFOs
Plastic molded AFOs, consisting of: shoe insert, calf shell, calf strap attached proximally
The rigidity depends on the thickness and composition of the plastic, and the trim line and shape
Contraindication: fluctuating edema and insensation
Permitting a closer fit & more precise control of pressure distribution
Types of thermoplastic AFO
Posterior leaf spring (PLS)
1. Most common form of AFO with a narrow calf shell & narrow ankle trim line behind the malleoli
2. Places ankle in neutral or 5-10 degrees of PF
3. Used for help dorsiflexion (DF assist) and resisting ankle plantarflexion
4. No medial-lateral control
5. Useful for foot drop
Spiral AFO
1. Consists of a shoe insert with spiral
2. The spiral starts medially -> passes around the leg posteriorly -> passes anteriorly to terminate at
the medial tibial flare where a calf band is attached
3. For rotational deformities in the tibia
4. Indication: (1) control the PF & DF & inversion, (2) prevent foot slap at heel strike, (3) provide
extension moment at the knee to assist stability.
5. Contraindication: (1) inadequate hip strength, (2) moderate to severe spasticity, (3) edema
Solid AFO (static AFO)
1. With a wider calf shell and trim line anterior to the malleoli
2. Rigid ankle foot orthosis
3. Prevent PF & DF, resist any varus and valgus deviation of the hindfoot & ankle
-> place in neutral position
4. Indication: spastic patient, edema
AFO with flange
 1. Stabilize ST joints effectively
2. Flange placed in the medial side is to control foot-ankle valgus (lateral side -> valgus)
3. Static type of orthosis
4. indication: medial or lateral instability
Hinged AFO
1. Allows sagittal plane motion at the ankle incorporating a mechanical ankle joint
2. Type of orthosis that improves mobility in functional activities (e.g. going up and down the stairs)
Ground / floor reaction orthosis
1. Provides appropriate foot support that influence the rotation of more proximal joint
2. The anterior tibial shell closing helps stabilize the knee during gait
3. Provides maximal resistance to plantarflexion and encourages knee extension
4. Useful for CP patients with incompetent or overly lengthened triceps surae and mild crouch gait
Dynamic AFO (DAFO)
Supramalleolar ankle foot orthosis (SMAFO)
1. shortest of the AFOs, ending right above the malleoli
2. controls varus/valgus and supports heel in neutral vertical position
3. useful for flexible pes planus, planovalgus, hyper-pronated foot

Metal AFO
 Consists of a shoe or foot attachment, ankle joint, 2 metal uprights (medial and lateral), with a calf
band connected proximally.
 Stirrup: anchors the uprights to the shoes between the sole and the heel
-> The most commonly used method of attachment is a steel stirrup which is riveted to the shank
of the shoe directly underneath the malleoli
-> Encompasses the shoe like a U and provides a permanent attachment between the uprights and
the shoe
-> Enables more accurate congruence between the mechanical and anatomical joints
-> Split stirrup – some what heavier, thicker, and less durable than the solid stirrup
 Caliper: a round tube placed in the heel of the shoe, which connects to the uprights and also
allows for easy detachability of the uprights
Type of metal AFO
Varus and valgus control – Metal AFO
Goals
Correction of rotational deformities at the ST joint
Attachment of a T-strap along side the shoe distal to the ST joint
Lateral and medial T-straps
Sown to the lateral aspect of the shoe
It has a buckle (扣帶) secured around the medial upright or lateral upright
Lateral T-straps -> controls varus malalignment
Medial T-straps -> controls valgus malalignment
Up right, calf bands and cuffs
Weight-bearing AFO
 Unloads weight bearing forces during stance phase for individuals with painful, unstableor rescently
repaired ankle or foot
A.k.a patellar tendon bearing AFO
allows weight distribution to patellar shelf
reduces weight bearing forces through foot
Indication: ankle fussion, post-surgical ankle condition
Single and double upright AFO
Shoe-clasp AFO
Shoe or foot attachment
Stirrup (蹬)
- The most commonly used method of attachment is a steel stirrup which is riveted to the shank of the
shoe directly underneath the malleoli
- Encompasses the shoe like a U and provides a permanent attachment between the uprights and the
shoe
- Enables more accurate congruence between the mechanical and anatomical joints
- Split stirrup – some what heavier, thicker, and less durable than the solid stirrup

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