1.1 AFO's & Bracing

Question 1

AFO’s purpose

Answer 1

Couple the foot with the leg to improve its control

When mechanical control of the foot alone is inadequate

Question 2

Indications of AFO’s and bracings

Answer 2

Support and align the foot and leg
Prevent or correct a deformity
Substitute or enhance function
Decrease pain or discomfort

Question 3

Prefab pros

Answer 3

Off the shelf (take and go)

Ideal for trial or temporary use

Question 4

Prefab indication

Answer 4

Mild involvement

Question 5

Prefab cons

Answer 5

Limited fit for difficult size limb (S, M, L)

Minor modifications only

Question 6

Custom pros

Answer 6

Made from positive cast (reduced or corrected position)
Custom contoured fit (bony proeminences)
Anatomical design (neutral)
Articulation with fixed, free, assist or resistance-type motion
Biomechanical and innovative designs

Question 7

Custom goal

Answer 7

Stop excessive pronation or movement

Question 8

Indication for rigid/solid type AFO

Answer 8

To restrict or prevent sagittal plane ankle motion

Question 9

Indication for dynamic hinged type AFO

Answer 9

To allow partial or full sigittal plane ankle motion
Always begin with this type before going with solid. If it does the job, you get a less impeded gait that could cause other compensations.

Question 10

Types of AFO

Answer 10

Rigid/Solid
- Solid ankle polypropylene AFO
- Supra-malleolar orthosis (SMO)
- Total control orthosis (TCO)
Dynamic/Hinged
- Hinged polypropylene AFO
- Dynamic control orthosis
- Richie brace
Posterior leaf spring (PLS)
Charcot relief off weight (CROW) walker

Question 11

Solid ankle polypropylene AFO

Answer 11

Unibody 90°
Full length to prevent ankle pf and toes df
Indications :
Posterior tibialisis tendon dysfunction
Severe pronation problems
Spastic equinous (toe walker)

Question 12

Supra-malleolar orthosis (SMO)

Answer 12

More control than orthosis but less than AFO

Single or double upright

Question 13

Total control orthosis (TCO)

Answer 13

Total contact custom mold + leather and plastic foot orthosis
Very corrective and agressive
Indications :
Same than other solid AFO but more severe conditions Abnormal motion
More severe pronation in transverse and frontal plane

Question 14

Hinged polypropylene AFO

Answer 14

Articulated ankle + velcro closer

Often trim line posterior to malleoli

Question 15

Dynamic control orthosis

Answer 15

Variation of Richie Brace
Custom molded plastic
Prevent abnormal motion in frontal and transverse plane (no sagittal = hinged)
3 pressure points system in closed chain
- STJ : foot orthosis plate
- Tibia : meidal upright
- Fibula : lateral upright
Indications :
Ankle injuries and sprains

Question 16

Posterior leaf spring (PLS)

Answer 16

Polypropylene
No strap around ankle
5° dorsflexed at ankle
Taper portion of achilles tendon to provide spring effet to aid ankle dorsiflexion and gait
Indications :
Weak dorsiflexors (TA, LEO)
Foot drop

Question 17

Charcot relief off weight (CROW) Walker

Answer 17

Custom molded copolymer plastic with foam liner
Removable multidensity PPT/plastazole insole
Built-in rocker bottom sole
Optional patellar band
Indications :
Neuropathic ulceration
Secondary neuropathy
Charcot changes
Trauma, fractures
pre/post surgery