Tuesday, April 17, 2012

AFO: You can check out anytime you like, but can you ever leave?

I often get questions about ankle foot orthoses (AFOs), and how to get out of them. I'm not a big fan of AFOs because they encourage a sort of "learned nonuse." It's actually more like "learned disuse." (Learned disuse: You're not learning to not use the body part, but you learning to use body part incorrectly.) And keep in mind, every movement you make changes the way your brain is wired. So it's very easy to get used to an AFO. Let's put it this way:

It's easy to walk into an AFO. It's hard to walk out.

In any case, I get a lot of e-mails about this subject. Here's an example:
I wear a big brace on my right leg. I am paralyzed on the right side. I walk with a one-point cane. I walk with an open hinge (articulating) AFO.
They opened the hinges on my old brace several years ago. I walk around my apartment with the old one. But when I go out I use the bigger brace which isn't open at hinges.
I read on Deans' Stroke Musings that you recommend the Air Cast. Which one for stroke survivor do you like? They have a lot of different ones on their website.

Here's my answer:

First of all, the disclaimer:


Never discontinue the use of an orthotic without first consulting the appropriate health care provider. Then call your doctor. Then have your doc talk to any other providers as needed. Then discuss it some more. Thank you.)

Wear a brace on the ankle that satisfies two things:
1. Keeps you safe
2. Challenges* you

*Challenge: Walking naturally challenges you to lift your foot. If you can lift your foot up and down to stay safe (not trip) then you might consider questioning an orthotic that helps lift the foot.

Gradation would usually be something like this:
1. Rigid AFO
2. Articulating AFO (where the ankle joint moves just a little bit)
3. A stirrup (stabilizes both sides the ankle but allows the ankle to move up and down freely)
4. A high top shoe (like a basketball shoe)
5. Nothing

There are a wide variety of other options between a rigid AFO and barefoot. Here are some. a variety of products. Some help bring the ankle up during gait, others support the ankle. The stirrup is usually associated with one particular company: AirCast.



Kadima said...
This comment has been removed by the author.
Kadima said...

What about switching to Walkaide or Bioness?

Kadima said...

How about switching to a FES device like Walkaide or Bioness?

Peter G Levine said...


I'm a big fan of those technologies. They do well in clinical research. They may be a bit out of the scope of my blog entry. But maybe not...thanks for bring them up!

oc1dean said...

Pete, So is that like the Roach Motel? I'm still waiting for the roach killing video game.

Mike said...

i started with a hinged afo; wsitched toActive Ankle T2 Guard; then aircast. now no more support after the locomotor therapy and pedalling. took me a long time( 3 years to walk again with good balance and stability)i am now crossing the roads w/o fear.no fall since my afo days

Amy said...

I love this post!

Tamara said...

I started with an AFO 3 years ago and I hated the ugly thing, because I used to wear nice high heels all the time. Fortunately after about 7 or 8 months I found a great PT who gave me a malleoloc, after that I got a malleotrain. Now I'm wearing orthopaedic shoes, which aren't that bad as I used to think. I found a model online that were an option for me to wear, my doctor said, so I had them made after the image I found online.

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