• Ankle-Foot Orthosis:


Foot-Ankle Controls. An ankle-foot orthosis (AFO) is commonly prescribed

to control impaired ankle/ foot func?on. These may include a custom-
molded polypropylene AFO (posterior leaf spring, modified AFO, or solid
ankle AFO), or conven?onal double upright/dual channel AFO. The least
restric?ve AFO is the posterior leaf spring (PLS) used to control drop foot.
An AFO of higher-density plas?c that 

covers more surface area can provide addi?onal control of calcaneal and
forefoot inversion and eversion. A solid ankle molded AFO provides
maximum stabiliza?on through its lateral trim lines that project more
anteriorly. Movement in all planes (dorsiflexion, plantarflexion, inversion,
and eversion) is limited. The conven?onal double upright metal AFO may
be indicated for pa?ents who cannot tolerate plas?c AFOs owing to
sensory impairments, girth fluctua?ons, or diabe?c neuropathy, or who
require addi?onal controls. A posterior stop can be added to limit
plantarflexion while a spring assist can be added to assist dorsiflexion
(Klenzak joint). Advantages of a conven?onal AFO include bePer
stabiliza?on of the ankle, allowing improved heel-strike and push-off.231
Disadvantages include heavier weight, less cosme?c appearance, and
increased difficulty donning and doffing. • Knee Controls. Knee instability
following stroke can be controlled with an AFO by adjus?ng the posi?on
of the ankle. An ankle set in 5° dorsiflexion limits knee hyperextension,
while an ankle set in 5° plantarflexion decreases the flexor moment and
stabilizes the knee during midstance. A pa?ent with knee hyperextension
without foot and/or ankle instability may benefit from the applica?on of a
Swedish Knee Cage or strapping to protect the knee. Extensive bracing
using a knee-ankle-foot orthosis (KAFO) is rarely indicated or successful.
The added weight and restric?ons in normal knee joint mo?on signifi-
cantly increase energy costs and limit independent func?on. The need for
an orthosis or a par?cular type of orthosis may change with con?nuing
recovery. The therapist may need to recommend a change in prescrip?on
or discon?nuing the use of a device. With limited reimbursements,
ordering a new orthosis may prove problema?c and speaks to the need to
an?cipate changes when ordering the ini?al device. For example, a good
op?on for the pa?ent who needs a custom-molded solid AFO is to order a
hinged AFO with a plantarflexion stop. As the pa?ent regains sufficient
knee and dorsi- flexor control, the device can be adjusted to remove the
stop and allow the hinges to work. Ortho?c training includes donning and
doffing, skin inspec?ons, and educa?on in safe use of the device during
gait. See Chapter 30, Ortho?cs, for a more complete descrip?on of
ortho?c devices, examina?on, and training.