Ankle Foot Orthosis
Ankle Foot Orthosis (AFO):Are designed to offer maximum stability and support to the ankle foot complex. The A.F.O’s resist all movement allowing no planterflexion or dorsiflexion, and hence hold the foot in the position that it was cast in.
By maintaining total intimate contact the ‘point’ pressure, and hence rubbing is reduced.
The A.F.O’s are most commonly made of Polypropylene, Homopolymer and Subortholon.
They are used for any condition where the foot/ankle complex requires stabilisation.
Hinged A.F.O’s were developed to overcome the problems created by using fixed A.F.O’s. Although fixed AFO’s controlled the foot it also meant all ankle movement was totally lost and prevented the child developing a true symmetrical gait pattern, making walking up a slope , climbing stairs and moving from sitting to standing extremely difficult.
A simple hinge lined up with the anatomical ankle joint allows the foot to Dorsiflex freely whilst controlling planterflexion and lateral movements of the ankle and foot.
There is now a large variety of joints available each one having different properties, allowing the hinged AFO to be far more effective.
By adding an adjustable motion stop (back stop), the amount of plantar-flexion can be further ‘fine tuned’. This refinement also allows more effective control of the knee allowing moderate Hyperextension to be controlled.
Hinged AFO’s are most commonly made of Polypropylene (coloured or white), or Homopolymer.
HAFO’s are used for a variety of conditions, most commonly for Cerebral Palsy, be it hemiplegic or diplegic. But are also used as ‘night-splints’ as they allow the amount of stretch to be increased gradually without different splints being made.
The Anterior Floor Reaction Orthosis, (A.F.R.O), is a variant of the standard fixed A.F.O, which was modified to allow greater control of the knee.
The plastic extends around the front of the leg, covering the Tibial tuberosity and the Patella. By ensuring contoured shaping a corrective force can be applied to ‘push’ the knee back into extension and hence improve the crouched gait pattern with conditions such as cerebral palsy.
Sustentaculum-Tali-Correction: When a foot is placed into an Orthosis if the foot moves pressure and rubbing results, to alleviate this whilst offering increased control the ‘Sust-Tali’ correction method was created.
As the Orthotist casts the foot, ‘he’ cups the calcaneous, pushing the Thenar prominence into the medial aspect of the calcaneous and distal to it’s mid-line, this ensures a good primary heel shaping.
At the workshop after initial rectification the primary heel shaping is increased to increase the heel grip.
Firm pads can be added to the medial aspect to increase the ‘grip’.
Sustentaculum - Tali correction can be added to virtually any type of foot Orthosis, but the patient must be fully assessed due to Sust-Tali correction applying a ‘high level’ corrective force.
Neuro-Physiological Footplates: This ‘shaping’ is most commonly used with Dynamic Orthotics but can be used in fixed and hinged A.F.O’s.
The specific shaping is vital to improve stability and reduce tone. ‘Sunken’ areas for the metatarsal head pad area and calcaneous pad provide stability of these crucial forefoot and rearfoot areas. Active support of logitudinal, metatarsal and perineal arch systems, as well as under the toes provide a combination of neutral stability and inhibitive forces to achieve maximum activation of normal postural control.