An orthosis is an appliance for any part of the body that serves to support, align, prevent or correct deformities of a body part, or to improve the function of moveable parts of the body. An AFO supports the entire foot and ankle complex, affecting the motion of the entire body. The AFO provides a means of controlling or eliminating abnormal ankle and/or foot motion. By controlling the entire ankle and foot joint complex, a solid AFO places the ankle and foot in the most neutral position possible. Usually the AFO is worn with a flat heel/sole shoe such as an athletic shoe. The goal of any AFO is to support and control the ankle and foot complex so that the deformation of the foot structure is prevented or corrected and to improve the ability of an ambulatory patient to stand and/or walk.
Who wears AFOs?
Most patients who require AFOs have neuromuscular (nervous system and brain) problems resulting from a variety of disorders, including cerebral palsy, spinal bifida, Down syndrome, or head injuries and stroke. The problems associated with these disorders are caused by damage or malformation of the neural systems that control the movement of the muscles and/or provide sensory information about position and movement.
For the neurologically involved patient, the process of development may have been partially or substantially disrupted. Muscle strength or movement has been compromised, inhibiting the development of the skills required for standing and walking. Without normal daily use of the legs and feet, muscles remain underdeveloped and weak. Tendons and ligaments are not stretched and strengthened by the activity of walking. The bones, dependent on the strength of the muscles, tendons and ligaments to hold their structures together, become misaligned.
AFOs may be required to assist with muscle imbalances resulting in abnormal walking pattern, abnormal positioning of the feet, or to provide improved positioning and support to enhance performance and balance, while preventing abnormal contractures. Since AFOs are a specific, individual, custom molded appliance, an AFO must be prescribed by a medical practitioner, such as an MD, physical therapist or podiatrist. However, for an AFO to be effective, the patient must be willing to wear it. For certain individuals with skin sensitivity issues, special considerations can be made to cushion the AFO to protect pressure-sensitive areas.
How can I get AFOs?
Each patient is an individual, requiring a brace that addresses their specific functional challenges and goals. For this reason, most patients are “cast” for orthotics, so each AFO is a custom fit for that particular individual. Casting is done by a physician, physical therapist, or podiatrist and consists of applying a simple cast to the foot, ankle and lower leg, allowing it to dry for approximately 15 minutes, then removing the cast. The cast is then sent to an orthotist, who designs and fabricates the AFOs. The AFOs are then sent back to the physician, physical therapist, or podiatrist who fits the child with the new AFO and evaluates fit and performance during activities. As a child with physical challenges grows, changes, and achieves functional goals, their requirements for medical equipment also changes. Depending on each individual child’s growth and development needs, AFOs can easily be replaced with a new AFO.
AFO’s Ankle Foot Orthoses, By: Daryn Burgdorf, MPT
Published: March 4, 2007 © Carolina Pediatric Therapy
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