Ankle foot orthotics (AFOs) are customised, carefully prescribed braces that are applied to the foot, ankle and lower leg to best help support a person during their care for a range of conditions and injuries. By carefully cradling the foot and ankle and keeping it in a fixed position, AFOs can help the lower leg overcome weakness and instability while controlling movement to help reduce pain, improve comfort, and support recovery from injury.

Our AFOs are highly popular in our patients with neurological conditions, including

Charcot Marie Tooth Disease, Cerebral Palsy, those recovering from a stroke, and more. They are used extensively in both adults and children, and are custom-made, meaning that they are prescribed and designed uniquely for your feet using a 3D scan. This means you get a well-fitted and functional device with the right specifications for your unique circumstances.

Which Conditions Require Ankle Foot Orthoses?

When certain criteria are met, we use AFOs in the management of conditions affecting both children and adults, including:

• Foot drop 
  
• Posterior tibial tendon dysfunction (PTTD)
  
• Neuropathy (either as a result of diabetes or another cause)
  
• General muscle weakness
  
• Nerve damage (such as after an accident)
  
• Arthritis
  
• Cerebral palsy
  
• Multiple sclerosis
  
• Stroke
  
• Tendinopathies in the feet and legs
  
• Recurrent falls
  
• Ankle instability or weakness
  
• Severe pain
  

AFOs have a very significant effect on the foot and ankle, with the potential to greatly influence (and optimise) movement. For some people, they will be a first-line treatment to support their gait, independence and quality of life. For others, they may try other treatments first and then move to an AFO if the nature of their condition means that progress has not been made as expected.

How Do Ankle Foot Orthotics Work?

As your AFO with us is custom-made, it works in the specific ways we prescribe it to, based on the problem you are facing and the unique characteristics of your feet, ankles and legs. This varies for each person, but generally, all AFOs will function to control and support movement and stabilise the foot and ankle, alongside in-built features that can offload certain areas when standing on the device. The ultimate goal of wearing an AFO is to support stable, steady and fluid movement, so you can keep doing the things you love and maintain as much independence as possible.

For those with foot drop or muscle weakness, the AFO brace will keep the foot in a neutral position where the foot doesn’t drop, so the patient can keep walking comfortably without hitting their toes on the ground and risking a trip - or without having to hitch their hip up to clear the ground which can lead to other pains and problems. For others, keeping painful joints or tendons stable can assist the healing and repair process, preventing further damage. Other conditions like posterior tibial tendon dysfunction can benefit from AFOs by helping prevent the condition from progressing.

Benefits Of Foot Ankle Orthotics

In our experience, our patients who have opted for AFOs due to the nature of their condition have yielded great benefits, including that they:

• Reduce pain and reduce fatigue by redistributing forces and pressures on the foot and ankle
  
• Allow you to stay weight-bearing and promote a more natural gait pattern by supporting weakened or unstable muscles and joints.
  
• Can help prevent the development of foot deformities or contractures by maintaining proper alignment and joint range of motion. They can counteract muscle imbalances or tightness, preventing the progression of conditions such as an equinus contracture.
  
• Enhance strength and stability, controlling the forces on the feet and legs.
  
• Are more lightweight than old-style AFOs, making them the best suited for everyday life and comfort
  
• Significantly reduce the risk of pressure sores and allow for calf expansion through their custom-design
  
• Have a low profile, meaning they’re generally less bulky than a traditional AFO
  
• Promote air flow and comfort
  
• Are highly customisable, both during the design process and after fitting
  
• Can effectively address multiple foot complaints at once

Types Of Ankle Foot Orthotics

We offer several types of ankle foot orthotics across our Brisbane and Newmarket clinics, and can work with you to help you get the best device for your foot condition or ailment. Some of our range include:

UCBL

The ‘UCBL’ is a firm orthotic device designed to provide maximum support and control for individuals with significant foot and ankle instability, or other deformities. It features a deep heel cup, a flange on both sides of the device, and a full-length footplate that extends to just before the ball of the foot. The UCBL effectively restricts excessive pronation (rolling in) and supination (rolling out) of the feet and ankles while maintaining better alignment and stability. It is commonly prescribed for conditions such as severe flatfoot, cerebral palsy, significant ankle instability, or other neurological disorders that require substantial control and correction.

Supramalleolar Orthosis (SMO)

The SMO is a lightweight and flexible AFO that offers support and stability around the ankle joint. It typically covers the ankle and extends just above it. In our clinics, we use the Surestep SMO, which is designed to provide stability to both sides of the foot and ankle through compression while allowing normal foot and ankle development in growing children. It is commonly used for children with conditions like flexible flatfoot, low muscle tone, mild to moderate ankle instability, and other balance issues. The SMO allows for some range of motion while providing support and alignment.

Posterior Leaf Spring AFO

The Posterior Leaf Spring AFO is a dynamic AFO that consists of a thin, flexible leaf spring that runs along the posterior aspect of the lower leg. It is primarily used for individuals with weak or paralysed dorsiflexor muscles (muscles responsible for lifting the foot). The leaf spring assists in ankle dorsiflexion during the swing phase of gait, helping individuals clear the foot while walking and preventing foot drop. This type of AFO is lightweight, promotes a more natural gait pattern, and allows for some ankle plantarflexion (allowing the foot to point downwards somewhat).

Solid AFO

The Solid AFO is a rigid orthotic device that provides maximal control and immobilisation of the foot and ankle. It is typically made from a solid thermoplastic or composite material that encloses the foot and extends along the calf. The Solid AFO is prescribed for conditions that require extensive support, such as severe ankle instability, spasticity, ligament injuries, valgus/varus deformities - and even when other foot problems are accompanied by mild knee instability. It greatly restricts ankle and subtalar joint (where the ankle meets the heel bone) motion, providing stability and preventing unwanted movements.

Articulated AFO (Free Ankle AFO)

The Articulated AFO, also known as the Free Ankle AFO, combines the stability of a solid AFO with the added advantage of ankle joint mobility. It consists of two components: a rigid section supporting the calf and a hinged ankle joint allowing controlled ankle motion. The Articulated AFO is often prescribed for individuals who require both stability and limited ankle range of motion, such as those with mild posterior tibial tendon dysfunction, mild degenerative arthritis, subtalar joint instability, foot drop, severe flat foot, or those who have suffered trauma-related injuries.

Plantarflexion Stop or Dorsiflexion assist AFO

The plantarflexion (PF) stop or dorsiflexion (DF) assist AFOs are specialised devices designed to address specific gait abnormalities or muscle imbalances. 

• A PF Stop AFO prevents unwanted plantarflexion (pointing the foot downward), while permitting free dorsiflexion (lifting the foot upward). It is commonly prescribed for patients with weak dorsiflexor muscles or those who have drop foot. It can also be used to treat tight plantar flexor muscles, peroneal nerve paralysis and knee hyperextension.
  
• A DF Assist AFO assists with dorsiflexion, aiding in dorsiflexion during the swing phase of gait for increased toe clearance and safety. It also has passive plantar flexion resistance, and allows for smooth plantarflexion from when the heel first touches the ground to when the foot is firmly flat on the ground, while also supporting knee stability. This type of AFO is used to optimise gait mechanics and address conditions like drop foot, where there is difficulty lifting the foot while walking.

Floor Reaction AFO

The Floor Reaction AFO utilises a combination of rigid components and flexible joints. It is designed to improve knee control, providing stability and aid in knee extension during the stance phase of gait, where a person is weight bearing (standing) on the affected leg. The Floor Reaction AFO works by transferring ground reaction forces from the foot to the thigh, assisting in knee extension and preventing knee buckling. It is commonly prescribed for individuals with quadriceps weakness or knee instability, helping to improve gait and maintain stability during weight-bearing activities.

Ankle Foot Orthotics Assessment 

Getting an AFO starts with a comprehensive assessment to ensure an AFO is a good choice for your condition, symptoms and goals. This involves a detailed history, a comprehensive physical assessment and testing, and a video gait analysis with an in-shoe pressure analysis where suitable. Your podiatrist will discuss all of your options from the results of an analysis, including what role an AFO could play and what you can expect from an AFO under your circumstances in the long-term.

Ankle Foot Orthotics Measurement

If you and your podiatrist agree that an AFO is the right choice for you, the next step is having measurements completed. This may involve testing for muscle strength and flexibility, range of motion testing, a foot posture index and more. An accurate impression of your foot and ankle are then taken, which has traditionally been done using casting, but that we now capture using innovative 3D scanning. Paired with the results of your gait analysis, this gives your podiatrist all of the information they need to create your AFO prescription, selecting the best design and style to match your needs and activity levels. The final part of the equation is helping you select the best shoe to be worn with your AFO, whether that is one that you already have, or one that we recommend and order in for you at the time of your appointment. 

Ankle Foot Orthotics Fitting

Once your AFO has been created and delivered, it must be fitted by your podiatrist. The fitting process ensures that the device is the right fit for your foot and ankle, while teaching you everything you need to know about how to put on and wear your AFO. Sometimes, your AFO may need some slight adjustments to have it feeling maximally comfortable on your feet, which is where we can help. We’ll also check how your AFO is working together with your shoe.

Do I Need To Wear My Ankle Foot Orthoses All The Time?

This all depends on the nature of your condition and your symptoms. For many of our patients, they find it difficult to walk comfortably without their AFO, or feel unsteady and are more vulnerable to injury. Hence, they wear their AFO’s as much as possible to help them move with confidence, and improve their ability to complete every day activities. 

When discussing whether an AFO is right for you, this is something your podiatrist will give you advice on based on your unique circumstances, so you will have a better idea of what having an AFO will look like for you on a day-to-day basis.

Visit one of our Brisbane Podiatry clinics

If you would like to talk to one of our team, visit us at one of two Brisbane based locations, CBD & Newmarket.

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