AFO

[Paige Kelly]

Can we discuss use of posterior leaf spring, hinged, and solid AFOs?

[Sharon Manuel]

Paige, just curious if you are asking about when to use each?

[Helen Carey]

Orthoses are tough and not well covered in any of the major textbooks. You definitely want to know the function of each device, such as motions they block, motions they allow, etc. Posterior leaf spring is flimsy so designed to support foot drop; it won’t hold up to spasticity such as equinus/ankle PF posturing. Hinged and solid AFOs function primarily to block PF posturing, so are best in spastic situations. The hinge allows for ankle DF for functional tasks, such as squatting and descending stairs (plus forward advancement of the tibia during stance phase of gait). Do you have any specific questions?

[Paige Kelly]

Yes- asking when to use! Thank you, Helen!

But you can add a dorsiassist to a hinged AFO, correct?

[Nicole Viverito]

There are 2 really great AFO fact sheets that I found through APTA that do a nice job of laying out the info regarding the brace, what movement it limits/assists, and when to use them.

[Helen Carey]

Yes, the APPT has a fact sheet. That is why we didn’t do one.

Yes, a hinged AFO can have a posterior strap (usually D-ring with velcro) which can adjust the amount of DF allowed. That could be useful if the child crouches instead of posturing into PF.

[Helen Carey]

Best practice would indicate that you should use the least restrictive device possible, since devices add weight and bulk and can unintentionally hinder function (such as AFOs hindering crawling and sitting on the floor, but providing stability in stance). AFOs can sometimes assist with knee hyperextension in stance, depending on the child’s biomechanics and tone.

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