| BRACE DESIGNS |
Plastic Orthoses
Plastic AFO’s are by far the most prescribed design. They are light weight, low profile, intimate fitting
and virtually invisible in long pants. You can achieve better control of motion and, if made correctly,
are tolerable if not comfortable. Some potential drawbacks are: limitation of footwear styles, possible
necessity of a slightly larger shoe, heat and hardness of footplate. Footplates can be padded, but
this typically requires a larger shoe. This is often unnecessary.
**It is important when fabricating plastic AFO’s, that rectifiable conditions be corrected in the
Orthosis. Orthoses fabricated in a mal-aligned, uncorrected position can lead to a rigid, difficult-to-
reduce deformity when worn for extended periods of time. Orthoses should be evaluated for proper
fit and function by prescribing physicians or treating therapists.
and virtually invisible in long pants. You can achieve better control of motion and, if made correctly,
are tolerable if not comfortable. Some potential drawbacks are: limitation of footwear styles, possible
necessity of a slightly larger shoe, heat and hardness of footplate. Footplates can be padded, but
this typically requires a larger shoe. This is often unnecessary.
**It is important when fabricating plastic AFO’s, that rectifiable conditions be corrected in the
Orthosis. Orthoses fabricated in a mal-aligned, uncorrected position can lead to a rigid, difficult-to-
reduce deformity when worn for extended periods of time. Orthoses should be evaluated for proper
fit and function by prescribing physicians or treating therapists.
| Leaf spring AFO, also called PLS AFO (posterior leaf spring) |
Solid Ankle AFO
Hinged AFO
| Supramaleolar AFO, SMAFO or SMO |
| Low Profile Hinged AFO (AKA “Ritchie Brace”) |
| The UCB, UCBL Orthosis (University of Cal., Berkley; University of Cal. Biomechanical Laboratories) |
This is the most prescribed AFO design. It is implicated
when motion needs to be limited as much as possible. It is
used to treat many chronic conditions like PTTD, arthritic
conditions of the foot and ankle, chronic achilles tendonitis,
charcot arthropathies, fractures, severe plantar fascitis,
and other conditions where midfoot, hidfoot, sub-talar and
talocrural motion is undesirable.
These are often used prior to ankle fusion as an indicator
for surgical outcome. Carbon inserts can be molded into
plastic for added rigidity, if indicated. Dynamic force straps
can be added to minimize valgus or varus conditions. Since
solid AFO's limit motion, toe clearance can be a concern;
however, this is often remedied by placing a 1/4" inch heel
lift in the opposite shoe.
This is also the most prescribed design for children with
disabilities. In spina bifida, they're used for stable support
in order to maintain axial alignment and protect joint
structure. In cases where spasticity or high tone is an
issue, as is often seen in children with CP, these are made
with tone reducing footplates and padded instep straps to
maintain neutral alignment and prevent contractures from
developing. These children often need surgery to correct
equinus contractures that won't be corrected through
conservative measures.
when motion needs to be limited as much as possible. It is
used to treat many chronic conditions like PTTD, arthritic
conditions of the foot and ankle, chronic achilles tendonitis,
charcot arthropathies, fractures, severe plantar fascitis,
and other conditions where midfoot, hidfoot, sub-talar and
talocrural motion is undesirable.
These are often used prior to ankle fusion as an indicator
for surgical outcome. Carbon inserts can be molded into
plastic for added rigidity, if indicated. Dynamic force straps
can be added to minimize valgus or varus conditions. Since
solid AFO's limit motion, toe clearance can be a concern;
however, this is often remedied by placing a 1/4" inch heel
lift in the opposite shoe.
This is also the most prescribed design for children with
disabilities. In spina bifida, they're used for stable support
in order to maintain axial alignment and protect joint
structure. In cases where spasticity or high tone is an
issue, as is often seen in children with CP, these are made
with tone reducing footplates and padded instep straps to
maintain neutral alignment and prevent contractures from
developing. These children often need surgery to correct
equinus contractures that won't be corrected through
conservative measures.
There are many variations of the hinged AFO. Most
prescribed is the hinged AFO with a 90 degree PF
stop. They can also be made in free (FROM, full range
of motion) ankle, free ankle with DF assist joints
(available in different durometers and strengths),
and DF assist with a PF stop. All these designs can
be modified/customized even further by manipulating
plastic trimlines, strapping and plastic thickness.
These are prescribed based on the patient's
capabilities, disabilities or deficits, daily activities and
prognosis.
An AFO can be made to take into consideration
expected gains in mobility and strength. For
example, a patient that has recently suffered a
stroke and is recuperating nicely would be ready for
gait training but may have a difficult time due to the
hemi-plegia. His foot tends to go into an equinovarus
position in stance and gait and extensor tone may be
present. At this time he would benefit most from a
solid ankle AFO and a 1/4" inch lift in the opposite
shoe to aid in limb advancement. Since this patient
has been making significant progress, you feel it
won't be long before he'll be ready for a hinged AFO.
The AFO can be made with hinges incorporated, but
the plastic is not cut until the patient is ready for
that design. We simply transform the Orthosis in a
few minutes in the machine room once the patient is
ready for motion. This option must be ordered up
front as a simple solid AFO cannot be made hinged
after the fact. Communication between the rehab
team is essential to achieve optimal outcomes. A
good Orthotist can be an invaluable member of the
team. He should be well versed in design
recommendation based on stated or demonstrated
strengths, weaknesses, abilities, goals and pertinent
medical history. We get to design and build little
works of art that hopefully improve a person's life.
prescribed is the hinged AFO with a 90 degree PF
stop. They can also be made in free (FROM, full range
of motion) ankle, free ankle with DF assist joints
(available in different durometers and strengths),
and DF assist with a PF stop. All these designs can
be modified/customized even further by manipulating
plastic trimlines, strapping and plastic thickness.
These are prescribed based on the patient's
capabilities, disabilities or deficits, daily activities and
prognosis.
An AFO can be made to take into consideration
expected gains in mobility and strength. For
example, a patient that has recently suffered a
stroke and is recuperating nicely would be ready for
gait training but may have a difficult time due to the
hemi-plegia. His foot tends to go into an equinovarus
position in stance and gait and extensor tone may be
present. At this time he would benefit most from a
solid ankle AFO and a 1/4" inch lift in the opposite
shoe to aid in limb advancement. Since this patient
has been making significant progress, you feel it
won't be long before he'll be ready for a hinged AFO.
The AFO can be made with hinges incorporated, but
the plastic is not cut until the patient is ready for
that design. We simply transform the Orthosis in a
few minutes in the machine room once the patient is
ready for motion. This option must be ordered up
front as a simple solid AFO cannot be made hinged
after the fact. Communication between the rehab
team is essential to achieve optimal outcomes. A
good Orthotist can be an invaluable member of the
team. He should be well versed in design
recommendation based on stated or demonstrated
strengths, weaknesses, abilities, goals and pertinent
medical history. We get to design and build little
works of art that hopefully improve a person's life.
| Hybrid AFO |
The SMAFO is a low profile design that is
primarily used in children, but can be an
effective tool for use in adults as well.
These are typically used to treat varus and
valgus deficiencies of the ankle, pes
planovalgus, hypotonia and toe walking in
children (when made with a plantarflexion
block). This low profile design is popular with
physical therapists that typically prefer minimal
intervention as it doesn't interfere much with
muscular function.
It's primary function is to maintain axial
alignment in stance and gait. When metatarsus
ab/adductus is present, they are made with
long medial or lateral trimlines. The standard
design allow full range of motion in PF and DF.
primarily used in children, but can be an
effective tool for use in adults as well.
These are typically used to treat varus and
valgus deficiencies of the ankle, pes
planovalgus, hypotonia and toe walking in
children (when made with a plantarflexion
block). This low profile design is popular with
physical therapists that typically prefer minimal
intervention as it doesn't interfere much with
muscular function.
It's primary function is to maintain axial
alignment in stance and gait. When metatarsus
ab/adductus is present, they are made with
long medial or lateral trimlines. The standard
design allow full range of motion in PF and DF.
This is a very dynamic design most often used to treat
weak dorsiflexors of the foot such as drop foot, peroneal
palsy and in some cases of Charcot-Marie-Tooth disease.
This design allows the foot to plantarflex at heel strike,
provides good mediolateral stability in stance, facilitates
toe clearance in the swing phase of gait and gives good
plantar proprioceptive feedback. These are typically made
in slight, 3-5 degrees, dorsiflexion.
weak dorsiflexors of the foot such as drop foot, peroneal
palsy and in some cases of Charcot-Marie-Tooth disease.
This design allows the foot to plantarflex at heel strike,
provides good mediolateral stability in stance, facilitates
toe clearance in the swing phase of gait and gives good
plantar proprioceptive feedback. These are typically made
in slight, 3-5 degrees, dorsiflexion.
| Patellar Tendond Bearing AFO (PTB AFO) |
The PTB AFO is designed to transfer weight from the
foot/ankle complex to the patella tendon as well as
through hydrostatic compression, the calf area.
This orthosis is prescribed to treat chronic or acute
conditions of the foot and/or ankle where weight
bearing in contraindicated. When fabricated correctly,
this orthosis can unload as much as 90% of the load
typically borne the distal tibia, talus and heel.
This is a difficult orthosis to fabricate and have
actually met very few practitioners able to fabricate it
properly. I discovered a unique method of fabrication
which has proven to be very effective. Before I fill the
cast with plaster, I cut it horizontally above the ankle
at its narrowest point. I then separate the cast, reseal
it, then fill with plaster. The shape of the calf gets
larger as it goes up the leg. By separating the cast,
the belly of the calf muscle is held in place 1/2" higher
than usual through hydrostatic compression and
doesn't allow the heel to touch bottom. Over time
there will be volume changes which may necessitate
adding 3 or 5 ply socks to calf area or adding padding
inside the brace to maintain a snug fit.
The PTB AFO is typically made in two designs, full
plastic or as a double upright orthosis with a stirrup
attached to the shoe and metal uprights attached to a
plastic calf section. This design is indicated when
plastic around the ankle is contraindicated, such as
the presence significant fluctuating edema or to
accommodate dressings. Patient education is critical to
success.
foot/ankle complex to the patella tendon as well as
through hydrostatic compression, the calf area.
This orthosis is prescribed to treat chronic or acute
conditions of the foot and/or ankle where weight
bearing in contraindicated. When fabricated correctly,
this orthosis can unload as much as 90% of the load
typically borne the distal tibia, talus and heel.
This is a difficult orthosis to fabricate and have
actually met very few practitioners able to fabricate it
properly. I discovered a unique method of fabrication
which has proven to be very effective. Before I fill the
cast with plaster, I cut it horizontally above the ankle
at its narrowest point. I then separate the cast, reseal
it, then fill with plaster. The shape of the calf gets
larger as it goes up the leg. By separating the cast,
the belly of the calf muscle is held in place 1/2" higher
than usual through hydrostatic compression and
doesn't allow the heel to touch bottom. Over time
there will be volume changes which may necessitate
adding 3 or 5 ply socks to calf area or adding padding
inside the brace to maintain a snug fit.
The PTB AFO is typically made in two designs, full
plastic or as a double upright orthosis with a stirrup
attached to the shoe and metal uprights attached to a
plastic calf section. This design is indicated when
plastic around the ankle is contraindicated, such as
the presence significant fluctuating edema or to
accommodate dressings. Patient education is critical to
success.
This design functions similarly to the PTB AFO. We cut and
separate the cast the same as with the PTB AFO.
In this design the trimlines are approx. 1 1/2" below the
head of the fibula. This Orthosis relies solely on hydrostatic
compression of soft tissue to unweigh the distal tibia, talus
and calcaneus. In this design we use very thin
polypropylene and modify the model for total contact. It
wraps around the entire leg. We add a thin tongue and hold
it together with 5 velcro straps. This design fits in more
shoes and is as effective or even more effective than the
PTB AFO. This can be somewhat difficult to don and patient
education and selection are important.
This design is also not as durable as the PTB AFO. This
orthosis will last up to 6 months and should only be used to
treat healing conditions like talus, calcaneus, distal tibia
fractures, avascular necrosis, charcot joint, tibial stress
fractures, shin splints. This is one amazing orthosis when it
comes to removing weight to allow healing and weight
bearing.
separate the cast the same as with the PTB AFO.
In this design the trimlines are approx. 1 1/2" below the
head of the fibula. This Orthosis relies solely on hydrostatic
compression of soft tissue to unweigh the distal tibia, talus
and calcaneus. In this design we use very thin
polypropylene and modify the model for total contact. It
wraps around the entire leg. We add a thin tongue and hold
it together with 5 velcro straps. This design fits in more
shoes and is as effective or even more effective than the
PTB AFO. This can be somewhat difficult to don and patient
education and selection are important.
This design is also not as durable as the PTB AFO. This
orthosis will last up to 6 months and should only be used to
treat healing conditions like talus, calcaneus, distal tibia
fractures, avascular necrosis, charcot joint, tibial stress
fractures, shin splints. This is one amazing orthosis when it
comes to removing weight to allow healing and weight
bearing.
| Wraparound AFO |
The UCB fits below the ankle and is typically used to
treat calcaneal alignment and support the arches of
the foot.
It is mainly ordered for pes planovalgus,
talocalcaneal varus and, when extended, lateral or
medial trimlines can be used to treat metatarsus
ab/adductus. These are also used to treat the
hypotonic foot as seen in many Down's Syndrome
patients. These are often not covered by insurances.
treat calcaneal alignment and support the arches of
the foot.
It is mainly ordered for pes planovalgus,
talocalcaneal varus and, when extended, lateral or
medial trimlines can be used to treat metatarsus
ab/adductus. These are also used to treat the
hypotonic foot as seen in many Down's Syndrome
patients. These are often not covered by insurances.
This design is often used to treat valgus, varus,
pronation and supination issues of the foot and
ankle. It is similar to the SMAFO in it's function
and indications. It is a little less limiting than the
SMAFO as is most often used in the adult
population.
pronation and supination issues of the foot and
ankle. It is similar to the SMAFO in it's function
and indications. It is a little less limiting than the
SMAFO as is most often used in the adult
population.
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This design is a combination of a double upright
AFO with plastic componentry. This design
offers the adjustability and strength of metal and
the intimate fit of molded plastic. There are dual
channels in the stirrup which allows us to
AFO with plastic componentry. This design
offers the adjustability and strength of metal and
the intimate fit of molded plastic. There are dual
channels in the stirrup which allows us to