AFO TYPES AND CONSIDERATIONS

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AFO/Description Benefits Considerations Key AFO Design Examples

that May Limit Considerations
Success
Solid or Rigid o ↑ DF in swing o Desire to allow o Material strength provides ↑ Solid AFO
Provides rigid o Adjustability of stiffness volitional muscle motion restriction & ankle o Anterior trimlines
support of ankle in by changing trimlines activation control o Thicker materials
desired position o ↑ stance phase knee o ↓ ankle PROM o ↑ AFO stiffness may lead o Fixed at ankle in slight PF,
that has flexion or extension by o Bulk & weight of to ↑ knee flexion at IC neutral, or DF based on
implications for restricting ankle motion AFO control needed
o Anterior trimlines ↑ ankle
knee control o ↓ equinovarus in stance o Desire for
control & AFO rigidity
o Possible ankle control allowing ankle DF
o AFO set in DF leads to knee
with PF spasticity during functional
flexion in stance
o ↑ static balance mobility
o AFO set in PF leads to knee
extension in stance
o ↑ AFO stiffness may ↑ knee
flexion at IC

Ground Reaction o ↑ DF in swing o Genu recurvatum o Anterior proximal contact of Ground Reaction AFO
Provides knee o Strong stance phase knee o Strong AFO leads to stance phase o Fixed at ankle in slight PF
stability through a flexion control hyperextension knee extension o Anterior shell for added tibial
posteriorly directed o Possible↑ gait speed if a thrust in stance o ↑ AFO stiffness may ↑ knee control
force on the soft heel or rocker sole is o Quadriceps flexion at IC o Carbon or plastic options
proximal tibia added to the shoe spasticity o AFO set in PF leads to knee
o ↑ static balance o Bulk & weight of extension in stance
AFO

Semirigid o ↑ DF in swing o PF spasticity o Material property choices Semirigid AFO

Provides varying o Adjustability of stiffness (≥MAS 3) restrict or allow motion o More posterior trimlines
degrees of rigidity by changing trimlines o ↓ strength or o AFO set in DF leads to knee o Ankle in slight PF, neutral, or
based on design & o ↑ stance phase knee control of the flexion in stance DF based on control needed
materials used flexion or extension by ankle or knee o AFO set in PF leads to knee o Some ankle motion allowed
limiting ankle motion muscles extension in stance based on material thickness
o ↑ gait speed if AFO has o Equinovarus and flexibility
o Anterior trimlines ↑ ankle
fewer restrictions to control & AFO rigidity
movement o Posterior trimlines ↓ ankle
o May ↑ dynamic balance control & AFO rigidity
based on design

Copyright Academy of Neurologic Physical Therapy, printed in Journal of Neurologic Physical Therapy: April 2021-Volume 45 – Issue 2 – p112-196 ANPT Knowledge Translation Task Force: Elizabeth Cornforth, PT, DPT,
NCS; Bobbette Miller, DPT, NCS; Therese Johnston, PT, PhD; Lisa Brown, PT, DPT, NCS; Andrea Ecsedy, PT, DPT, NCS; Megan Greenwood, PT, DPT, MSPT, NCS, PCS; Ryan Koter, PT, DPT; Suzanne O'Neal, PT, DPT, DHSc, NCS;
Katherine Sweet, PT, DPT, NCS; Daniel Miner, PT, DPT
Flexible/ o PF spasticity o Material properties allow Posterior Leaf Spring AFO www.neuropt.org
o ↑ DF in swing
Posterior Leaf o Lightweight (≥MAS 3) motion o Most posterior trimline
Spring Provides o Pre-fabricated options o ↓ strength or o Posterior trimlines ↓ ankle o More ankle motion allowed
varying degrees of o ↑ gait speed control of the control & AFO rigidity due to material flexibility
flexibility based on ankle or knee o Minimal to no mediolateral
design & materials muscles ankle support
used o ↓ dynamic o Minimal to no effect at the
balance knee

Articulating o ↑ DF in swing o PF spasticity o Hinges allow motion Double Metal Upright AFO
Provides varying o Adjustable as patient’s (≥MAS 3) o Stops restrict motion o DF & PF stops set by adjusting
degrees of motion needs change o ↓ ankle PROM o AFO set in more DF leads screws/bars in each channel
at the ankle through o Allows for volitional o Bulk & weight of to ↑ knee flexion in stance o Springs can be added for DF
hinges with optional muscle activation AFO o AFO set in more PF leads to assist
stops to limit ROM o ↑ stance phase knee o ↓ medial/lateral ↑ knee extension in stance o Good option with edema & to
if desired flexion or extension by ankle stability allow modifications with
allowing or restricting recovery
ankle motion
o ↓ equinovarus in stance Articulating Plastic AFO
with design that o Many options for hinge types
encompasses more of the o DF & PF stops achieved by
ankle straps, hinge types, and/or
materials abutting
o ↑ gait speed if AFO has
o Good option to allow
less motion restrictions
modifications with recovery
o ↑ static balance if AFO
has more motion
restrictions
Dynamic o ↑ DF in swing o PF spasticity o Material property and/or Carbon fiber AFO
Enhances or resists o ↑ Push-off force (≥MAS 3) spring choices assist, restrict o Stores & releases force for
ankle motion while o Allows for volitional o Equinovarus or allow motion push-off
allowing some muscle activation o Knee buckling o AFO set in DF leads to knee o Minimal medial/lateral
motion and/or o Possible ↑ stance phase o Genu recurvatum flexion in stance support at ankle
energy storage knee flexion or extension o ↓ ankle PROM o AFO set in PF leads to knee o Minimal to no adjustability
by supporting sagittal extension in stance
plane ankle motion Articulating AFO, DF assist
o Possible ↓ equinovarus in o Free DF with some DF assist
stance with design that from this hinge
encompasses more of the o PF stop created by contact of
ankle shells posteriorly
o ↑ gait speed o Pin or longer shells can be
used posteriorly for more PF
restriction
Copyright Academy of Neurologic Physical Therapy, printed in Journal of Neurologic Physical Therapy: April 2021-Volume 45 – Issue 2 – p112-196 ANPT Knowledge Translation Task Force: Elizabeth Cornforth, PT, DPT,
NCS; Bobbette Miller, DPT, NCS; Therese Johnston, PT, PhD; Lisa Brown, PT, DPT, NCS; Andrea Ecsedy, PT, DPT, NCS; Megan Greenwood, PT, DPT, MSPT, NCS, PCS; Ryan Koter, PT, DPT; Suzanne O'Neal, PT, DPT, DHSc, NCS;
Katherine Sweet, PT, DPT, NCS; Daniel Miner, PT, DPT
 www.neuropt.org

References:
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