When ever it comes to treating patients, there are many shades of gray. However, for simplicity, let’s break things down to black and white for a moment.
In physical therapy, when working with any patient we generally approach their rehab in one of two ways:
- Recovery (or full return to activity, wellness, motion, etc)
- Compensatory (if a person will not ever return to full activity).
Now there are many reasons for the latter and sometimes people move between spectrums (remember that gray?). However, there are many tools that can help individuals to compensate for less than optimal physical performance, be it temporarily while they are healing (crutches on a broken leg) or something more permanent (a wheelchair for an individual with a spinal cord injury).
My studying today focused on a type of compensatory strategy we use in physical therapy: Orthotics. Specifically:
Ankle-Foot Orthosis (AFO)
There are many types of AFOs and they are applied to control position and motion of the ankle, compensate for weakness, or correct deformities.
Our Alien friend above presents with foot-drop (or the inability to hold up the front of his foot while walking)…do my PT friends remember the best kind of AFO for him?
- Posterior Leaf Spring : with a trim line posterior to the malleoli (ankle bones). It assists with dorsiflexion but requires the patient to have medial lateral control.
For those very curious (or perhaps also studying for the boards), here are some more notes on other types of AFOs:
Metal AFOs consists of 2 metal uprights connected proximally to a calf band and distally to a mechanical ankle joint and shoe.
- Ankle joint may have the ability to be locked and not allow any motion, or set to have limited anterior / posterior capability depending on patients need.
Plastic AFO is fabricated by a cast mold of the patient’s leg.
- More cosmetic & lighter
- Requires that if a patient presents with edema it doesn’t significantly fluctuate.
- Proper fitting requires pt be casted in subtalar neutral
- Footplate can be incorporated to assist with tone reduction.
Solid AFOs control dorsiflexion and plantarflexion and also inversion and eversion with a trim line anterior to the malleoli.
Can be fabricated to keep ankle positioned at 90° or with articulating joint:
- Articulation allows tibia to advance over the foot during the mid – late stance of gait.
Posterior Leaf Spring – plastic AFO with a trim line posterior to malleoli
Assist with dorsiflexion and prevent foot drop
Requires Medial Lateral Control by patient
Floor Reaction AFO
- Can also influence knee control: assists with knee extension during stance through positioning of a calf band and or positioning at the ankle.