ORTHOSES-PRESCRIPTIONS
SUMMARY
FOOT DROP
1. Custom non-hinged plastic AFO set in a few degrees of dorsiflexion with a posterior trim line (posterior leaf spring AFO). It helps the ankle “spring” into dorsiflexion after the foot is lifted off the ground in a plantar-flexed position from pushoff.
2. If there is significant subtalar joint instability a hinged plastic AFO with metal double-action ankle joints with springs in the posterior channels (dorsi-assist) would provide mediolateral stability yet also permit plantar flexion.
PLANTAR SPASTICITY
3. Hinged custom plastic AFO with a single midline posterior stop or a hinged custom plastic AFO with pins in the posterior channels to provide plantar stop at 90o.
4. Metal ankle joints with posterior pins would provide better mediolateral support & permit dorsiflexion with the anterior channels left open, allowing for a normalized gait and passively stretching the plantar flexors.
LUMBAR SPINAL CORD INJURY
5. Bilateral custom plastic ground reaction (anterior tibial shell closing) AFOs fixed in 10 degrees of plantar flexion.
6. The anterior tibial shell closing & 10 degrees of plantar flexion both help create knee extension moments with weight-bearing to add stability to the knees during ambulation (a walker is still needed).
Reference(s)
Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.
