AFOs Expert Views

AFOs (Ankle Foot Orthoses) are commonly used to help children with cerebral palsy walk better, but their effectiveness can vary. Research shows that rigid AFOs with a fixed ankle alignment of 90 degrees and standard footwear designs may not always improve walking or balance significantly. Elaine Owen developed a clinical algorithm in 2010 that focuses on customizing AFOs and footwear for each child. This approach, called AFO-FC/IAFD, involves adjusting the alignment of the lower leg and thigh and modifying footwear to better support walking and balance. The individualized method aims to align with therapy goals and improve mobility and stability for children with cerebral palsy.

The expert emphasizes that Ankle Foot Orthoses (AFOs) are a crucial treatment for cerebral palsy when designed and used correctly. They can significantly impact a child's ability to walk, reduce pain, and prevent deformities. However, the expert also warns that poorly made orthotics often end up unused, leading to frustration and guilt for families. This highlights the importance of ensuring AFOs are properly fitted and tailored to the individual's needs.

AFOs, or Ankle Foot Orthoses, are devices worn on the lower leg to improve walking and motor skills in children with cerebral palsy. They help control the ankle, making strides more even and walking safer. However, wearing AFOs all the time can lead to muscle atrophy, where muscles shrink and weaken because they aren't being used. This is why it's important to balance their use with periods of muscle activity to maintain strength.

Dr. Tyler Susko explains that AFOs (Ankle Foot Orthoses) are commonly used for people with cerebral palsy and other mobility challenges, especially for conditions like drop foot. These devices are custom-molded and help by limiting plantar flexion, which is the downward movement of the foot, making it easier to clear the floor while walking. He notes that AFOs are affordable and widely available, but they apply restrictive forces to the ankle joint, which could interfere with natural motor control signals from the brain. In contrast, his company's Cadense shoes aim to improve mobility without altering the ankle joint, instead using variable friction technology to make walking easier.

Julie Perfect discusses the use of Ankle Foot Orthoses (AFOs) in children with cerebral palsy, emphasizing the importance of proper posture and alignment for effective movement. She explains that solid AFOs are her preferred choice for children who lack the strength to control their tibia's forward movement. By keeping the ankle solid, children can develop the necessary strength in their calf muscles (gastrosoleus) to control their gait. Julie also mentions that hinged AFOs can be used later, once the child has developed sufficient strength to manage forward tibial movement.

Brigid Driscoll discusses the use of Ankle Foot Orthoses (AFOs) for children with cerebral palsy and other conditions like low tone and hypermobility. She emphasizes the importance of aligning the knee as close to neutral as possible when using ground reaction AFOs, as even slight knee flexion can lead to children leaning forward and going up on their toes. Driscoll also highlights the need for flexibility in orthotic systems for children with low tone and hypermobility, using thinner materials to allow dynamic movement while controlling excessive motion. She advises waiting until children reach an appropriate age for weight-bearing before bracing, to ensure muscle activation and developmental progress. A hybrid system combining AFOs with SMOs (Supramalleolar Orthoses) is recommended for advanced exercises and postural control.

Dr. Cylie Williams, a podiatrist and senior research fellow, discusses the use of Ankle Foot Orthoses (AFOs) for children with cerebral palsy. She emphasizes the importance of balancing alignment and functionality, noting that sometimes sacrifices in alignment are necessary for better function and ease of life. Dr. Williams highlights the need for collaboration between professionals, such as orthotists and podiatrists, to optimize the design and effectiveness of AFOs. She also mentions the importance of understanding foot mechanics, such as the subtalar joint axis, and adjusting pressure points in the orthotic to improve control and alignment.

Beverly Cusick emphasizes the importance of using solid AFOs (Ankle Foot Orthoses) over articulated ones for children with cerebral palsy. She explains that solid AFOs help improve motor learning and postural control by reducing the degrees of motion at the foot and ankle, which allows for better alignment and strength development in the trunk and legs. Cusick also highlights that articulated AFOs can lead to issues like crouch gait because they allow the tibia to fall forward, which can hinder proper muscle development. She advocates for starting with core alignment and using tools like solid AFOs to build strength and control in proximal body structures.

Nancy Hylton, a renowned physical therapist, discusses the use of dynamic orthotics like AFOs for children with cerebral palsy and other conditions. She emphasizes the importance of flexible systems that stabilize motion around the midline, which helps improve balance and muscle strength. Hylton prefers orthotics made from polyethylene, such as the cricket line, for their flexibility and ability to support weak muscles. She advises wearing orthotics consistently, including during therapy, to challenge balance and strengthen muscles. Her approach focuses on allowing controlled movement while providing stability to avoid compensatory strategies that could worsen alignment issues.

Nadine Smith discusses the use of Ankle Foot Orthoses (AFOs) in children with dyskinetic cerebral palsy. She highlights that while AFOs are often recommended to maintain functional leg positioning, they can cause significant pain, especially in children with distal dystonia. This pain arises because the increased muscle tone during activities causes the feet to press against the hard plastic of the orthoses. Smith notes that this pain is a common issue clinicians face and emphasizes the need for careful consideration of the impact of AFOs on comfort and pain management.