Dynamic Ankle Foot Orthoses (AFO)
About Dynamic AFO
Dynamic AFO are medical devices to provide stability, load-reduction and redistribution, and mechanical assistance to facilitate walking in individuals with a range of conditions affecting foot and ankle functioning and/or pain.
Dynamic AFO were initially used for individuals with traumatic damage such as ankle fractures, nerve damage and traumatic arthritis, including those who had undergone fusion surgeries for treatment of these conditions. More recently, use of dynamic AFO has expanded to include a wider range of conditions, including club foot, cerebral palsy, and intractable osteochondral lesions of joints of the foot and ankle.
Many dynamic AFO are inspired by, and share design elements with, the Intrepid Dynamic Exoskeleton Orthosis (IDEO) developed at The Center for the Intrepid, a US military rehabilitation facility in San Antonio, Texas.
A typical IDEO-style dynamic AFO has three major components: a foot plate, a carbon fiber spring, and a tibial cuff.
The foot plate is customized for each patient and can serve a variety of functions including ameliorating drop foot, adjusting alignment, transferring load away from injured areas of the foot, limiting undesired motion, and facilitating an effective walking gait.
The carbon fiber spring stores energy as weight is shifted onto the limb during walking, releasing it to assist with the push-off phase of walking.
The cuff holds the calf firmly, allowing some of the load that would typically be borne by the foot and ankle to be borne instead by the patellar tendon and calf.
Photo Credit: English: Linda Hosek, Public domain, via Wikimedia Commons
Dynamic AFO Providers
Exosym: The Exosym orthosis is a direct descendant of the IDEO. It is available exclusively through a program of the Hanger Clinic in Washington State that integrates patient evaluation, device manufacture and patient training in the use of the device at one facility.
Fabtech PDE braces: Fabtech Systems, a prosthetic and orthotic fabrication company, has developed a modular dynamic brace system built around a carbon spring they call the Posterior Dynamic Element (PDE). Braces incorporating Fabtech Systems PDEs are available from a newtork of orthotists who either produce their own braces using this technology, or use Fabtech Systems as the fabricator for devices for their patients.
Momentum Offloading Brace: In the UK, a dynamic AFO, the Momentum Offloading Brace is available through the Blatchford Clinic.
Photo Credit: Ankleocl.net
Dynamic AFO Training and Support
Physical therapy and training in the use of dynamic AFO appears to be a valuable component of adjusting to use of these devices. Studies on US military populations have shown that a specialized physical therapy rehabilitation program for users of the IDEO AFO improved physical performance and that users of the IDEO who received the specialized physical therapy were more likely to return to active duty than IDEO users who did not participate in the rehabilitation program.
In the civilian context, training is provided on site as part of the program for new Exosym recipients.
Specialized dynamic AFO training is also available though Therapy Nexus.
Online Community Support: There is a Fabtech PDE brace /Exosym Brace Facebook group for discussion among dynamic brace users and other interested parties, as well as an Exosym Clubfoot Brace Support Facebook group. There is also an official Facebook group of the Harbor Clinic exclusively for Exosym users.
Photo Credit: English: Linda Hosek, Public domain, via Wikimedia Commons