The orthotic management of Foot Drop is often achieved with the use of an Ankle Foot Orthosis (AFO), sometimes referred to as a splint or brace. These come in two major classes, either stock or custom-made devices. Both types of appliances have advantages and disadvantages to them.
Foot drop can have many causes
This guide will deal with a subset of Stock AFOs made in fabric.
The main advantage of a fabric AFO is that they are not hard. A regular criticism of plastic or carbon fibre devices is that they are very hard. If not fitting correctly, ‘hard’ splints can rub or prove to be uncomfortable.
Fabric AFOs are generally easier to fit inside shoes or are entirely external to the shoe.
The main advantages of fabric devices are also their main disadvantage in that they are soft. The lack of rigidity can be a compromise causing a decrease in support, and often they don’t provide as much lift as a rigid device.
Rigid devices can also influence the knee and provide increased stability, which is not something a fabric device can achieve.
Generally speaking, the most suitable patient is someone with a flaccid foot drop who has good knee control and plantarflexion strength.
Clinicians will use this class of AFO in various patients after careful assessment and following clinical best practice.
Buchanan Orthotics supply a number of Fabric AFO’s for footdrop:
The Textile Drop Foot Orthosis consists of a fabric ankle wrap around the leg just above the ankle, which the elastic section lifts the foot attaches. It is required to be snugly attached to the leg to prevent it from being pulled down by the foot section.
There is a clasp that fits between the laces. While it works best with laces it can also be used in Velcro shoes with more than one strap.
This commonly used style of AFO is good because it can provide a large amount of lift to the foot as the elastic can be pulled to an appropriate tension to lift the foot.
Generally, they are comfortable as there is nothing placed inside the shoe but require suitable footwear to be worn.
The downside to this style of AFO is that you require the hand strength to pull the Velcro tight, and the ankle section can be pulled down in some leg shapes.
The Airmed Textile foot drop orthosis can be worn without footwear with the addition of a plantar band however, this will not provide as much lift as when worn with footwear.
The GoOn from OttoBock attaches directly to the foot, allowing it to be worn with and without shoes. It comprises of ‘spring’ elements that travel down the anterior ankle to the dorsum of the foot.
The spring elements effectively lift the foot up from the foot's dorsum, unlike many other devices that lift the foot up from the plantar surface.
Spring elements on the GoOn
The GoOn is universal, and fits left and right. Its adjustable straps allow for customisation to individual patients. This makes it a great product to keep stock inventory down as one device will fit most adults.
As there is no rigid section under the foot, patients feel it comfortable to wear within footwear.
The Neurodyn achieves its dorsiflexion assistance by two elastic straps that cross in a figure of 8 fashion and attach at the back of the leg.
The Neurodyn foot lift also has a lateral strap to reduce supination or inversion of the ankle.
Like some of the other devices featured, the Neurodyn can be worn without footwear.
To get the most of the device, the elasticated straps need to be pulled tight, so patients require good upper limb strength if they are donning the device themselves.
Fabric AFO’s are highly effective devices in the correct patient group but they are not without compromises.
Generally, the fabric foot drop AFO’s are best in patients with: