An Ankle-Foot Orthosis (AFO) is a medical device worn around the lower leg, ankle, and foot to provide support and control movement. It is commonly prescribed to address conditions like foot drop, muscle weakness, or ankle joint instability. Correct application is paramount for achieving the intended biomechanical support and ensuring user comfort. Proper placement maintains mobility and prevents complications such as skin irritation or pressure sores, which can occur rapidly if the fit is incorrect.
Pre-Application Checklist
Before attempting to put the AFO on, inspect the skin and the device itself. Check the skin covering the foot and leg, especially around the bony areas of the ankle and heel, for any existing redness, blisters, or open pressure points. Applying the brace over irritated skin can quickly worsen the condition and potentially lead to skin breakdown.
Appropriate hosiery is required for safe AFO use. A seamless sock made of a breathable, moisture-wicking material like cotton or an acrylic blend is recommended to reduce friction and absorb perspiration. The sock must be pulled completely smooth, removing all wrinkles, and extend above the top edge of the AFO. This creates a continuous protective barrier between the skin and the plastic shell.
The AFO itself requires a quick check to confirm its readiness. Ensure the brace is clean and that all straps or fasteners, typically hook-and-loop closures, are undamaged and functioning properly. All straps should be completely unfastened and positioned out of the way, allowing the foot to slide into the orthosis without obstruction. Inspecting the device for any sharp edges or cracks prevents unexpected injury during wear.
Step-by-Step Application Guide
Donning the AFO begins with properly seating the foot inside the device while in a comfortable, seated position. The heel must be pushed firmly down and back into the heel cup, ensuring full contact with the bottom surface. This step is the foundation of a correct fit; a heel that is not fully seated will cause misalignment and lead to excessive pressure points.
Once the foot is firmly in place, secure the straps, generally starting with the one closest to the ankle or foot and working upward toward the calf. Securing the lower strap first helps lock the heel into the orthosis, preventing it from migrating upward during activity. Each strap should be tightened snugly enough to prevent foot movement inside the brace, but not so tightly that it restricts circulation or causes discomfort.
The final action involves integrating the AFO into proper footwear, which is mandatory for most plastic orthoses to function effectively. The shoe must be designed to accommodate the bulk of the AFO, often requiring the removal of the shoe’s insole to create sufficient room. The AFO, with the foot inside, is then inserted into the shoe. Secure the shoe’s laces or fasteners as the very last step to hold the AFO firmly inside the shoe, further stabilizing the foot and ankle.
Ensuring Proper Fit and Alignment
After the brace and shoe are secured, assess the fit and alignment to confirm comfort and function. To check strap tightness, attempt to slide one or two fingers between the strap and the leg; the fit should be snug, but not overly restrictive. Pressure checks should focus on bony prominences, such as the malleoli (ankle bones) and the heel, where excessive force is most likely to cause skin issues.
Visually verify that the brace is sitting straight on the leg and is not twisted or rotated, which would compromise the intended support. The AFO’s goal is to hold the foot in a functional, neutral position; rotation suggests the brace is not properly aligned with the leg’s natural axis. Ensure the toes are not cramped and that the footplate is not causing undue pressure on the tips of the toes.
For a new AFO or after adjustment, a short initial wear protocol is advised to monitor the skin’s reaction. After the first 30 minutes of wear, remove the brace and sock and inspect the skin for redness. Red marks that disappear within 15 to 20 minutes are typically normal reactions to pressure. However, any redness that persists longer suggests a concentrated pressure point and requires immediate attention from an orthotist for professional adjustment.