Ankle Foot Orthosis (AFO)

An “orthosis” is a brace, or an appliance that supports a body part. Sometimes, an order will be placed for an AFO, which stands for Ankle/Foot Orthosis. Ankle and foot refer to the body parts being supported. This brace can function as a removable cast, to protect the bones, joints, and tendons of some of the stresses of walking and bearing weight.

Examples are pictured below.

With this brace (AFO), the patient is able to bear weight, and usually a regular shoe can be worn, although sometimes the side with the brace required a half or a whole size bigger to accommodate the fact that the AFO has some thickness to bear the stresses.

This type of brace is usually padded, and sometimes will require adjustments by the orthotist (brace provider), as foot shapes can change in subtle ways over time.

However, this brace also alters normal ankle and foot motion that occurs with walking.

Normal walking and normal ankle motion involves the ankle moving up and down during the various phases of the gait cycle. Just before the heel strikes the ground (heel strike), the ankle and toes are lifted up. In the mid stance phase, the body weight and the knee are moving over the ankle joint (also involving ankle motion), and for the toe off phase, the toe points down (more ankle motion).

Since these motions are prevented by the AFO, the shoe needs to have a rocker bottom modification, so that the sole of the foot can roll from the heel, to the midfoot, and then to the toe.

These types of shoes are now commonly available, as pictured here from the Sketcher company, their Shape Up brand.

Aircast Stirrup

Sometimes, for more limited instability, or when less support is needed, a brace can be used that allows for some up and down motion of the ankle, but gives more restriction to the side to side (subtalar) motion. This brace looks like a stirrup, fitting on the inside and outside of the ankle by a strap under the heel, and straps around the leg just above the ankle. This more limited brace can usually be worn within a lace up shoe.

These stirrup braces are often available on or