by John Robb, CPO

An ankle-foot orthosis (AFO) is a support or brace used to help control the position and motion of the ankle and foot. AFOs can help compensate for weakness, allow injuries to heal, or correct and prevent deformities. They are most used with patients suffering from neurological or orthopedic conditions such as stroke, multiple sclerosis, cerebral palsy, foot drop, fractures, sprains and arthritis. AFOs help these patients achieve the level of mobility they desire. They may enable them to participate in activities ranging from daily living tasks to walking around the grocery store to mountain climbing. As Orthotists, it is our job to work with patients to understand their personal goals and help patients reach them.

Over the years, the materials used to create AFOs have evolved. The first AFOs were crafted out of steel, wood, and leather. Obviously, they were bulky, heavy, and not particularly comfortable. Next came plastic, or polypropylene, that has been used for many years. It has been a very useful material for many reasons:

1. Plastic is easy to shape using heat and vacuum-forming devices we use in our fabrication lab.
2. Plastic mills well, which means the shaping tools we use work well with it.
3. Plastic is lightweight.

Plastic has been good to us, but it does have its downsides, too. Research shows that plastic has the propensity to fatigue and change shape without the user realizing it. It can stretch or elongate. Also, can be a bit bulky.

Over the past decade, carbon fiber has begun showing great promise as a primary material in AFOs. There are a number of reasons for this:

1. Research gathered, both through studies and anecdotally, shows that a carbon-fiber AFOs may help facilitate a more normal gait, which is crucial for reducing cardio-pulmonary consumption in the patient. An abnormal gait can also produce other musculoskeletal problems.
2. Carbon fiber AFOs have a flat footplate, so adding foot orthotics and fitting shoes is easier
3. Other research shows that walking speed may increase, strength may increase, and there may be increased willingness for patient’s to be more active.
4. AFOs have many customizable options, which allow clinicians to try different configurations, and, at Reach, we can quickly make adjustments for patients whenever they need a tweak.

Carbon fiber AFOs have a lot of great advantages, but they are not for everyone. They may not be for those who:
1. Have severe knee hyperextension
2. Are dealing with spasticity
3. Have a severe deformity

As Orthotists, we have a great deal of options at our disposal to help improve the quality of life for our patients, and we take very seriously the responsibility to make recommendations that will allow for our patients’ greatest success. We always invite conversation with our patients, so please let us know if you are interested in learning more about carbon-fiber bracing and if it might be right for you!

John Robb

John Robb, CPO
John is certified by the American Board for Certification in Orthotics & Prosthetics. John has been practicing in Orthotics & Prosthetics since 1990 and has taken particular interest in treating more complex diagnoses. He regularly speaks for medical professionals and currently serves on the board for the Virginia Orthotic & Prosthetic Association. In his spare time he enjoys spending time with his family, coaching youth sports and playing golf.