Lower-limb orthoses

A lower-limb orthosis or "arch supports" is an external device applied to a lower-body segment to improve function by controlling motion, providing support through stabilizing gait, reducing pain through transferring load to another area, correcting flexible deformities, and preventing progression of fixed deformities or orthotics for plantar fasciitis.

Foot orthoses- orthotics or arch supports

Foot orthoses comprise a specially fitted insert or footbed to a shoe. Also commonly referred to as "Orthotics" these orthoses provide support for the foot by distributing pressure or realigning foot joints while standing, walking or running. A great body of information exists within the podiatry and pedorthotic community describing the sciences that might be used to aid people with foot problems as well as the impact "orthotics" can have on knee, hip, and spine conditions. As such they are often used by athletes to relieve symptoms of a variety of soft tissue inflammatory conditions like plantar fasciitis.[7] They may also be used in conjunction with properly fitted orthopedic footwear in the prevention of foot ulcers in the at-risk diabetic foot.

Ankle-foot orthosis (AFO)

Schematic ankle-foot orthosis
An AFO worn on the left foot with ankle hinge

An ankle-foot orthosis (AFO) is an orthosis or brace (usually plastic) that supports the ankle and foot. AFOs are externally applied and intended to control position and motion of the ankle, compensate for weakness, or correct deformities. AFOs can be used to support weak limbs, or to position a limb with contracted muscles into a more normal position. They are also used to immobilize the ankle and lower leg in the presence of arthritis or fracture, and to correct foot drop; an AFO is also known as a foot-drop brace. No evidence exists to support the concern that using an orthosis will keep neurologic repair from taking place.

Ankle-foot orthoses are the most commonly used orthoses, making up about 26% of all orthoses provided in the United States.[8] According to a review of Medicare payment data from 2001 to 2006, the base cost of an AFO was about $500 to $700.[9] An AFO is generally constructed of lightweight polypropylene-based plastic in the shape of an "L", with the upright portion behind the calf and the lower portion running under the foot. They are attached to the calf with a strap, and are made to fit inside accommodative shoes. The unbroken "L" shape of some designs provides rigidity, while other designs (with a jointed ankle) provide different types of control.

Obtaining a good fit with an AFO involves one of two approaches:

  1. provision of an off-the-shelf or prefabricated AFO matched in size to the end user
  2. custom manufacture of an individualized AFO from a positive model, obtained from a negative cast or the use of computer-aided imaging, design, and milling. The plastic used to create a durable AFO must be heated to 400°F., making direct molding of the material on the end user impossible

The International Red Cross evidently believes there are four major types of AFOs, ergo the other 357[citation needed] types would be considered minor:

Flexible AFOs Anti-Talus AFOs Rigid AFOs Tamarack Flexure Joint
may provide dorsiflexion assistance, but give poor stabilization of the subtalar joint. block ankle motion, especially dorsiflexion; do not provide good stabilization for the subtalar joint. block ankle movements and stabilize the subtalar joint; may also help control adduction and abduction of the forefoot. provide subtalar stabilization while allowing free ankle dorsiflexion and free or restricted plantar flexion. Depending upon the design; may provide dorsiflexion assistance to correct foot drop.[10]

The International Committee of the Red Cross published its manufacturing guidelines for ankle-foot orthoses in 2006.[10] Its intent is to provide standardized procedures for the manufacture of high-quality modern, durable and economical devices to people with disabilities throughout the world.

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