An ankle foot orthosis, or an AFO, is a foot brace. For Stroke Survivors, I always recommend a foot brace that allows the most movement possible in the foot and ankle while also “helping” the foot lift. An AFO is something that I consider a tool in the rehab process for a Stroke Survivor. My plan for my Clients is to work on increasing flexibility and coordination in their foot and ankle so that in the future they can walk to some degree without an ankle foot orthosis. To make the transition from walking with a foot brace to walking without it there needs to be a plan. When I make my plan I think about some of the following things.
Can you be safe? Oftentimes for stroke survivors and ankle foot orthosis provides protection. It provides protection for your foot and ankle when you are up on your feet, helping to maintain normal alignment and prevent injury. It can also help prevent falls. If your ankle foot orthosis works to help your foot lift up, it can keep you from dragging your toes when you're walking. Dragging your toes can lead to a fall, so having a tool to help lift that foot up can help you be safe for when you're walking.
Just because your foot is lifting some, does not mean you should stop using the brace. This is something I see frequently in clients who come to see me in person. Lots of times people have active movement in their foot and it's lifting some when they're walking. When I say some I mean it's lifting up a quarter to maybe halfway of what would be the natural amount of lift the foot would have when walking. Generally folks who are in this situation are not consistent with the amount that they're able to lift their foot. Maybe in distracting situations they drag their toe more or toward the end of the day when there's fatigue the foot doesn't lift enough. For folks who are in this situation I actually recommend that they get back into some type of helping foot brace that encourages them and helps them use the movement that they have. This allows them to walkin a more automatic way, and it discourages othercompensations that people make when their foot is dragging. These compensations can actually be holding back improvements in walking. So getting back into that foot brace is actually helpful in improving their walking toward a person's perceived goal
If you are stopping due to discomfort- consider talking to an expert to see if there is a better option for you. It could be that a particularAFO was chosen for youdue to the way you were moving and functioning at a particular time. It could be that you have made improvements that would warrant a new ankle foot orthosis to be a more powerful tool in your walking improvement. Speaking with a therapist about the best option for you is a great way to go. They can make a recommendation and you can see an orthotist - the people who make the braces hyphen to get that better brace fabricated for you.
It doesn't have to be all or nothing. When I'm working with a client on beginning to walk without the foot brace we do it in specific ways. For example I might have them only walk in their house without the foot brace and then anywhere else they'll use it. And then we choose ways to further incorporate not using the foot brace in to their life. For more challenging situations, like going to a street fair or at a family reunion, I might recommend that they wear the foot brace so that they can focus on the enjoyment of the occasion and not on whether they're going to trip and fall in front of family and friends. So just remember it's not all or nothing.
Have a plan. Making the change from using an AFO to walking without it should be in a planned. Working with your rehab team on what that plan needs to look like for you is really helpful in being successful in transitioning out of your ankle foot orthosis for the long haul.
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