Carbon AFOs

are anatomical alignment and stiffness always the same across carbon AFOs?

no, there are a variety of manufacturers and they are all different

why would you use a custom fit AFO?

-reliable sizing

-greater consistency in performance

-improved replication

why carbon?

-lightweight (high strength to weight ratio)

-less material

-dynamic motion

indications for a carbon AFO are typically found in what plane?

mostly sagittal

indications carbon AFO

-drop foot

-mild coronal weakness

-partial foot amputation (can combine w/ toe filler)

-decreased distal proprioception

contraindications carbon AFO

-severe knee weakness/ deformity (custom)

-contracted or right achilles

-moderate to severe spasticity

-long stride/ long levers (sizing may not be appropriate)

-very large gastroc

-jumping sports

an anterior shell on a carbon AFO provides what type of moment?

extension moment at the knee

what information do you have to collect from a patient to determine carbon AFO sizing?

-tib tubercle (for anterior shell)

-fib neck (for peroneal nerve)

-calf circumference (posterior cuff)

-shoe size (trace insole)

what boney prominences do you have to check are clear of rigid contact in a carbon AFO?

-tibial tubercle (anterior shell)

-medial/lateral malleolus

-navicular

-head or shaft of 5th met

-fib head

what fit checkout do you have to look at for tissue?

soft tissue impingement

-circumferential containment of strap

-peroneal nerve

-excessive strut contact

what fit checkout do you have to look at for shoe?

shoe fit

-toe box clearance

-appropriate heel containment

how can you troubleshoot fit issues with the tibial crest?

anterior shell - pretib pads

posterior cuff - increase surface area across anterior strap

how can you troubleshoot fit issues with the malleoli?

-medial/lateral strut selection

-shift footplate within the shoe

how can you troubleshoot calf compression of the soft tissue?

heat and expand cuff

how can you troubleshoot excessive strut contact?

shift footplate anterior or posterior to reduce contact

how can you troubleshoot shoe fit issues?

-heat relieve tow rocker

-trim toe length (last resort*)

ranging from least lax ligament to most lax what would you prescribe for pronation/eversion?

lateral strut

foot orthotic

t strap (medial)

UCBL

SMO

ranging from least lax ligament to most lax what would you prescribe for supination/inversion?

medial strut

foot orthotic

t strap (lateral)

UCBL

SMO

In your clinical observation you notice the patients foot is slapping to the ground. Why?

strut is too soft

In your clinical observation you notice there is rapid knee flexion at initial contact. what is wrong with the strut?

strut is too stiff

In your clinical observation you notice there is excessive knee flexion at midstance and terminal stance. what is wrong with the strut?

anterior shell is too soft; posterior cuff is too firm

In your clinical observation you notice there is excessive knee extension at midstance and terminal stance. what is wrong with the strut?

anterior shell is too firm; posterior cuff is too soft

In your clinical observation you notice there is excessive knee flexion at midstance and terminal stance. what is wrong with the footplate?

mid and forefoot are too soft or rockered

In your clinical observation you notice there is excessive knee extension at midstance and terminal stance. what is wrong with the footplate?

mid and forefoot are too stiff

AFO ____ stiffness is key characteristic that determines how much support or restraint an AFO can provide

ankle