Ankle-foot orthosis are braces worn at the ankle that encompass some or all of the foot. Diseases that affect the musculature or weaken the affected area require orthosis to strengthen the muscles or rehabilitate them and other joints of the foot and ankle. Tight muscles that need to be lengthened and loosened also benefit from orthosis.
When we think of diseases that affect the musculature we think of the big boys: muscular dystrophy, cerebral palsy, polio and multiple sclerosis. We rarely think that arthritis and stroke can affect the musculature, but these are both conditions that can negatively affect the muscles in your foot and ankle.
However, the good news is that whatever trauma there is that affects those muscles, there is a way to correct it. The orthosis helps to control range of motion, provide support by stabilizing walking, correct deformities, and manage pain loads. A podiatrist would be consulted for those who have experienced direct trauma to the foot or ankle, have an arthritic condition that is affecting their joints, or has developed another kind of muscular disease.
Before the advent of modern orthosis devices, it wasn’t uncommon to see polio victims wearing metal braces from mid thigh to the bottom of the foot, or children wearing metal braces around their ankle and foot. However, both designs and materials have improved dramatically, allowing for new levels of comfort, functionality, and appearance. Many orthosis are now made from plastics in the shape of an L and designed to fit inside a corrective shoe. These can be rigid, buckling at the calf and extending the length of the foot to support the ankle. This same design except with a hinged ankle provides support while walking by normalizing the gait. In the past, boots lined with leather and fiberboard provided the rigidity needed for correction and support. Now corrective shoes are available with built up soles to correct the gait or manage pain by sharing it with another area when the foot spreads during walking.
The podiatrist would prescribe this orthosis in the rigid L shape because the foot moves on a hinge. If the hinge isn't functioning as intended due to an injury or malformation, the muscles tighten up, thus making it difficult to flex the foot. When we walk, the foot flexes and muscles stretch. This brace or orthosis would support the ankle and musculature during flexion of the foot, in much the same way a knee brace works. Corrective shoes are for people whose feet hit the ground backward, causing tight muscles and arch problems. Wedges and rocker bars on the heels correct the step to heel first and rock onto the ball of the foot, resulting in relaxed musculature and strengthened ankles.
Appearance also counts when we consider a particular support device, especially if the item is intended for regular, daily wear. The L shaped orthosis is contoured to the calf and flesh-colored, fitting into a sneaker or dress shoe. At present, corrective shoes are more attractive than past models, enabling patients wear such devices with greater comfort and confidence.
