Research & Presentations
A Flexible AFO: Contradiction to Traditional Thought? By Suzanne Guiffre, PT, EdD; Joseph Whiteside, CO, LO; and Cathy Bieber Parrott, PT
This article is a follow-up to research originally presented at AOPA’s Second World Congress and Centennial Celebration in Las Vegas in September 2017.
Introduction Research shows ankle-foot orthoses (AFOs) improve walking ability, reduce energy expenditure, and improve selfconfidence in persons with neurologic conditions.1 However, noted disadvantages of AFOs are orthotic size and weight, discomfort, safety issues, poor effectiveness, and the finding that dissatisfaction with AFOs has been found to be up to 75 percent, with lack of compliance ranging from 6 percent to 80 percent.2 Some report AFOs are too restrictive to movement and skin problems are an issue.3 Prior to this study, we tracked users of thermoplastic AFOs (n = 104). Fortyeight percent (50 clients) were unsatisfied
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with their AFO. It was discovered that this lack of tolerance included 12 with a solid AFO, 30 with an articulating, 13 with a carbon fiber, and one with a double upright. Non-use did not seem related to the origin of the AFO (our clinic versus another), type of AFO, or diagnosis. The most common problem with non-use was postural instability resulting in limited walking ability. Other problems included weight, lack of comfort, decrease in dynamic balance, and inadequate ankle varus control. It was unacceptable that so many patients were dissatisfied or not using their AFO; thus, alternatives were pursued. There is previous research on silicone AFOs that showed increased comfort; however,
