An ankle foot orthosis (or AFO) is used to improve walking pattern by reducing, preventing or limiting movement of the lower leg and foot and by supporting weak muscles. They are also used to maintain joint alignment, accommodate deformity and help reduce spasticity. AFOs encompass the leg and foot and are worn with shoes and socks.
An R-wrap AFO encloses the whole lower leg from just below the knee to the toes. It has a front shell and a back shell which helps to disperse the forces being applied to the lower limb, especially if spasticity is present.
An R-wrap AFO consists of a separate back and inner shell (see picture). The shells are very flexible and can be pulled open quite easily. They need to be worn with a long sock.
- Put on the inner or top shell on the leg.
- Open out the back shell and slide the foot and inner shell either down from the top, or backwards from the front, holding the outer shell open.
- Fasten the heel/ankle strap first, as firmly as possible making sure that the heel is all the way down. Doing the strap up firmly will keep the heel down.
- The calf strap should be just firm enough to allow contact between the leg
and the R-wrap AFO. Too firm will cause pressure marks around the top of it.
- Make sure the toes are sitting comfortably and are not clenched.
- The toe straps must be firmly secured, but not too tight.
R-Wrap AFOs can be made to fit into a shoe, or they have been made with a walking sole such as the example on the right, which also has a toe strap.
How to wear your AFO correctly
- An R-wrap AFO must be worn with a smooth, long sock underneath to act as a barrier between the orthosis and your skin. The sock will prevent the skin from sticking to the plastic and reduce the chance of skin problems. Make sure that your heel is right down inside the AFO, with the ankle strap and/or shoe fastened firmly.
- The R-wrap AFO is best worn in a lace-up shoe or one that can adjust to its additional size. Some sandals are suitable to wear with an R-wrap AFO. These must have a solid-heel counter and an adjustable forefoot section. Check your child’s footwear choice with their orthotist. Some R-wrap AFOs have a sole already attached so shoes are not required.
- A “weaning in” time, (e.g. gradually increasing the time spent wearing the orthosis each day), is sometimes needed as your skin may need to adjust.
- Check the skin for potential problems (e.g. reddened areas, blisters or sores) prior to fitting the R-wrap AFO and post fitting of the R-wrap AFO. With any new orthosis, expect some reddening of the skin to occur. This reddening should disappear as the skin accommodates to the brace. If the red markings remain 20 minutes post fitting please contact your orthotist for a review appointment.
- With growth the R-wrap AFO will need to be adjusted and/or replaced. Your orthotist or therapist can review its fit and decide if new orthoses are required.
Common problems with AFOs
- Reddened areas – may be caused by:
- Incorrect application.
- Incorrect fit.
- Change in body shape (e.g. growth, tonal fluctuations, or changes in ankle/foot alignment).
- Type of socks, eg. socks that are textured, like a ribbed sock, may cause a variation in pressure between the leg and the brace. Nylon socks may cause friction.
- Variation in thickness of sock or wrinkles in socks.
- Sweaty skin and/or poorly dried skin.
- Skin breakdown – stop wearing your AFO and contact your orthotist for a review appointment.
How to prevent skin problems
- Dry skin properly after showering.
- The use of talcum powder or orthotic powder (available from pharmacies) may be beneficial. Perfumed talcum powder is not advisable as some ingredients in the perfume can cause a skin irritation.
- Wear a long sock (cotton preferably) without wrinkles under the AFO.
- Change socks during the day if perspiration is a concern.
- Early attention to reddened areas can prevent pressure sores developing.
- Wash the AFO regularly in warm (not hot) soapy water.
- Do not soak it in water as this will dissolve or weaken any glues used to make it.
- Rinse it well in clean water so no residue remains.
- Towel and/or air dry. Do not dry with heat (e.g. in front of heater or with a hair drier) as this may alter its shape.
- Check straps routinely for wear and tear and ensure that they fasten securely.
- Check soles for excessive wear and ensure that the tread is safely intact.
- Look over the plastic for fractures, high wear areas or indications of deformation.
- R-wrap AFOs have minimal parts, but the glued soles, Velcro straps and plastic chafe and loops should be checked for deterioration. Rivets should also be checked regularly for any breakage that may result in strap / loop failure.
Queensland Paediatric Rehabilitation Service
Lady Cilento Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
In an emergency, always call 000.
If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.