An ankle foot orthosis (AFO) is used to improve walking patterns 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 to help reduce spasticity. AFOs encompass the leg and foot and are worn with shoes and socks.
How to wear your AFO correctly
- An AFO needs to 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 any skin problems. Make sure your child’s heel is right down in the AFO with the ankle strap and/or shoe fastened firmly.
- The AFO is best worn in a lace-up shoe or one that can adjust to the additional size of the AFO. Some sandals are suitable to wear with an AFO. These must have a solid-heel counter and an adjustable forefoot section. Check your child’s footwear choice with their orthotist.
- A “weaning in” time (i.e. gradually increasing the time wearing your orthosis each day), is sometimes needed as your skin may need to adjust to the wearing of your AFO.
- Check the skin for potential problems (e.g. reddened areas, blisters or sores) prior to fitting the AFO and post fitting of the 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, an AFO will need to be adjusted and/or replaced. Your child’s orthotist or therapist can review the fit of the AFO and decide if new orthoses are required.
Common problems with AFOs
- Reddened areas – may be caused by:
- Incorrect application of AFO.
- Incorrect fit of AFO.
- Change in body shape (growth, tonal fluctuations, 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 your AFO.
- Rinse 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 the shape of the AFO.
- 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.
- Rivets or screws should be checked regularly. Re-tighten screws if they are loose, but do not overtighten them. Hinged AFOs have screws to attach the ankle joints. These screws must be maintained for the joints to function properly.
Queensland Paediatric Rehabilitation Service
Queensland 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.