BELOW KNEE ORTHOSIS PRESCRIPTION

BASIS FOR PRESCRIPTION:

The focus is on pathomechanical abberation

such as paresis, paralysis, spasticity, abnormal
involuntary movement and abnormally pattered
movements, sensory disturbances, fixed
deformities and edema.
Proper prescription:
One should evaluate the patient systemically

ONSET OF ILLNESS
Often indicates wether or not the motor disability is still
evolving and if such is the case, one may elect to delay
an orthotic decision or be prepared to change the
prescription later.
Post stroke patient:
It is usually safe to prescribe sometime between 8 and
12 weeks

ANXIETY, TENSION OR APPREHENSION

May intensify a spastic pattern and change the motor
picture episodically so that an orthosis which is adequate
most of the time may be inadequate during period of
increased spasticity.

PATIENTS WITH NEUROLOGICAL DISORDER

REQUIRING AFOS (GROUP I)
1. Weakness or absence of dorsiflexors, without severe weakness or the
plantar flexors.
2. Good to fair mediolateral stability during stance (no marked varus or valgus)
3.
4.
5.
6.
7.

Passive ankle dorsiflexion at 90 degrees

Absent to moderate spasticity
Adequate knee stability and motor power, with or without recurvatum
Adequate hip strength
Reduced or absent passive position sense at the ankle without mediolateral
instability during swing or stance, ddespite adequate motor power at the
ankle

ORTHOSIS

Plantar flexion during swing (foot drop) and

provide a mild degree of mediolateral
stability in swing and stance, yet not hinder
the physiological tendency to plantar
flexion resulting in foot-flat immediately
after heel-strike.

SHOE CLASP ORTHOSIS

Provides the least assistance, is

inconspicuous and is least expensive.

WIRE SPRING AFO

Also provides relatively modest

assistance for dorsiflexion during
swing phase; the shoe heel must be
fitted with medial and lateral pins to
receive orthosis.

 Most GROUP I patients, however , are

likely to be fitted with plastic posterior
leaf spring AFOs.

 Another alternative for GROUP I patient is

the double metal upright AFOs with
dorsiflexion (and plantarplantarflexion if
required) spring asssist.
The orthosis is considerably heavier than
the other option.

GROUP II
1. Severe weakness or absence of ankle dorsiflexors and plantar
flexors
2. A mild to moderately severe defect in mediolateral alignment
during swing and or tendency toward varus or valgus during
stance
3. Absent to moderate spasticity
4. Adequate motor power at the knee than in group I
5. Passive position sense loss at the ankle

DOUBLE METAL UPRIGHT AFO.

Group II patients benefit from double metal

upright AFO.
The absence of plantar flexion power
requires a dorsiflexion stop at 90 degrees
so the patient will not drop off near the
end of the stance phase.

 If mediolateral stability during stance

phase is not assured by the upright in
the AFO, the uprights may be attached
to an insert molded to realign the foot

 Some patients with cerebral

pathology demonstrate equinovarus
position of the foot during the swing
phase of gait which persists into the
stance phase

PLASTIC SPIRAL AFO

Prevents foot drop, assist push-off by

resisting dorsiflexion of the ankle during the
stance phase and promotes mediolateral
stability, particularly if the foot tends to
collapse into valgus during stance

 This may be done by a shoe insert, or a varus

correction strap, with a double upright AFO or
by a hemispiral AFO.
RECURVATUM in the adult with neuromuscular
disorder is not necessarily undesirable because
eliminating recurvatum at the knee often
includes buckling.

1.The orthosis of choice for this group is the

PLASTIC SOLID ANKLE AFO
2.A DOUBLE UPRIGHT METAL AFO which
allows no movement at the ankle can also
be utilized , along with shoe insert or
correction strap and a solid stirrup riveted
to a strong shoe with a longer counter.

GROUP III
1. Weakness or absence of both ankle dorsiflexors and plantar
flexors
2. Severe spasticity, resulting in marked equinovarus of the foot
during swing and stance.
3. Adequate hip and knee and hip musculature to permit weight
bearing on the involved limb.
4. Severe position sensory loss coupled with moderate to severe
spasticity; these may be the only criteria
5. Pain on movement of the ankle joint may be the only criterion.