Back in my days as a student athletic trainer, my favorite injury to take care of was a sprained ankle. I enjoyed them because they were a common occurrence and because ankle rehab is very involved and detailed.  My favorite part of the rehab process was when the athlete was ready to return to play and we would decide what sort of ankle support was needed to make sure that they were able to play a game without incurring any additional injury.  Usually our support method of choice was a solid ankle tape. Some of those tape jobs were works of art, incorporating all types of stretchy and supper strong tapes in with the plain white athletic tape. We did heel locks and figure 8s and figure 4s and extra stirrups and horseshoes and basket weaves.  When the tape was done we wanted to sign our names to it and take a picture of our handiwork. Taping was so fun, and it introduced me to the concepts of how to correctly support an injury in order to encourage healing while still allowing function. It was this experience that got me interested in braces.

 Ankle tape

In athletic training, we often fit an athlete with an ankle brace if they show signs of chronic ankle instability. The braces are more convenient for the athlete than getting an ankle tape every day.   Depending on the type of injury, we can choose between several kinds of ankle braces to decide which would provide the best stability and prevent re-injury.

When I was first getting into the field of Orthotics, I thought most of the ankle braces I would be making and fitting would be somewhat like the braces that we used in athletic training. How wrong I was! It turns out that I had failed to take one important consideration into account: Population. Athletic trainers work mostly with athletes (no surprise there).  Most Orthotists spend much of their time focused on patients with chronic conditions or disabilities. The majority of these patients are not going to be playing basketball any time soon.

Playing basketball with an ankle brace Walking with an AFO

Every once in an odd while these patients need ankle braces for the same sort of reasons that my athletes need to wear a brace: because they injured their ankle at some point and they need to protect the joint so that the injury doesn’t reoccur. I will categorize this as ligamentous instability. In other words, at some point this person severely sprained a ligament in their ankle and as a result the ankle is unstable. This the type of injury I was used to dealing with in the athletic training world. (And to tell you the truth, it is still my favorite…)

Ligaments (ankle sprains)

But there is a much bigger category of people with a different sort of ankle instability. This is the group of people with muscular instability. The ankle is a very complicated joint, which relies on an intricate system of small muscle groups to hold the foot in the correct position to allow you to walk and stand. The patients who are being treated by orthotists usually have some sort of weakness in one of these muscle groups. As a result of this deficit, the positioning of their foot and ankle is faulty and they are at risk of tripping and falling if they do not wear a brace. Because muscular weaknesses can lead to some unusual joint alignments, custom braces are often needed to accommodate the patient’s unique ankle structure.

Ankle muscles balance of forces

Here is a pretty dramatic video of a guy demonstrating how much better he can walk with the use of his custom ankle braces.

This leads me to another difference between the ankle braces that I was used to in athletic training and the braces from the field of Orthotics. Terminology. In athletic training and rehabilitation, we are content to call a brace a brace. But orthotists call a brace an “Orthosis”. If multiple braces are being spoken of, they are called “Orthoses”.  Therefore, if you hear someone referring to an ankle brace as an “Orthosis” you can bet that the brace was made by an orthotist. It is also a pretty safe bet to assume that the brace was either custom made for that person or at least custom fit to them. Because it is cumbersome and annoying to keep saying “Ankle Orthosis”, the term is commonly shortened to the abbreviation “AFO” (which stands for Ankle, Foot Orthosis).

AFOs can be described as the “bread and butter” of the orthotic industry. They are by far the most common type of orthosis. The AFO category is broad and varied. This makes sense because there is a wide variety of people who need AFOs for many different reasons. My next few posts are going to talk some more about AFOs. Upcoming topics to include:  some of the most common reasons people would need an AFO, types of AFOs, and the history and future of AFOs. I have already started to scratch the surface of this topic in these previous blogs: https://walkwellstaywell.wordpress.com/2013/10/20/creative-problem-solving/   https://walkwellstaywell.wordpress.com/2013/09/22/lace-up-ankle-braces/ . But it’s a big topic and there is plenty more to say on the subject. Stay tuned for more info!

Walk Well

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