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Ankle foot orthosis for drop foot: what an AFO is and how to live with one
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- Long seamless cotton socks for AFO wear. Best for: The layer between skin and AFO. See options on Amazon
- Extra-wide shoes with a hook-and-loop opening. Best for: Fitting a shoe over an AFO. See options on Amazon
- Shoes with removable insoles and a low heel. Best for: Making room for the foot plate of an AFO. See options on Amazon
What an AFO does for drop foot
NHS Highland's orthotics service describes an AFO as a device designed to control the foot and ankle to improve walking, and notes it can also slow the development of contractures, or tightening of joints. Each one is made or supplied to suit the individual. Mayo Clinic, discussing drop foot treatment, says a brace on the ankle and foot or a splint that fits into the shoe can help hold the foot in a normal position, alongside physical therapy to keep the leg strong and the ankle and knee moving.
An AFO is a clinician-led device. A doctor or physiotherapist usually refers you, and an orthotist assesses, fits and reviews it. Over-the-counter supports are covered on our foot drop brace page.
AFO styles your orthotist may choose
Gillette Children's lists four common AFO styles: solid ankle, articulated, posterior leaf spring and floor reaction. Which one you get depends on your assessment.
| Style | What the name tells you |
|---|---|
| Solid ankle | One rigid piece; the ankle does not bend inside it |
| Articulated | Has a joint at the ankle so some movement is allowed |
| Posterior leaf spring | A more flexible style; posterior means it runs behind the calf |
| Floor reaction | A specialist style; ask your orthotist what it is meant to do for you |
Gillette describes its AFOs as lightweight, custom-moulded plastic shells, sometimes with pads and straps. Your orthotist will explain why your style was chosen and what it should and should not do.
Putting it on and wearing it in
- Pull on a close-fitting long sock.
- Place the heel firmly at the back of the AFO.
- Fasten all straps securely.
- Put your shoe on over the AFO.
NHS Highland suggests building up wear over several days: 30 to 60 minutes on day one, 1 to 2 hours on day two, 2 to 3 hours on day three and 4 to 5 hours on day four. Your orthotist will say how long to build up to, which may be a few hours, all day or overnight.
Shoes that work with an AFO
- Take the AFO shoe shopping. NHS Highland says you may need shoes wider or longer than usual.
- Fastening. Lace-up or hook-and-loop shoes adjust best, and a low opening makes fitting easier.
- Removable insoles create extra room inside.
- Heel height. About 1 to 1.5 cm. Avoid high heels and, if possible, very flat shoes.
Skin, cleaning and driving
Contact your orthotics department if redness does not fade after 30 minutes, or for sores, blisters, pain, rubbing or damage to the AFO, NHS Highland advises. Wipe the AFO with a damp cloth and towel dry. Do not soak it, use detergents or put it near heat, which can distort its shape. Pick fluff and hair out of the straps, and bring the AFO with you to every review appointment so the orthotist can check the fit as your leg changes.
For driving, NHS Highland says you must tell your insurer, and you may prefer to take the AFO off to drive and put it on after getting out of the car.
What to look for when you buy
Long seamless cotton socks for AFO wear
Best for: The layer between skin and AFO
NHS Highland asks for a close-fitting long sock between skin and AFO. Seamless toes and no thick ribbing reduce pressure points under the plastic.
Watch out: Too thick a sock can make the AFO and shoe too tight.
See options on AmazonExtra-wide shoes with a hook-and-loop opening
Best for: Fitting a shoe over an AFO
NHS Highland suggests shoes that may be wider or longer than usual, with lace-up or hook-and-loop fastening and a low opening.
Watch out: Try them on with the AFO in place before you buy.
See options on AmazonShoes with removable insoles and a low heel
Best for: Making room for the foot plate of an AFO
Removing the insole gives extra depth, and NHS Highland suggests a heel of about 1 to 1.5 cm.
Watch out: Very flat shoes can change how the AFO works; check with your orthotist.
See options on AmazonQuestions people ask
- Can I buy an ankle foot orthosis for drop foot online?
- Off-the-shelf braces are sold, but an AFO for drop foot is usually prescribed and fitted by an orthotist, who chooses the style for your leg and cause.
- How long should I wear my AFO each day?
- Build up slowly, starting with 30 to 60 minutes on the first day, then follow your orthotist's target.
- What shoes do I need with an AFO?
- Usually wider or longer shoes with a low opening, lace-up or hook-and-loop fastening, a removable insole and a heel of about 1 to 1.5 cm.
- Is red skin under an AFO normal?
- Some redness after removal is expected. NHS Highland says to contact the orthotics department if it does not fade after 30 minutes.
- Do I wear an AFO at night?
- Only if your orthotist says so. NHS Highland notes the wearing plan may be a few hours, all day or overnight, depending on why it was prescribed.
- Can I drive wearing an AFO?
- NHS Highland says to tell your insurer. You may prefer to take it off for driving.
Sources
- Ankle foot orthosis (AFO) information leaflet (nhshighland.scot.nhs.uk), NHS Highland Orthotics
- Ankle-foot orthosis (AFO) (gillettechildrens.org), Gillette Children's
- Foot drop: diagnosis and treatment (mayoclinic.org), Mayo Clinic