STRENGTHENING THE CASE FOR CARBON FIBER AFOs
by Cary Groner, LER Magazine

Clinicians are gathering data, both anecdotally and through studies, that elucidate the advantages of using carbon-fiber ankle-foot orthoses (AFOs) to manage foot drop instead of the more traditional plastic posterior supports that cross the heel. It’s been known for a while that carbon-fiber AFOs provide energy return at toe-off; what’s increasingly intriguing is evidence that the devices allow the calf muscles to fire, preventing atrophy and often allowing muscle tissue to regenerate.

“This use of carbon is a paradigm shift in the orthotic industry,” said Carey Jinright, CO, of Precision Medical Solutions in Montgomery, AL. “We’re going from creating static alignment to creating a functional environment.”

Jinright explained that plastic posterior longitudinal supports (PLSs) were never intended to provide energy return or help normalize gait.

“As clinicians, we became very narrowly focused,” Jinright said. “We saw the patient dragging their toes during swing phase and thought, for safety reasons, that we wanted those toes to clear the floor. The problem was that if you do that with static alignment, what happens at heel strike? The patient is locked into a 90-degree position, and a lot of times they overcome that fixated angle through excessive flexion of the knee.”

“A carbon-fiber AFO helps facilitate a more normal gait,” Jinright said.

“If the patient can achieve controlled motion, why would we want to take that away? Our goal should be to control excessive motion—pronation or supination—not the useful motion they already have,” he said.

According to Randy Stevens, BOCPD, CFO, who practices in Harrisburg, PA, patients wearing plastic posterior AFOs sometimes demonstrate recognizable gait patterns that practitioners can take as a cue for a different type of intervention.           “You’ll often see a little more hip hike, then not as much toe off at the end of the gait cycle,” he said. “The energy restoring aspect of carbon AFOs increases range of motion in the knee and hip, and leads to less abducted gait patterns. More muscles are firing, so we’re not contributing to weakening of the gastrocs. Oftentimes a more normal gait brings with it a more erect posture, as well.”…

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