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A Therapist’s Guide to Finding the Perfect AFO Brace for Foot Drop

man walking with foot drop brace and four-prong cane

Foot drop involves difficulty lifting the front portion of the foot, a movement known as dorsiflexion. Because this can make it difficult to walk and safely navigate around, therapists often recommend using an ankle foot orthotic, or an AFO brace for foot drop.

While an AFO is an excellent way to address foot drop, it is easy to become overly reliant on your brace. This can result in a slower recovery journey, or even cause further complications.

In this article, you’ll learn when it’s appropriate to use an AFO brace for foot drop and what to look for as you shop around.

Why Should You Use an AFO Brace for Foot Drop?

Approximately 20% of stroke survivors experience foot drop. This condition involves difficulty with dorsiflexion, which can cause the foot to “drop” or drag when an individual is walking.

Typically, when individuals walk, the brain sends messages to various muscles to keeps the toes from dragging on the ground. When the communication between the brain and the muscles is disrupted, such as after a stroke or brain injury, foot drop can occur.

The inability to effectively lift the foot off the ground can be a significant safety concern. When the toes drag, it is easy to trip over items on the ground, such as a rug or crack in the sidewalk.

Furthermore, many individuals with foot drop also experience numbness in the affected foot. This means they may be unable to feel small changes when walking on uneven surfaces, increasing the possibility of a fall.

How a Foot Drop Brace Can Help Correct Poor Walking Patterns

Rather than letting their toes drag, some individuals with foot drop choose to swing their affected leg out to the side with each step to avoid dragging their toes. Others choose to lift their leg up high, like they are marching, to allow their foot to clear the ground.

However, these different walking patterns do not address the actual root cause of foot drop, nor are they likely to promote recovery. On the other hand, they are likely to cause further complications, such as chronic pain and faster rates of fatigue.

This is why doctors and therapists frequently suggest wearing an AFO brace for foot drop. AFO braces support the ankle, keeping the toes aligned with the rest of the foot, rather than allowing them to drag.

This increases your safety when walking and helps prevent the development of abnormal gait patterns. In turn, those who use a foot drop brace are able to move around more safely and easily.

Drawbacks of Using a Foot Drop Brace Long-Term

person with AFO brace for foot drop showing underneath his sneakers as he takes a step forward

Although AFO braces are a widely used treatment for foot drop, there are several disadvantages. AFOs can reduce air circulation around the foot and ankle, potentially leading to the development of wounds.

Some types of AFOs can also make it more difficult to feel the walking surface beneath the feet, causing challenges with balance. They also may be uncomfortable and not visually appealing.

The most significant drawback is that while foot drop braces are an excellent way to compensate for the muscle weakness associated with foot drop, they do not promote a full recovery. Rather than rehabilitating the affected neural pathways that cause foot drop, AFO braces simply address the outward physical symptoms.

When individuals use an AFO brace for foot drop, their brain no longer needs to use the neural pathways associated with lifting the toes. Over a long period, these unused neural pathways become progressively weaker.

This can result in learned nonuse, where the brain notices that you are no longer using a function and decides it is no longer necessary to keep that skill. This is the origin of the popular phrase in neurological recovery: “use it or lose it!

If you don’t use your ankle mobility, you’ll lose your ankle mobility.

How to Overcome Dependency on Foot Drop Braces

The goal of neurological recovery isn’t to merely find compensation techniques for everything. Rather, optimal recovery involves retraining the neural pathways and muscles to function appropriately.

This is achieved through neuroplasticity, the mechanism that your brain uses to rewire itself and form new neural connections. Neuroplasticity is activated through repetitive practice.

By repeating foot drop exercises frequently, neuroplasticity will start to engage and begin reconnecting your brain to your muscles. Physical therapists may also use functional electrical stimulation to promote better communication between your nerves and muscles.

As your ankle and foot mobility gradually improves over time, you may be able to begin reducing time spent using your AFO. With your doctor or therapist’s approval, you may begin to practice walking without your AFO in a safe environment.

It may take time to fully recover your ability to walk properly and safely without your foot drop brace, but neuroplasticity makes it possible.

What to Look for in an AFO Brace for Foot Drop

person wrapping a soft AFO brace for foot drop around ankle using big velcro strips

Your doctor or physical therapist is the best resource for choosing the perfect AFO. After all, every individual is different, which means that everyone will benefit from different types of foot drop braces.

In order to have a productive conversation with your therapist, it helps to be aware of the various characteristics that are available in AFO braces.

Here are some factors that should be considered when purchasing an AFO brace for foot drop:

  • Rigid or soft. Rigid braces are more supportive, while softer braces are more comfortable and less likely to cause skin integrity issues.
  • Hinged or solid. Hinged braces allow individuals to continue using their ankle muscles, while solid braces fully support the foot and ankle and may result in ankle contractures (severe spasticity) when used for long periods of time.
  • Custom-made or prefabricated. While custom-made options are personalized and adapted to your specific needs and body structure, prefabricated options may be more appropriate if you’ll be using it only short-term as you pursue a full recovery.
  • Easily concealed or outwardly visible. Although this is not the most practical consideration, some individuals may feel strongly that they want their AFO brace to be as discreet as possible.
  • Cost-effective or more expensive. Costs of AFOs vary greatly depending on your insurance coverage and the type of AFO needed.

It is important to keep these factors in mind when deciding which AFO brace for foot drop is most appropriate for you.

Should You Use an AFO Brace for Foot Drop?

AFO braces are frequently one of the first treatments prescribed for individuals with foot drop. However, for many, an AFO should be used as a temporary safety aid rather than a permanent treatment.

We encourage you to start practicing foot drop exercises on a regular basis, preferably with a full-body rehabilitation exercise regimen. This will optimize neuroplasticity and help you regain use of your ankle and foot. As you continue to improve, neuroplasticity can help you slowly start to outgrow the need for an AFO. And with enough time and effort, you might be able gradually wean off of your AFO altogether.

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