3. Practical advice and tips for carers > Physical deficits

Physical deficits

16) Walking with an AFO (Ankle-Foot Orthosis) video

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This short film is about using an Ankle/Foot Orthosis or AFO. This device may be used for people after a stroke to help with their walking.

Sometimes after a stroke the affected foot does not lift as the person takes a step. This is called foot drop. Sometimes the ankle is weakened or becomes unstable and it may cause the foot to fall inwards or outwards as the person takes a step.

Bill without AFO walking away
This is Bill. Look at his right leg as he is walking. He has to use a lot of effort to lift his foot at each step.
His foot drags along and he has to use his hip and his body to move his weight across to his left side as he walks.
Walking like this can be very tiring and can make Bill more likely to fall or trip when walking on carpets or uneven ground.

Bill without AFO walking towards camera
As he walks towards us, you can see how the effort of walking also affects his right arm. See the position of his arms. The right arm is becoming tighter as he tries to balance. This is known as increased tone or spasticity.
He also has to be careful to adjust his balance when he stops walking or if he has to change direction.

Physio manipulating foot.
We will now see Bill’s physiotherapist manipulate and stretch the muscles and structures in his foot before she puts on his AFO.
If the person you care for has an AFO, ask your therapist to show you how you can help to do this at home unless you have been given instructions. (Do not attempt to do this unless you have been shown how).
The therapist can show you how to position your hands and the amount of pressure to use.
Start by firm but controlled stretches, moving the foot up and down at the ankle. The ankle may feel tight when you push the foot up. Be careful if the person has pain, swelling or a wound on the foot.

Next the therapist manipulates the foot to loosen the structures in the middle of the foot using side to side movements.
She then gently stretches the toes until the foot is flat but relaxed. Next she rocks the foot from side to side.

Putting on AFO
Because the AFO is made of plastic socks made of cotton or socks which are absorbent are often more comfortable to wear.
Each person is carefully measured so that the AFO fits securely without rubbing or marking of the skin. Positioned correctly there should be no gaps around the heel. If the foot is still not fitting into the AFO then try a few more stretches before fitting again. The Velcro strap should fit securely but not too tightly.

You may need advice about the type of shoes to use with an AFO. Shoes like Bills with Velcro fastenings are good because the shoes will fit well on both feet even though one shoe will eventually stretch slightly because of the AFO. Some people will find they have to buy shoes which are a size or width fitting larger for the AFO and then use an insole in the shoe on the non affected side.

Make sure the shoe fits securely so the AFO will not slide inside the shoe. It should not be too tight because the foot may swell once the person has been walking or wearing shoes for a while .

Bill Walking with AFO on.
Now we can see Bill walking with his AFO on.
Notice how his foot lifts clear of the ground on each step. He is walking faster and with much less effort than before.
Also notice how his hands are by his side, compared to the tense right arm before. He stops smoothly with one controlled movement.