Addressing Calcaneus Gait With AFOs

I received a call from a colleague with questions regarding how to make an AFO for a patient who had a poor outcome following a spinal surgery. She developed a dropfoot on the left side. This is not an unusual complication of such a surgery. What was unusual, however, was that on the right side, she had posterior weakness rather than anterior weakness and developed a calcaneus type of gait. She has a difficult time plantarflexing her right foot. This resulted in her walking on her heel on the right side while having a typical dropfoot on the left side. Our client decided to use a dorsiflexion-assist functional AFO for the left dropfoot (to prevent plantarflexion). However, he was not sure what to do for the calcaneus type of gait on the right.

As far as I know, there are no AFOs designed specifically to stop dorsiflexion for the right foot. This would require an AFO that either surrounds the entire foot to keep the foot dorsiflexed or an AFO that has some sort of strap to hold the foot to the foot plate. After we discussed this case, we decided that the best option would be to use a gauntlet AFO for the right foot. The gauntlet AFO essentially stabilizes the entire foot and ankle, and does not allow dorsiflexion or plantarflexion so it should provide greater stability.

I have not previously run into this problem. I would certainly appreciate any input or comments from readers who might have other options on how to handle this situation.

Editor's note: This blog was originally published at http://www.prolaborthotics.com/Blog/tabid/90/EntryId/298/Default.aspx and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com .



Doug Richie DPM FACFASsays: August 30, 2014 at 12:01 pm

A ground reaction ankle-foot orthosis is specifically designed to prevent tibial progression thru mid-stance, thus controlling ankle joint dorsiflexion. This is a solid AFO with a proximal plastic collar which extends circumferential around the tibia and fibula. The brace deforms with forward momentum and can provide some recoil during terminal stance to provide ankle plantarflexion and assist with propulsion.

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