Keys To Prescribing AFOs For Senior Patients
However, despite the high prevalence of foot problems and the significant impact these impairments have on older people, they often go unreported because many older people consider foot and ankle pain an inevitable consequence of aging rather than a medical condition.10,11
Pertinent AFO Considerations For Foot and Ankle Osteoarthritis
Clinicians have utilized AFOs for many years to stabilize osteoarthritic joints with the goals of reducing motion and minimizing ground reactive forces to the involved joint. Without question, a gauntlet style AFO is the best fit for these purposes.
Although articulated devices have been proposed and can offer some benefit, custom gauntlet style solid ankle AFOs perform better for pain reduction and biomechanical control.12 In a 2006 article, Huang and colleagues reported that a solid gauntlet style AFO is the best option (over an articulated style) for those with ankle osteoarthritis arising from ankle motion.13
However, clinicians must take care to choose accommodations that will benefit the senior patient’s needs. Although some have deemed gauntlet style AFOs as less advantageous because of the absence of a functional foot orthosis (FFO), most quality labs can incorporate a good FFO into a gauntlet style AFO. For those with isolated subtalar joint osteoarthritis, an articulated style of gauntlet AFO may be of benefit so as not to lock normal ankle joint range of motion.
Additionally, one must assess the trim lines of the AFO you are prescribing. Most quality AFO manufacturers such as Arizona AFO, Langer Biomechanics and others can offer at least one style of AFO (the Arizona Standard AFO) with specific trim lines designed to control both the ankle and subtalar joint. These companies also offer an AFO style with trim lines that will lock the ankle while leaving the subtalar joint free. An example of this would be the AZ Sporty. Choosing the right trim line for your gauntlet style AFO can be critical for patient adherence and success.
While the “standard” style gauntlet AFO is very familiar to the podiatric physician, this trim line style may not always be necessary if the patient does not have osteoarthritis in the subtalar joint. The photo above at left and the next two photos below demonstrate three common types of trim lines available for the osteoathritic patient in order to maximize normal motion while offloading the affected joint effectively.
The most common issue in prescribing a gauntlet style AFO for senior patients is getting them to fit into an acceptable shoe.