Keys To Prescribing AFOs For Senior Patients
- Volume 25 - Issue 8 - August 2012
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The most common issue in prescribing a gauntlet style AFO for senior patients is getting them to fit into an acceptable shoe.
Any gauntlet style AFO will naturally take up space in the shoe, often resulting in the need for a different style or size shoe. Choosing footwear that can accommodate the AFO and the patient’s foot without being too bulky, heavy or aesthetically unpleasing can be challenging. Lycra (stretch) styles with extra depth are usually the best options but the length of the AFO footplate and the style of the AFO will determine the best shoe style. Having a stock of shoe styles that fit well with AFOs can be extremely valuable when dispensing and assessing the AFO on the patient.
First, consider the options available for AFO topcover material. Although the classic leather gauntlet AFO offers greater stability and remains the gold standard for maximum stability and support, one may consider materials that are less bulky and lighter in weight. The Arizona AFO utilizes a more lightweight, breathable synthetic material (AZ Breeze) than leather and can often be a better alternative for seniors or patients with diabetes.
Nine Prescribing Pearls On AFOs For Osteoarthritis In Senior Patients
• Consider a plastic thickness appropriate for the patient’s body size. You can specify this with the central fabrication facility from which you obtain your AFO. Make sure the patient’s body size and weight match the chosen thickness of plastic for the inner shell of the gauntlet.
• Educate your senior patients about the need for proper footwear to use with their AFO in order to achieve the best outcome. We often set ourselves up for failure by not taking the time to set the right expectations for our patients with regard to what they are getting and what will be required of them to achieve the best outcome.
• Keep in mind that anything that limits too much motion in a senior patient can reduce balance and increase the risk for falling. Studies have suggested that a solid style AFO can reduce balance and postural stability in compromised senior patients, and one should avoid this unless other pathologies exist that necessitate a solid style.14
• Adding extrinsic posting to the AFO can be valuable in some cases in which frontal plane deformity exists. However, these accommodations will often require more space in the shoe.
• Increased heel/foot height in a senior patient can reduce postural stability and thus increase the risk of falling. One should ensure careful selection of the proper style of AFO and footwear in order to keep the patient as close to the ground as possible.
• Full-length foot plates are valuable under some circumstances (i.e. a significant forefoot deformity that needs accommodation). However, these modifications can reduce balance and often require a bigger shoe.
• Don’t sacrifice comfort and padding for your senior patients. A thin layer of Plastazote or a pocketed accommodation over at-risk areas around the ankle or foot can add comfort and improve adherence.
• Velcro is always optimal with senior patients.
• For severe osteoarthritis of the ankle, subtalar joint or both, an extended style of AFO can be extremely effective.