Can A Comprehensive AFO Offer Superior Compliance?

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Emerging as a custom gauntlet-type ankle-foot orthosis (AFO) with wide-reaching indications, the ProLab Orthotics Custom Gauntlet AFO reportedly offers non-surgical stabilization of the rearfoot and ankle in all three planes. Jonathan Kreger, DPM, attests he uses the Gauntlet AFO for conditions beyond the manufacturer’s recommended indications with very positive results.

“Compliance with the Stabilizer AFO is excellent and much better than with standard polypropylene ankle and foot orthoses or other braces,” maintains Dr. Kreger.

[3]Dr. Kreger notes that he uses the Gauntlet AFO most often for osteoarthritis of the ankle, severe adult acquired flatfoot deformity, ankle instability, residual clubfoot deformity and dropfoot deformity. According to the manufacturer, physicians may utilize the Gauntlet AFO for:

• neuromuscular instability of the subtalar joint;
• Charcot arthropathy;
• nonreductible pronation with subluxation;
• chronic ankle instability;
• delayed ankle fusions;
• post-surgical rearfoot fusions;
• Stage III and IV rigid nonreducible adult acquired flatfoot; and
• subtalar degenerative joint disease following calcaneal fracture.

“Initially, the Gauntlet AFO is more comfortable for patients to start using than other custom AFOs,” adds Dr. Kreger, a podiatrist in practice at the Ukiah Podiatry Group in Ukiah, Calif. “There is less of an adjustment period needed.”

Key Casting Considerations
ProLab Orthotics advises utilizing a semi-weightbearing casting technique in conjunction with the Gauntlet AFO. Dr. Kreger recommends accommodating at least a half an inch to an inch larger shoe size for the best fit. In his experience, the Gauntlet AFO is much more effective using a half-inch raised casting pillow under the heel.

“If you do not use the casting pillow with at least a half-inch level, the posterior superior aspect of the AFO will irritate the lower posterior leg,” advises Dr. Kreger.

ProLab Orthotics provides a 12-minute video of a casting demonstration using a STS mid-leg sock at: http://www.prolaborthotics.com/StabilizerAFO.htm [4]. The manufacturer recommends casting on a half-inch, heel-raised footboard unless one is using the device for instability of the subtalar joint. In those cases, the manufacturer suggests a neutral subtalar casting position.

Other Pertinent Pointers
Dr. Kreger also notes that the device will not restore neutral position to the subtalar joint in flatfoot deformities. In these cases, Dr. Kreger says the device provides support for the foot in a more pronated position.

The Gauntlet AFO comes in three heights: 5, 7 and 9 inches. In his experience, Dr. Kreger says the 7- and 9-inch sizes are most effective. For more severe deformities, Dr. Kreger suggests using the taller, 9-inch option.

Dr. Kreger also recommends using the laced, two Velcro top strap closure version of the AFO. The Gauntlet AFO also comes in three custom-molded polypropylene shell types, two footplate lengths, two lining and six closure options. ProLab Orthotics also offers to archive casting images to help avoid recasting of patients.