AFOs: All About Ankle-Foot-Orthoses

An ankle-foot orthosis, better known as an AFO, is a medical device or a solid brace for the lower leg. The primary use of an AFO is to help patients walk safely regardless of the condition they’re suffering from.

There are different types of AFOs, and most of them are custom-made to provide the best possible care for the patient.

AFO orthoses are one of the most prescribed types of orthoses in the US, and that’s because they have a wide application. Your podiatrist can help with finding the perfect AFO for your needs.

What Is an AFO (Ankle Foot Orthosis)?

An AFO is usually meant to provide the support that will better position your ankle or your foot while you walk. It’s also meant to offer stability when there’s weakness or deformity in your leg.

Another common use for AFO is foot drop, a condition that makes it very difficult for a person to lift the front part of their foot. That’s why an AFO is sometimes referred to as a “foot-drop brace.”

AFOs ankle braces

How Do AFOs Work?

Typically, an AFO has an L-shaped frame that goes around your ankle or your foot. One crucial purpose of an AFO is to make sure a person doesn’t drag the foot, improving the person’s gait.

It also helps to prevent a patient from tripping and getting hurt. But you shouldn’t confuse an ankle-foot orthosis with a walking boot, though. Unlike an AFO, a walking boot is only used in the event of a foot or ankle injury.

AFO Parts

An AFO is a medical device, but it doesn’t contain any electronic elements in its construction. However, it may have mechanical elements in the form of springs and dampers, which are there to assist in joint motion.

There are two types of AFOs in terms of how they’re made – articulated and nonarticulated. The nonarticulated AFOs are of one piece and are made from thermoplastic and other lightweight materials. But they do come in different designs, and some are rigid while others are quite flexible. 

The role of the rigid AFO is to ensure the ankle maintains a fixed position. But there is such thing as too rigid an AFO, and that can strain the knee.

The articulated AFO is usually made of lightweight materials combined with carbon composites and features an articulated joint. The articulated joint comes with pivots that control the motion of the AFO. 

We should also mention the AFO attached to the shoe form of the device and the AFO ankle gauntlet as well. An AFO attached to the shoe is also called an external AFO. Unlike traditional AFOs, this device is entirely outside the shoe to maximize comfort and minimize skin irritation.

An AFO ankle gauntlet is a type of AFO that serves as an alternative to rigid materials normally used for AFOs. It’s usually made from natural leather and certain stiff reinforcing materials.

How to Wear an AFO

An ankle foot orthosis might seem like a complicated device to wear. But in reality, once you understand the basics, wearing it can seem like second nature.

It’s essential, though, to make sure that you ”break in” your AFO properly to avoid any discomfort. Here’s how you correctly put on your AFO:

  1. Make sure to wear a long cotton or AFO-specific sock.
  2. If your AFO has Velcro straps at the front, loosen them.
  3. Slide your foot in slowly and position it to fit properly at the back of the brace.
  4. Fasten the Velcro straps so that your AFO feels snug but not tight.

It’s important to ensure that the shoes you’re going to wear can accommodate your AFO brace. If necessary, you can remove the insole for a little extra room. It’s also prudent to consider getting shoes a size bigger and wider than you usually would wear with the AFO.

When you put your AFO on for the first time, you shouldn’t wear it longer than one hour that day. And when you remove it, pay attention if there are any points of irritation on your skin.

If there’s some redness, that’s okay, as long as it’s gone after 30 minutes. The second day, you can wear your ankle-foot orthosis for about two hours. And then proceed to check your skin and generally pay attention to your body’s cues.

Overall, it’s going to take anywhere from 7-15 days to fully break-in your AFO. After that, you’ll likely be able to wear it the entire day without issues.

How to Clean Your AFOs

Keeping your AFO orthotics clean is going to guarantee it lasts longer and serves your needs better. The good news is that it’s not a complicated thing to do. All that’s required is to clean it with a damp cloth from time to time.

If your AFO is made from plastic, you can also use some rubbing oil to remove excess oil or any dirt or residue. It’s not a good idea to submerge it in water and leave it there, however, because that could harm the fasteners and straps.

Also, it’s advisable to scrub the straps from time to time and let them air dry. And if you clean the lint from the hook fastener, it’s likely going to hold well for extended periods.

Who are AFOs for?

We already know that AFOs are one of the most common types of orthosis devices. Let’s take a closer look at the conditions patients suffer from where AFOs are beneficial.

AFOs elderly arthritis

AFOs for Patients with Instability in Lower Limbs

Even though the “A” in AFO represents “ankle,” the truth is that this device is more often prescribed for the foot by podiatrists and other clinicians. 

In case of lower limb instability that is often a result of an ankle sprain, some experts shy away from using an AFO. This is a complicated problem, and not everyone takes the same approach to treating it.

However, there is much evidence that shows using an AFO with other therapy interventions can lead to excellent outcomes. In cases of chronic ankle instability in patients who are in professional runners, an AFO is often recommended as a part of the treatment.

Patients with Arthritis

As we get older, the risk of arthritis becomes higher. The inflammation, swelling, and ultimate deformity of joints is a great source of discomfort for many patients.

It can be especially difficult for those who suffer from arthritis in their feet and ankles. Symptoms can include tenderness, pain, stiffness, and overall difficulty walking or even moving.

Depending on the severity of the condition, an AFO brace or AFO insert is often recommended by a specialist as treatment.

Patients with Fractures

The purpose AFOs in the case of ankle and foot fractures is to stabilize the bone and allow it to heal properly. But it’s also very useful post-fracture to prevent re-injury.

When talking about fractures, it’s important to point out that an “off the shelf” AFO won’t do. The AFO needs to be molded specifically for the patient to ensure the fracture heals properly. 

AFOs and Patients with Multiple Sclerosis

Patients with multiple sclerosis (MS) often experience difficulty walking, depending on which stage of the illness they are in. In some cases, the complaints are about general instability when walking. 

Other times it’s the weakness in their feet and ankles, muscle spasms, and foot drop. Another problem many MS patients have is that they often stumble. All these symptoms mean that they may benefit from wearing a comfortable AFO brace.

Stroke Patients

Many stroke patients suffer from gait abnormalities and foot drop. An ankle foot orthosis is often a vital part of their rehabilitation.

Specifically, the rigid AFO structure can significantly help in increasing gait speed and other forms of ankle and foot functionality. But using an AFO has a potential effect on the neural plasticity of the brain related to walking.

The reason is the use of an orthosis might lead to loss of muscle due to inactivity. And what is known about neuroplasticity suggests that patients may have a harder time recovering their motor abilities as a result of the immobilization.

AFOs foot drop

Are Orthopedic Shoes Covered by Insurance?

Since the need for AFOs can stem from different medical conditions, it’s natural to wonder whether items like an AFO insert and orthopedic shoes are covered by insurance. The answer to that question will vary depending on what type of insurance you have.

While it’s true that most health insurance companies provide some form of coverage regarding orthopedic shoes and inserts, often that coverage is insufficient. When it comes to a government program like Medicare, things are a little different.

Patients become eligible to be covered by Medicare at the age of 65. Some, if not most, conditions that require a patient to wear AFO typically appear at an older age, so the need for this type of coverage becomes more relevant.

At the present, Medicare will cover up to two pairs of custom-molded shoes and inserts every year. In most cases, Medicare will also cover shoe modification and extra-deep shoes.

Best AFO Shoes

There is some stigma around wearing an AFO, which can be especially difficult to overcome when you can’t find the right shoes to wear with your brace.

AFO shoes or AFO-accommodating shoes should be functional, but there’s no reason why they can’t be stylish as well.

But it can be a truly daunting task to find the pair of AFO shoes you can wear for all kinds of occasions. To make this a little easier, we’ve reviewed some of the best AFO wear for men, women, children, and even toddlers.

AFO Shoes for Men

Mt. Emey 9708 Men’s Athletic Walking Shoes by Apis

Your AFO brace is there to help you walk while you heal from a foot or ankle related issue. But when you’re going out for a walk, it’s essential that you wear shoes with better accommodation for the AFO, and that there’s room for internal modifications. This Mt. Emey model provides such accommodation along with seamless lining to minimize friction.

The shoes feature an EVA outsole that has a symmetrical cut-line, which means easy modifications. This pair of stylish shoes for AFO is made from leather and fabric. In terms of fit, they’re true to size. They’re also a suitable solution for people with wider feet. You can purchase them in three colors – white, black, and brown.

Mt. Emey 9501 Extra Deep Shoe by Apis

This Mt. Emey model from Apis represents a double-depth-style shoe, which is specifically designed to accommodate AFOs and other types of orthopedic devices. People suffering from foot deformities such as bunions and hammertoes would likely find this model very comfortable.

These are not typical walking shoes, though. They feature a more classic, dressy, or business style of shoes. The material of the upper is soft leather, and the sole is made from durable rubber. The lining is also genuine leather that provides more than enough breathability.

They are much deeper than traditional shoes in this category, which means they provide more ankle support and are suitable for people with chronic ankle weakness. Internal modifications are also possible because they have a removable insert that provides a more flexible fitting.

Drew Shoe Men’s Navigator II Sneakers

If you’re looking for a classic leather Oxford shoe that can accommodate your AFO brace, the Drew Shoe Navigator sneakers are an excellent option. Made from soft leather and a synthetic sole, they provide enough breathability and support for your aching feet.

They’re incredibly easy to put on due to the easily adjusted Velcro straps. They’re suitable for patients with arthritis who have pain in their feet and need to wear an AFO brace but suffer from pain in their hands as well. This pair of shoes features a double added depth and has a padded collar and tongue.

Drew Shoe Men’s Big Easy Boot

It can be quite a challenge to find boots that fit over AFOs, but fortunately, this pair from Drew Shoe does just that. These boots are scuff resistant and fully supportive. The Velcro strap makes putting them on and taking them off extremely easy and convenient.

And the genuine leather material allows for enough breathability in case you’re suffering from nail or toe related issues. They also feature a Drilex lining that provides moisture-wicking properties that will help during damp weather. 

If what you’re looking for is arch support, the tempered steel shank delivers just that. Both insole and outsole are made from polyurethane.

AFO Shoes for Women

Propet Women’s Tour Walker Strap Sneaker

Propét is a company that has been around for nearly 40 years and has, during that time, mastered the art of producing comfortable and functional orthopedic shoes. This particular pair of sneakers is designed for women who suffer from foot-related issues and is one of their more attractive models.

You can get it in eight different styles and colors, and each of them combines classic design with functionality. The upper material is 100% leather, and the sole is made from rubber. Patients suffering from diabetes and qualify for Medicare should know that their insurance covers these shoes. 

Women’s Sugar Mary Jane Flat by Trotters

It can be extremely complicated to find flat stylish shoes for AFO. However, this particular pair from Trotters provides enough cushioning and arch support for women with an AFO brace to try them out.

The company uses the softest leather to produce its shoes, and the insoles and outsoles are very flexible and make walking a little easier. Another characteristic of this pair and what makes them a suitable choice for AFO wear is that they adapt to your foot’s shape. This particular model is available in four colors.

Drew Shoe Magnolia 14326 Women’s Casual Shoe

Drew Shoe offers a line of women’s orthopedic shoes as well. In fact, they have a long history of producing some of the best orthopedic shoes that help with many foot and ankle related conditions.

This pair features very clean lines in terms of design and is a great choice for spring and early fall. The Velcro strap isn’t too prominent, but it’s strong enough to make sure the shoes stay firmly on your feet. They are true to size and are wide enough to accommodate your AFO brace.

Propét Women’s Madi Ankle Strap Snow Boot

Boots that fit over AFO are uncommon as it is. But when you need a pair that can withstand cold weather and snow, the choices narrow even more. But Propét seriously delivered with their snow boot, so there’s no need to stay at home because you don’t have the right shoes to go out.

The upper is synthetic and water-resistant. The rubber sole will ensure that there’s less risk of slipping while you’re on a walk. These shoes have double insoles, so you can remove one or both if there’s a need to use your own AFO insert instead. If you’re looking for winter boots with color, however, these are available only in black.

Aravon Women’s Beaumont Fisherman Sandal

When we think about orthopedic shoes, images of bulky and heavy shoes often come to mind. But fortunately, we live in an era when an orthopedic shoe like the Fisherman Sandal by Aravon exists. They are lightweight, beautifully designed sandals that provide enough stability for anyone who struggles with it.

The intricate upper is leather, the outsole is rubber, and the midsole is EVA lightweight foam. Another great thing about this particular pair is that they’re available in extended sizes and widths, which means that women with AFO braces can comfortably wear them. They come in three colors. 

AFO Shoes for Kids

When buying the right AFO shoes for your kid, things aren’t as simple as getting just a size bigger shoe. And it’s not just about having the shoes wide and deep enough to put them over the AFOs.

Overall, the shoes you’re looking for should offer a range of wide styles, provide deep toe boxes, have at least one removable insole, and most importantly, have large openings.

BILLY Footwear Kids Unisex Classic Lace High

The first thing you notice about Billy Footwear shoes is the wrap-around zipper, which ensures a super-efficient way to put on and remove the shoes. This means everything, because we all know how slow kids can be when it comes to putting their shoes on.

The vamp features a lace-up that delivers an extra custom fit for your child’s feet. The shoes have a textile lining for breathability, and a cushioned footbed that will let them roam around outside all day without their feet getting tired.

The outsole is a durable rubber that provides plenty of flexibility. Another fantastic thing about these shoes is that they come in nearly 20 colors and styles and are available in sizes to fit toddlers to teenagers. 

AFO Shoes for Toddlers

Toddler’s feet and ankles are sensitive, and even when they’re walking around, they might still struggle with maintaining balance. But for toddlers who need to wear AFO braces, picking the right shoes becomes absolutely essential.

Memo Alex Boys’ Corrective Orthopedic Boots

If your child needs to wear a type of AFO to help with problems like flat feet or pronation, or they’ve sustained a foot or ankle injury, they need good corrective shoes. These boots by Memo are a fantastic choice because they’re flexible and lightweight. 

Many children’s orthopedic shoes tend to be massive for their small feet. But not this pair, which features a rubber outsole that’s made specifically to help with different issues while walking. The shoes provide extra depth to accommodate AFOs and allow for modifications to the insole.

Both the upper and the interior lining are made from the softest leather to promote breathability. The two Velcro straps allow you to put the shoes on their feet quickly. And it makes it difficult for them to take the shoes off.

Different Types of AFO Braces

Is an AFO Brace Right for You?

You can purchase an AFO brace online or over the counter when you’re experiencing pain in your foot or ankle. And in many instances, wearing it will alleviate any discomfort you might be feeling.

But when foot drop, loss of balance, or muscular issues in the foot is related to more serious conditions, a person will need an AFO brace prescribed by a podiatrist. There are many types of AFO braces, so let’s have a look at the most common.

AFO Ankle Brace

Med Spec ASO Ankle Stabilizer

This is by far the most popular type of brace and is the most widely available on the market. The primary purpose is to protect the ankle and provide enough support while walking. It has an elastic cuff closure, which is essential when treating ankle sprains. The nylon material used to make it is durable and strong, and it’s going to fit comfortably in most shoes. The size is universal, and it will fit both the left and right foot.

Molded AFO Brace

Ankle Foot Orthosis Support AFO Brace by Furlove

AFO braces can be made from molded plastic, and these are usually one piece and have a curved structure to provide a more ergonomic fit.

Abnormal walking patterns and foot drop are common conditions stroke patients have to deal with during their recovery. That’s why they often need AFO braces like this model by Furlove, which will help them walk a little easier.

It’s very efficient when it comes to correcting foot drop, and it can help with the post-stroke rehabilitation process. These AFO braces promote flexibility and will help lessen the chance of injury. They also feature high-adhesive Velcro straps, a detachable flannel pad, and thick foam padding for extra comfort.

AFO Brace for Running

Zenith Ankle Brace for Running

This is a type of AFO brace that moves as you move. It’s designed to provide maximum ankle support for those who like to stay active. If you love running and playing basketball, but ankle pain is making that difficult, you’ll likely benefit from a brace that can immobilize your foot without causing any discomfort. It’s made from high-quality nylon, which means you’ll be able to use this brace for a very long time without it losing its shape.

AFO Light Brace

BioSkin Trilok Ankle Brace

An AFO light brace is usually used by patients who have a relatively mild case of foot drop. They’re generally not very bulky, as is the case with this particular model from Bioskin. When you need a high-quality light brace that can help with plantar fasciitis, light ankle sprain injuries, and other issues with ankle instability, this could be the choice for you.

It’s made from Lycra and polyester, which provide more than enough comfort for your ankle and foot. And if you’re worried about an allergic reaction, the brace is hypoallergenic. It’s easy to put on and will fit any size foot.

Drop Foot Brace

AFO Brace Medical Ankle Foot Orthosis by Furlove

Foot drop is one of the main reasons why people wear AFO braces. It’s not always easy to find the right foot drop brace, but this model by Furlove is an excellent option. It features a breathable liner, strap fastening buckle, fixation strap, and a supportive strip made from polypropylene.

We should point out that this AFO brace is a little narrow compared to most, and that to get the right size, you should consult the company’s size chart. A great feature of this brace is that it’s easy on your skin. It’s also easy to clean and maintain.

AFO Brace for MS Patients

NEOFECT Drop Foot Brace

Multiple sclerosis is a condition that can cause issues with gait and walking in general among many patients. One of the main complaints is general instability and numbness in the feet. That’s why ankle braces like this one from Neofect are a good tool that can potentially help with those issues.

The main strap is relatively wide, which allows for blood circulation as well as adequate ankle support. It’s pretty inconspicuous in terms of design and will fit comfortably in almost any slightly wide shoe.

AFO Brace for Kids

Memo Sprint CP Kids Ankle Support Combat Boot

Sometimes kids need to wear AFO braces in order to correct flat feet, fix problems with foot ligaments, or other foot and ankle-related issues. These combat boots by Memo are incredibly well-made and durable.

The upper is made from breathable natural leather, and the outsole is flexible rubber. They also feature a tightening strap to adjust to your child’s feet, an easy fitting lace system, and enough toe protection for them to safely run around.

AFO Brace for Toddlers

Custom Orthopedic Ankle-Foot Brace

If your toddler is suffering from foot drop, a custom AFO by RousuCare is an option to consider. These are hand-made by orthotists, who are professionals who understand the development of a child’s feet. The brace is made from a thermoplastic material that’s especially gentle on your child’s skin.

It’s also lightweight and features an open design to ensure your toddler’s feet remain dry and cool at all times. This model also has a uniquely created stretch that helps with your child’s foot’s musculature and can help with foot-related pain.

AFO Brace for Babies

Splint Baby Ankle-Foot Brace by RousuCare

These baby AFO braces are made from a super-soft material that’s going to be kind to their feet. The AFO brace will fit on both the left and right foot. It’s designed to correct foot drop issues and other foot-related problems while your baby sleeps. These braces can help with the reduction of muscle contractions and inflammation.

AFO Socks

Wearing AFO Without Socks

While you can wear your AFO brace without socks if you choose to, it’s not exactly recommended. Socks are there to protect the soft tissue from the sometimes harsh materials of the AFO.

It’s particularly imperative to wear socks when you’re first breaking in your AFO brace, because that’s when your skin might react the most. But not all socks are created equal when it comes to AFOs, and it can be beneficial to choose AFO-specific socks to wear with your brace.

Why AFO-Specific Socks Are Helpful

Before we check out some of the best socks for AFOs, let’s understand why AFO-specific socks are better than traditional socks.

Socks that are made with AFO braces in mind are usually seamless and can reduce skin irritation. They also are less likely to slip down your leg and wrinkle. Finally, the best socks for AFOs will have enhanced breathability and anti-microbial properties.

Adult AFO Socks

SmartKnit Adult AFO Interface Seamless Sensitivity Socks

The materials used for these AFO socks are Lycra and polyester. They are completely seamless and wrap around your feet gently and comfortably. They also have anti-microbial properties, so you don’t need to worry about foot odors. They come in four colors and small and regular sizes. 

Core-Spun Patterned AFO Interface Socks

These socks are not entirely seamless, but they do feature a smooth seam that is more than comfortable. The material is soft and stretchy and moderately form-fitting. This US-based company creates socks that are thick and moisture-wicking. They’re also machine washable.

Kids’ AFO Socks

SmartKnit Seamless AFO Interface Socks

SmartKnit is a company that makes some of the best socks for AFOs on the market. They’ve also created AFO socks for kids that range from infant to small adult sizes.

They’re completely seamless and don’t have any heel design, which means that they will accommodate almost any child’s foot. They’re incredibly soft and form-fitting and will match any AFO brace.

AFO Socks for Toddlers

AFO Baby Socks by AFO Baby

These AFO baby socks are knee-high and suitable for babies who need to wear AFOs or other brace types. The toe seams are flat, and the leg cuff is comfortable. Five pairs come in a single pack, and you can get them in several sizes.