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Orthoses for the lower and upper limb and adapted footwear
An orthosis is chosen by what the weak muscle fails to do and in which phase of gait: isolated foot drop — a light posterior leaf spring; weakness with ankle instability or spasticity — a solid or hinged orthosis; a buckling knee — a long orthosis (KAFO) or a "ground reaction" orthosis.
Why it matters in the exam
Types of AFO: posterior leaf spring — flexible, lifts the foot in swing and suits weak ankle dorsiflexors without significant spasticity and without mediolateral instability; solid AFO — controls all ankle motion, suits spasticity, instability and calf weakness; a hinged AFO with a plantar-flexion stop — allows dorsiflexion in stance; a carbon fibre AFO — light, stores and returns energy at push-off; a ground reaction AFO (GRAFO) with an anterior shell — creates a knee extension moment and suits crouch gait and weak calf or quadriceps muscles. A solid AFO set in slight plantar flexion pushes the knee into extension, and in dorsiflexion — into flexion.
A KAFO suits quadriceps weakness with strength below 3 and an unstable knee, with a knee lock; a "Swedish knee cage" prevents knee hyperextension. In high spinal cord injury hip-knee-ankle-foot orthoses (HKAFO or RGO) are used for standing and therapeutic walking. In the upper limb: a resting hand splint; a wrist extension splint in radial nerve palsy; a thumb spica in de Quervain; an "anti-claw" splint (blocking MCP hyperextension) in ulnar nerve injury; and in C6 injury — a tenodesis splint that uses wrist extension to close the fingers.
Shoes and inserts: a rocker sole reduces forefoot pressure and suits metatarsal pain and a stiff big toe; a metatarsal pad is placed just behind the metatarsal heads, not under them; a medial heel wedge and a Thomas heel suit a flexible flat foot; a shoe raise suits leg-length discrepancy; and in diabetes with neuropathy — an extra-depth shoe with a custom total-contact insole. Spinal orthoses: a hyperextension brace (Jewett) suits a stable anterior compression fracture and does not suit an unstable or burst fracture; in the neck — a soft collar barely limits motion, and the halo limits more than all the others.
Key points
- Posterior leaf spring — simple foot drop.
- Solid — spasticity and instability.
- GRAFO — crouch and quadriceps weakness.
- KAFO — quadriceps below 3.
- Rocker sole and metatarsal pad — forefoot pain.
Summary table
| Orthosis | Main action | Suits | Does not suit |
|---|---|---|---|
| Posterior leaf spring AFO | Lifts the foot in swing | Foot drop without spasticity | Spasticity or ankle instability |
| Solid AFO | Controls all ankle motion | Spasticity, instability, calf weakness | Someone who needs free ankle motion |
| GRAFO (ground reaction) | Knee extension moment | Crouch, quadriceps or calf weakness | Fixed knee flexion contracture |
| KAFO | Knee lock | Quadriceps strength below 3 | Someone who can control the knee |
| Rocker sole | Reduces forefoot pressure | Metatarsal pain, stiff big toe | — |
A free exam question
מה היתרון של סד AFO עשוי מ( סיבי פחמן carbon fiber ) על פני סד AFO ?עם ציר (the question as examined, in Hebrew)
- א. מאפשר לעבור מישיבה לעמדה בצורה נוחה יותר
- ב. מספק יציבות מדיו-לטראלית
- ג. מותאם ל מבנה הרגל
- ד. משפר push off
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Sources
- AAOS Atlas of Orthoses and Assistive Devices, 5th edition (2019) — Lower limb orthoses and footwear
- Braddom's Physical Medicine and Rehabilitation, 6th edition (2021) — Upper and Lower Limb Orthoses
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.