Archive for February, 2014

Ankle Foot Orthoses (AFO) – Richie brace and Arizona Gauntlet

February 16, 2014

Ankle Foot Orthoses, or AFOs, are devices used to support the lower extremity. They usually cover the bottom of the foot and extend up the ankle. The size of the brace is custom fitted to the patient and varies based on the patient’s needs. Some cover the entire ankle up to just below the knee, while others barely extend past the ankle. They are usually prescribed to patients in order to help reduce pain while walking or while healing from injury. An AFO may also be used to assist with walking in people with neurological disorders, such as Charcot-Marie-Tooth syndrome or cerebral palsy. Diabetics who have lost sensation in their feet may also benefit from the use of an AFO to prevent injury.

One condition that is frequently treated with the use of an AFO is posterior tibial tendon disorder (PTTD), also known as adult acquired flatfoot. The posterior tibial tendon courses from the calf around the inside and behind the ankle and attaches underneath the midfoot on the side of the arch. The action of this muscle/tendon when functioning properly is to provid stable support for the arch of the foot. An important function of the posterior tibial tendon is to twist the foot inward while walking therefore creating a foot that is stable and able to propel the body forward. When there is decreased muscle strength in the posterior tibial tendon the foot no longer functions, as it should. With prolonged overuse, the posterior tibial tendon can lose its ability to create an adaquit arch, causing the foot to flatten. If this progressive condition is left unsupported the tendon can rupture and may need surgery.

RichieThe Richie brace is an AFO, commonly used to treat mild to moderate stages of PTTD. The brace is comprised of a custom foot orthotic and two hinged upright supports on both sides of the ankle. The brace supports the foot arch, rebalances the muscle strength in the foot and controls the position of the bones and joints of the foot and ankle. When used for PTTD, its purpose is to stop the posterior tibial tendon from over-working to maintain the foot’s arch, thereby reducing the chance of damage to the tendon. This low profile style device can usually be worn with many commonly available shoes. Most of the time, it may be necessary to use a shoe that is one size bigger than normally worn may be preferred for comfort.


Another AFO that is commonly used is the Arizona gauntlet AFO. This style of device is also worn with shoes and Arizonaimmobilizes motion at the ankle. It is effective in treating degenerative joint disease or ankle and foot arthritis. Arthritis can occur because of previous traumatic injury, such as an ankle fracture or sprain, or can happen as a process of aging. As these conditions progress, it becomes increasingly painful to move the foot and ankle. Using the Arizona brace restricts motion and can eliminate pain while walking. The brace is two-layered with a firm, durable outside and soft, leather inside. It is equipped with laces, which is convenient for those who may need to make minor adjustments to the size of the brace if the foot and ankle swells. This type of brace may also require that patients wear a bigger or extradepth shoe to accommodate the foot and brace. The Arizona gauntlet can also be used for PTTD.

If an AFO is the correct form of treatment for your condition, your doctor will recommend the appropriate type of brace for you.  The next step in the process for making your AFO is that a plaster or fiberglass casting of your foot and ankle will be taken. This model will then be sent to the orthotic lab to custom manufacture the device for your foot and ankle. When the lab returns the finished device to the doctor’s office the AFO will be checked to insure that it fits properly. After a brief break-in period the brace should be comfortable and must be worn as directed by your doctor.

If you are have pain when walking and are looking for a way to get back to being active, talk to your doctor about your options, possibly an AFO may be right for you.