If the brace and shoe fit then wear it with AFO

Whether the origin of “If the shoe fits, wear it” comes from Cinderella, the saying can be traced over two centuries. At those times, shoes were exclusively for feet. Today, thanks to certain medical technologies, people with mobile impairments can choose shoes that fit. Unfortunately, if you are wearing a brace for leg and ankle support, many shoes intended for feet alone do not fit. If they do initially, they wear out rapidly. There are new support braces for children and adults that benefit many incurable conditions. Finding a standard shoe to fit a foot with a brace is often very complicated. You don’t have to wait for a fairy. Knowledge, research, experience and a medical professional motion support team can help.

When the cobbler cobbled his first shoe, it was intended for one foot in each shoe. They may not have been comfortable but they were sturdy and protective from rough terrain. For years, any form of brace, prosthetic or orthotic placed in the shoe with a foot would stretch the leather and the shoe-last would not last.

Shoes and sneakers do not adapt or wear well with braces also inserted with your foot. In addition, many brace users can’t jump over puddles or maneuver easily around them. Walking on smooth surfaces is almost or more challenging than hiking in the woods. A recent class of more supportive hiking boots may help people who rely on braces for degrees of mobility. Low-cut models with flexible midsoles are excellent for day hiking. Materials impact a boot’s weight, breathability, durability and water resistance. These may offer stiffer but comfortable ankle support. They may be the comfort match for brace wearers or those seeking more support than ordinary shoes provide. Low-cut hiking shoes are available virtually everywhere shoes are sold. If the shoes fit, they will wear well with or without a brace.

Wearing a shoe with an AFO or Ankle Foot Orthosis, a new term for a supportive brace, means you’re using the shoe beyond its expected intent. Most shoes will not withstand this use.

An AFO is a form of brace that supports and aids a common joint action called dorsiflexion. Dorsiflexion of the foot is sometimes referred to as dorsiflexion of the ankle. Flexing the ankle joint so that the underside of the foot rotates upwards. That is, the upper surfaces of the toes (including the toe nails) move towards the shin bones at the front of the lower-leg. Many are born with diseases that disallow those muscles (or associated nerves) to function normally. An AFO is added to the foot and lower leg. Both are inserted in a shoe.

Can you necessarily go to any shoe store or order online for a pair of shoes to fit a brace or AFO? Many will find it a stupefying task. You might have to opt for orthopedic or custom shoes that, for many, are not insured and beyond affordability. Furthermore, these custom shoe designers are usually podiatrists or orthopedists. They are often ignorant of what AFO is and how it works.

Many AFO manufacturers recommend and warranty each AFO foot brace for use with sneakers. Most sneakers are soft and these can stretch rapidly to the point of instability. Yet there is more to this dynamic. Weight and foot-size are two significant variables that can quickly damage ordinary shoes. Few AFO manufacturers are aware or recommend low-cut hiking shoes.

Among the best patients for an AFO are children that are low in weight. Children want to be mobile and AFO is a form of brace that helps support ankle and lower leg muscles that are necessary.

The ToeOFF KiddieGAIT is among the more popular AFO braces that many pediatric therapists prescribe. This brace offers dynamic technologies that help children rise and move from wheelchairs and walk.

The Allard KiddieGATE is a dynamic AFO and is very different than the brace you might have seen, such as the ones Forest Gump wore in the movie. Those are static braces. Static AFOs are devices that hold joints in constant position and are made of rigid materials.

Dynamic AFOs have varying types including hinged, articulating, static progressive or inhibitory. The dynamic components may be based on materials, mechanical joints, exertion of forces on joints, freedom of joint motion, or inhibitory influences to properly guide foot motion to simulate a normal gait.

David Zwicker, New York orthotist with Prothotics labs, indicates that dynamic AFO devices are helping children find mobility in varying degrees, based on their conditions. There are many more to choose from. Zwicker, among many other caring orthotists, understand that mobility is very precious to people at any age. Orthotists strive to use and explore technologies that help find the best and most comfortable fit to deliver the best mobility possible. In some cases, physical therapy aids in using the AFO devices more effectively.

Lighter body weights do allow a brace and foot to fit more sturdily in shoes and sneakers. Low-cut hiking shoes may add a little more stability while allowing other muscles to stretch and perform properly.

Adults with an AFO, on the other hand, over 175 pounds, bear more pressure that compromises the fit and durability of most shoes and sneakers. As adults age, calf to ankle muscles become more limited across genders and more complaints rise of walking issues. Over the course of ages 40 through 80, compromised dorsiflexion increases although sometimes related to other joint muscular problems.

Then there are adult-onset nerve and muscle diseases that wear nerves and/or muscles more rapidly, such as multiple sclerosis and muscular dystrophy.

Passive adults over 60 experience normal muscle wear and require additional support from shoes. You find New Balance sneakers more prevalent on normal aging feet, without braces. Some wear over-the-counter orthotics for

There’s a drop-off of how aging people might treat drop-foot dorsiflexion. They use canes, walkers, and power scooters. Many are unaware of what an AFO brace is, Very few are stubborn enough to want to stand and walk. That may be why fewer elect a brace and fewer than that choose an AFO.

Heavier bodies, larger feet, heavier feet, and an AFO can stretch almost any ordinary shoe, including leather or synthetic New Balance sneakers.

Hiking shoes are more rigid but an AFO foot brace doesn’t comfortably fit in a boot. It can fit in hiking shoes just at the ankle, and not tied to the top.

Brands like Oboz Footwear, The North Face, and Merrell make low-cut hiking shoes that are more likely to properly support an adult foot with a dynamic AFO brace in a shoe, while allowing dynamic natural foot movement in accordance with the brace.

AFO users have very case specific support needs. Avoid shoes that offer special supports for normal people. Some offer 3–5mm thick inserts are sandwiched between a boot’s midsole and outsole to add load-bearing stiffness to the midsole. They vary in length; some cover the entire length of the midsole, while others only cover half. There are also Plate supports –
thin, semiflexible inserts are positioned between the midsole and the outsole, and below the shank (if included). They protect ordinary feet from getting bruised by roots or uneven rocks. Most AFO wearers are more likely to be concerned about walking smooth hills or slightly bumpy surfaces. This is why use of a cane is helpful to avoid accidents.

Hiking shoe brands are not on many AFO brace manufacturer recommended lists and, in some cases, may nullify a replacement warranty. Consult with your prescribing health practitioner.

If you are an adult who wants to retain upright mobility and a choose a brace for support, then a low-cut hiking shoe is a lightweight alternative to flimsy sneakers. Remember that NO SHOE was designed for a foot and a brace and, as an adult, using a brace places you in a minority. Do not use a shoe for more than 3 consecutive days and switch to another. None of these shoes will last long under daily use. All will be more dependable than sneakers.

Nothing is better than stable, healthy muscles. An AFO helps people who can’t move as a helping aid. Ask a physiatrist for a recommendation. Ask you user to customize it for your comfort, Competent, professional orthotists like David Zwicker, can help you adapt and optimize a new pseudo-active lifestyle.

If the brace and shoe fit then wear it with AFO but make sure your shoe provides the support you need. A foot, an AFO device and a shoe must work in concordance. People with neuromuscular mobility problems need the assurance that fit and support must coexist for better mobility degrees, when nerves, muscles, or both can’t do the job.

ToeOFF Walk Aide is for New Balance

Imagine, if you will, that a child or adult is stricken by an event that leaves muscles inactive. There is loss of movement and, with it, losses of freedom. New technologies and research are helping mobility challenged to meet those extra challenges that bring more than the sense of normal movement. We are talking 21st-century ways to help you move much better than you’ve dreamed.

Muscular Dystrophies, ALS and Multiple Sclerosis are leading diseases that immobilize patients. There are also conditions due to compressed or damaged nerves as results of development, accidents, and war. When nerves and muscles can’t evoke action potentials to stimulate movement, you are unable to move. There are many levels of research to infer causes and effects. Biochemistry has thus far been leading symptom control. Over the past 20 years, giant strides have developed technological devices that can help promote movement, albeit better movement than none. There are perhaps only a few million people in the USA where chronic immobilization is a symptom. New tech research is helping those walk forward.

Immobilization may often occur in the mind but many suffer immobility from muscle weakness to severe paralysis. Those with spinal cord injuries may become permanently paraplegic with the inability to move their legs at all but new studies with electrical impulses can help carve ways to mobilize the immobile of body. For those with weak leg muscles, pushing walkers or using wheelchairs and scooters are the common ways of finding mobility. Precious few seek out trying to walk with braces. Braces are changing. They are no longer clunky and heavy. ToeOFF is a leading orthosis that you fit in your shoe. For those who have a form of ankle weakness, ToeOFF offers dynamic mechanical devices that help people walk more naturally. In recent years, alternate technologies, such as Functional Electric Stimulation of nerves have been emerging (FES). Is there attractive hope toward mobilizing the immobile?

Until FES experiments began in the late 1990’s, if you couldn’t walk you used a cane or crutch for support. In more severe cases, you might have used a wheelchair or would have been bedridden and constantly dependent on others.

In the mid twentieth century during the polio epidemics, leather and steel leg-braces were quite a common sight. A Persian, in the 15th century, first described the coating of plaster for fractures and other bony injuries of the limb. By the 17th century, there were braces for those who could not walk but they were heavy and cumbersome. President Franklin Delano Roosevelt was stricken with polio and used braces to stand when making speeches. They were those heavy leather and steel contraptions that were difficult to put-on and take-off. His braces were extremely difficult to use. In recent years, uses of aluminum and carbon fibers make braces lighter. Adjustable rubber and/or Velcro straps make them easier to adjust. AA Swedish designed brace, sold in USA as ToeOFF, is a prescription brace that helps certain people walk better and more comfortably.

Allard ToeOFF is known as a dynamic Ankle Foot Orthosis, often referred as an AFO that aid those people that have muscular weakness from the muscle groups that disable ankles to move up and down. The result is foot drag. ToeOFF using a lightweight, mechanical carbon-fiber device that helps restore a more normal walking gait. It’s a great device and helps many people with muscular dystrophy, multiple sclerosis, neuropathies, and myopathies that are aware of ToeOFF and the availability of the ToeOFF line and the use of other dynamic AFO devices.

ToeOFF is an appliance that allows people to easily put on and fit into different types of shoes. It is a lightweight, supportive brace specifically designed to correctly position feet for walking without foot drop. It covers the symptoms attributed to weaknesses in dorsiflexion of the ankle. Dorsiflexion problems may come from acute or chronic conditions. ToeOFF is a non-electric device that acts as a dynamic brace that normalizes the way you walk when a group of muscles don’t allow that seemingly simple action. Foot Drop is a relatively common problem among people of all ages but is also a symptom of nerve and muscle diseases. It can disable walking. ToeOFF is a prescription brace that helps facilitate “normal” walking (within degrees and limits) in those people with dorsiflexion from weak muscles.

ToeOFF has become a great aid for people with diseases where dorsiflexion is a symptom. Where other muscles are not as weak, ToeOFF is a fantasy device that helps people with muscle diseases walk. For overcoming the challenges of biped walking, ToeOFF really offers an alternative to some from being confined to a wheelchair or scooter.

Science fiction sometimes becomes reality and neurokinetic and neuromuscular researchers have more avenues and tools with which to explore how to stimulate movement and mobility for many muscle group problems. Of course, many studies are too small to deliver impact. Through various independent resources, including injured veterans from recent and ongoing Asian wars, there has been a drive to test electrical impulses as means of preventing pain and restoring movement. It seems like fantasy but small steps are being realized every day. For some, small steps bring large results.

Stimulating muscle movement to enable the motion-challenged to find motion is now being experimented with as a means to help people walk. The principle isn’t a new one. About 300 years ago, Luigi Galvani at the University of Bologna in Italy. He realized that if he sent an electric impulse at the lower spine of a frog, the frog’s legs would twitch. Similar experiments helped Galvani create neurophysiology as a study of how nerves can activate muscles in the body.

Galvani’s studies transitioned to studies of stress. In law enforcement, a Galvanic Skin Response in the hand helps determine whether a person may be telling the truth or not. The skin conductance response, also known as the electrodermal response (and in older terminology as “galvanic skin response”), is the phenomenon that the skin momentarily becomes a better conductor of electricity when either external or internal stimuli occur that are physiologically arousing. It occurs in the fight or flight response at the root of placing the body on stress alert.

A Superman on screen, actor Christopher Reeve suffered virtually total paralysis after a spinal injury. The Christopher Reeve Foundation offered grants (in the last decade) to study Functional Electrical Stimulation of nerve tissue to help induce movement. Functional Electrical Stimulation applies small electrical pulses to paralyzed muscles to restore or improve their function. FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores.

For research, FES is extremely valid when FES is used with a functional task such as walking, cycling, or grasping objects for a number of rehabilitative purposes and across differing diagnoses. FES has demonstrated the capacity for strengthening muscles enhancing circulation and blood flow, reducing pain, and retarding muscular atrophy.

In 2001, Case Western Reserve University, Department of Veterans Affairs, developed an intramuscular implanted system that activates the hip, knee, and trunk muscles to facilitate ambulation. At the time, the problems of electrode integrity in addition to adjusting the wavelength and amplitude signal measurements demonstrated promise.

Over the years, Federal Drug Administration worked at approving several devices that could provide enhanced results. Bioness L300 Plus adds a thigh component that facilitates knee extension and adds stability during walking as well. Other similar peroneal nerve (associated with the muscles that cause foot drop) stimulators commercially available are the WalkAide System and the Odstock devices. These systems have demonstrated long-term improvement in walking skills for persons with stroke as well as persons with multiple sclerosis and, possibly, other (thus far) incurable muscular diseases.

Alas, the rub is that virtually all these disabling diseases and conditions have no cure. Devices like ToeOFF and FES help the immobilized meet the challenges of moving. When you’re immobile or paralyzed, the facility of movement is like a light from the sky, even if only a short one.

The AFO and FES devices available for public use have been approved by medical agencies and federal groups like the FDA. This doesn’t mean that there are no side effects and contraindications as patients use them. While ToeOFF and WalkAide (and similar devices) are approved for certain conditions, each individual may be affected uniquely. Improvements may be individual specific and may not likely be generalized to work equally for a general population.

FES seems to be laying the groundwork toward the future of orthosis and. thankfully, there are products that offer advanced alternatives to the AFO. As relatively new, and somewhat unknown through the medical profession, FES is still somewhat expensive and most insurances do not cover use of a device like WalkAide. In addition, a pair of AFO (generally covered by insurance) may cost in the $1,000 to $2,000+ range. The WalkAide System may cost around $5,000 for a single and, a bit more, for a pair. Often these conditions may affect both left and right legs. Poverty and lack of adequate health insurance for those disabled by chronic nerve and muscle diseases. The merits of these prosthetics, however, could be life-changing to those afflicted by conditions.

In cases like multiple sclerosis and muscular dystrophy, understanding the etiology (causes) of the disease dynamics and causes is extremely important. Dorsiflexion is only one of possibly hundreds of symptoms. ToeOFF and WalkAide are examples of special devices that assist at making immobilization levels more mobile. While FES is promising for some, others may not benefit from neural electric therapies and devices.

ToeOFF and other AFO may work better with patients of muscular dystrophy and diseases of weakening muscles that are not necessarily associated with nerve damage. WalkAide may have little or no effect in those cases and, ominously, dystrophies have not been indicated to be (possibly) effective using an FES product. FES has been shown to be effective by generating electrical signals along nerve pathways and the nerves that are primarily associated at controlling muscles in certain areas. Some cases of dystrophy patients may not gain positive effects from an FES device because weakness is due to a genetic disruption of a neurotransmitter called Dystrophin and those signals may not change the efficacy of those muscles that affect foot drop and some other gait issues. That is why ToeOFF may still be the most advanced form of orthosis for muscular dystrophy patients.

Understanding those subtleties requires an integrated approach between physiatrists and rehabilitation specialists familiar with the problems behind neuromuscular conditions of different severity and sources. This is one of many reasons why ToeOFF and WalkAide are prescription products. For the most part, the etiologies of many of these conditions still require further research as well. In limited studies, however, products like ToeOFF and WalkAide remain to offer considerable help for those that can benefit by them.

ToeOFF is a partial solution and professional orthotists like David Zwicker, in conjunction with your prescribing doctor, can help patients optimize mobile functions. An AFO is an appliance and the appliance fits in a shoe, primarily a New Balance sneaker is recommended. As shoes are designed for feet and not necessarily a foot and an orthosis, the material of the shoe needs to be strong and stable enough to support it. Otherwise your balance may be compromised. You may require a wider size and may find that shoes last months instead of years. It’s a consequence that can be annoying. It’s fortunate that New Balance makes shoes with several width selections. That helps. Afflicted with moderate to severe dorsiflexion, ToeOFF helps you walk more normally than if you did not wear it. As an alternative to one of those electric wheelchairs, ToeOFF is a good device.

WalkAide does not require to be placed in a shoe. The battery powered unit may be placed anywhere on the calf around the peritoneal nerve fiber that is beneath your knee. That makes WalkAide an attractive alternative but only where nerve fibers and muscles interact with functional electrical stimulation. It may not work with patients suffering from muscular dystrophies or certain myopathies.

An orthosis, like a dynamic AFO (such as the Allard ToeOFF device) is a form of prosthetic. You might have your physical leg but the muscles related to dorsiflexion (and walking) don’t work. For the past 100 years, these prosthetics were heavy and large. While wealthy victims of Polio (i.e. President Franklin Delano Roosevelt) had to learn how to use them, ToeOFF is part of a group of AFO that are light and easy to use. Neuro-prosthetics is the study and development of medical devices that replace or improve the function of damaged neuromuscular organ systems and restore normal body processes, create or improve function, and/or reduce pain.

There is no 100% solution as of yet. It is promising that technological strides are being researched to offer immobile, afflicted people some more choices at the ease of getting around. Ranges might be limited. I guess it’s better to have some mobile range than none. There is promise in better AFO and FES development as the future unfolds. At least, there is hope.

Don’t Drag your feet get your toes off

Street observations often show that quite a few people of all ages seem to drag their feet, gliding slowly on pavement. Some walk slowly, taking small steps, careful not to trip or fall. Are these people tired, weak, in pain or depressed? Sometimes all of these are in play. Emotion disorders for some may loosely involve motion disorders. This mode of walking is called Foot Drop. It is where the ankle does not elevate your foot to stride comfortably. The key to a normal and smooth gait is placed on what is called a dorsal muscle that, basically, works to get your toes off the ground. In some cases, a Toe-Off orthosis might help lift your toes off for better walking.

The ankle of each foot lies at the base of each leg as it meets the foot. It is often vulnerable to sports injuries or falls. How many kids complain about sprained ankles? How many game players have to sit through a season because of an ankle problem? Usually, these wounds heal. For others, there are diseases that chronically affect the foot. This makes walking difficult and painful. This makes walking alongside friends annoying. Most people adapt to it while others use orthotics, canes, walkers, and wheelchairs. These are entirely different perspectives than those that normally walk.

The joint at which the leg meets the foot is called a dorsal joint. This connecting joint consists of bone, ligaments, and muscles. There are four muscles involved – Tibialis anterior, extensor hallucis-longus, extensor digitorum longus and fibularis tertius. The largest and most evident of these muscles is the tibialis anterior, which can be seen superficially in the front of the lower leg. Dorsiflexion involves these muscles for just a couple functions, primarily lowering and lifting the foot for walking. It also aids left/right motion for smoothness and capability of coping with hills. Dorsiflexion helps establish the toes off and toes on movements that are necessary. When dorsiflexion doesn’t function, the foot remains in a dropped position. Getting your toes off for a normal gait is virtually impossible.

There are other muscles that help the dorsal muscles function. Nearby, Plantar flexion involves lifting the whole body. These go together because the world does not exist as a straight plane and body’s weight creates all sorts of subtle adaptations to the differences of weight, angles, and voluntary movement. Because the ground constantly has variables, human feet need to adapt to smoothly interface with it swiftly on contact. In normal function and anatomical position, the ankle joint has flexion (dorsiflexion) and extension (plantar flexion). Foot draggers have a lot to do to get their toes off the ground.

For many foot draggers, a trip to a physiatrist might help deal with the problem. Some may require physical therapy to help break old habits. Others may need a prescription orthosis. The latter occurs when certain diseases chronically influence the dysfunction of the dorsal muscles. One particular orthosis for helping people get their toes off the ground is a bracing device called Toe-Off.

Toe-Off is part of a group of products, called an Ankle Foot Orthosis (AFO), that help replace the action of the dorsal muscles, when the muscle group has been compromised. This is common in muscular dystrophies, myopathies that can waste these muscles to the point that your foot can longer raise on its own. Toe-OFF is a new generation AFO, covered by several patents. While most AFO get your toes off and up to facilitate a more natural walking gait, and share some similarities, Toe-Off is lighter and easier.

Toe-Off is known as a dynamic AFO. It is made of a lightweight moldable carbon fiber composite material and works with various shoe types. It employs a high activity design that enables freedom of motion and allows for simulated walking that functions and appears as if you aren’t using any form of brace, with the exception of a few chronic cases. Whether custom of off-the-rack, a dynamic AFO encourages range of motion, allowing children to learn movement by moving and providing minimal support, only where the patient needs it. Scientific research on dynamic AFO devices show improved performance, though studies must be further explored.

Many AFO allow use of your own shoes. You remove the insole of the shoe, slide Toe-Off inside and then replace the insole. Most shoes aren’t adequately sized to hold your foot and an AFO. Sometimes you may find greater comfort by shifting to a wider shoe. New Balance and Dr. Comfort are recommended brands. Do not anticipate normally long wear from your shoes. Typical daily wear might be around 6 months and leather shoes should be changed every 6 weeks or so to keep it supportive (as leather stretches).

Toe-Off uses a Swedish technology that uses a carbon fiber for support or action. When worn, it does take your toes off the ground. Your walking gait is more normal.

Toe-Off resembles an over-the-calf shin guard, set in place by adjustable Velcro straps. Shoes are ties normally. It provides leg support and foot support as it aids that toes off process.

To say that use of Toe-Off will let you run marathons or play basketball is a rare exception. It helps a foot dragger with foot drop walk virtually normal. That is remarkable.

The feel of the Toe-Off is like standing on a suspended rocking chair. It rocks your foot into the appropriate position. Depending on your condition, getting up from a chair or using stairs may be a little difficult. Toe-Off primarily focuses on replacing the simple dorsal inaction that results in foot drop. Maneuvering other than walking may still be difficult or impossible. For someone who can’t walk normally, Toe-Off is a necessary option for those who want mobility without resorting to a scooter or wheelchair device.

Because even smoothly paved roads have variable surface changes, use of a cane is helpful in those cases. Many times you may not need it or use it lightly. When the walkway has cracks, embedded rocks, or other surface irregularities, that cane could be the difference from walking to falling.

A physiatrist or sports physician usually must prescribe an AFO and Toe-Off requires a prescription. It’s an expensive technological tool but is covered by many health insurances. Usually, your doctor sends you to an orthosis specialist. Prothotic Labs is a New York based progressive Prosthetic and Orthotic facility. David Zwicker is one of their specialists. He is particularly attentive to patient’s comforts in using any of these devices. While Toe-Off, for example, is an excellent product, it may need to be fitted for comfort for individualized use, Zwicker specializes in this. Developing a cordial relationship with your orthosis specialist is necessary. Finding one is crucial. An AFO is a walking mobility device that replaces poor natural muscle control. You and it must act comfortably as one.

As for support, there are 3 Toe-Off models that cover children, moderately affected adults, and severely affected adults. Due to Myotonic dystrophy (one of the muscular dystrophies) I use the Toe-Off BlueRocker pair – their offering for severe cases. It is designed for helping Footdrop from disorders such as stroke, MS, post-polio, Myelomeningocele, Cerebral Palsy, Muscular dystrophy, CMT, and forms of Neuropathy. This is my second Toe-Off AFO and I find it to be very supportive. It does require the Comfort Link accessory for extra padding around the leg.

Braces have changed a lot since the days of President Franklin Roosevelt. They help easily mobilize the otherwise immobile. Getting your toes off the ground as a means of alleviating foot drop means you have many choices to explore from exercise to using an orthosis. A dynamic AFO, like the Toe-Off family of products, may just be a possible answer. So don’t drag your feet when walking. Get your toes off and seek professional help. Treatment is often easier than you might think.

Toe-Off is not a miraculous cure for the causes of dorsiflexion. You may or may not be comfortable using it, and may not restore your walking range before your ankle disorder. Depending on the severity of your condition, Toe-Off helps provide a sense of dignity at the challenges of achieving upright mobility when walking. Many people do regress to needing scooters. It’s an acquired, adaptive taste and a quiet idea of walking using your own two feet, albeit with an AFO brace like Toe-Off. A dynamic AFO, under advisement from your physician, may help you cope with walking challenges a little differently (at least for a while). Isn’t it time to get your toes off and walking?

Toe-off braces against foot drop

While most evident with aging, foot drop is a condition when ankle muscles or nerve signals cause your foot to drop when walking. Foot drop makes it difficult to lift the front part of your foot, so it might drag on the floor when you walk. It can affect people of different ages as well. While some mild foot drop conditions respond to physical therapy, moderate to severe cases often require a brace that helps reposition your foot to a normal gait. The Allard Toe-off is one such brace and the best of its kind. There are others as foot drop is more common than most people think. Statistics are difficult to ascertain because so many people function with foot drop and don’t recognize the mobility challenge. Certain diseases, however, make it a clearly disabling symptom. Toe-Off makes that disability somewhat less disabling for young and old challenged walkers.

Foot drop can be associated with a variety of conditions such as flexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Basically, Foot drop can be defined as a significant weakness of ankle and toe dorsiflexion during movement as you walk and stand. You drag your foot while walking. Some compensate when approached by hills and steps by elevating the hip. The result is a Frankenstein-monster like foot drop that results in imbalance and consequences like frequent falls. On level ground, the feet drag on the surface. Carpets and walkway cracks can often be threatening as a foot fails to lift.

Allard ToeOFF is a leader among several manufacturers making devices known as Ankle Foot Orthoses for children and adults to help cope with chronic foot drop. These are braces that fit into shoes and create a rocking motion at the base of the foot. It helps the foot simulate a smooth walking gait by lifting the toes off the ground, as evident in foot drop cases.

Foot drop may also be evident in young babies who have difficulties toddling at toddling ages. They have difficulty standing and walking. Pediatricians may recommend a Supra Malleolar Orthosis (SMO) if the child is 18 months or older.

Up to age 3, the diagnosis is usually hypotonia. Hypotonia is the medical term for decreased muscle tone. Healthy muscles are never fully relaxed. They retain a certain amount of tension and stiffness (muscle tone) that can be felt as resistance to movement. When it comes to orthotic management of pediatric patients with hypotonia, the medical literature is only beginning to document the effectiveness that clinicians have been reporting anecdotally for years. There may be several reasons for hypotonia in babies, including nerve, muscle, and metabolic syndromes.

An SMO is shorter than an AFO and usually has a baby-friendly decoration. It will help babies stand. Walking may require physical therapies. Sometimes a pediatric physiatrist (medical specialist in rehabilitation medicine) may organize a team of multifaceted supporters. Small studies indicate that the SMO with phased rehabilitation may help children overcome foot drop and walking issues within a couple years. After that, genetic testing may be required to determine whether hypotonia is more of a symptom of another disease than a condition itself.

Hypotonia is not the same as muscle weakness, although it can still be difficult to use the affected muscles. Depending on the cause, weakness may sometimes develop in association with hypotonia. As people age, muscle weaknesses may develop along with normall loss of lean tissues. Hypotonia influences the movement, condition, and action of muscles.

Foot drop is very evident in diseases like Muscular Dystrophy, Cerebral Palsy, CMT, Stroke, and Multiple Sclerosis patients. An Ankle Foot Orthosis (AFO) helps relieve foot drop. It resembles a brace but it fits in most of your shoes. Worn beneath long pants or skirts, an AFO is practically invisible.

While an AFO may not directly repair dorsiflexor problems or neuro-muscular conditions, it helps deliver a near-normal gait when walking. The key is near-normal but that is a vast improvement. You may experience difficulty ascending and descending stairs. Your speed may be slow, but significantly faster than dragging. Your maneuverability may be somewhat compromised. Compared to foot drop, an AFO is a very significant mobilizer for the somewhat immobilized.

The Dorsi-strap is the least invasive AFO and also relatively inexpensive in the $150 range. While users should first consult a sports medicine doctor about using it, purchase does not require a prescription. The manufacturer seems to promote its use as a cure-all, even supportive for obese and big people, but the Dorsi-strap is really only effective for very mild foot-drop conditions.

For moderate and severe foot drop, dynamic braces are often prescribed. These are light, generally made of carbon fiber, a foot-length foundation is placed in your shoe and covered with shoe’s (or your) orthotic. A vertical support goes up and the brace attaches to your leg by one or two Velcro straps. A dynamic response Orthosis helps support a stable, balanced gait for walking and enable better posture while doing so. These are expensive but when you’re immobilized, they help you become (somewhat) mobile. They are covered by Medicare and most insurance providers.

Some people might say that, if you’re immobile, why not get a wheelchair or scooter? It’s a good question from an outsider’s view. There are classes of stubborn immobilized adults who want the illusion of mobility as a biped (not including cane support) in a world designed for most healthy people that can walk normally. There are fewer doctors and people aware of dynamic AFO devices so few are seen. They are used, though a minority compared to wheelchair devices.

Among dynamic AFO manufacturers, Allard’s Toe-Off family recognizes this for adults with varying degrees of disability. They also remember children who can suffer at many levels when confined to wheelchairs when they have foot drop as a main concern. Allard’s KiddieGAIT offers innovative options that have never been available for AFO management of these challenges. Functional environments can be created that supplement gait function instead of immobilizing and inhibiting that function.

Designed to provide dynamic toe-off assist with maximum control for the unstable ankle, Toe-Off is available in five sizes from X-Small to X-Large to fit children through adults. The unique, patented design features a lateral strut which “wraps” over the instep to provide maximum medial-lateral and rotational control of the foot and ankle complex, when none or little normally exist. Approximate weight variations are Size 01 (XS) weighs 3.6 oz., Size 02 (S) weighs 4 oz., Size 03 (M) weighs 4.9 oz., Size 04 (L) weighs 6.4 oz. & Size 05 (XL) weighs 6.7 oz. This permits an almost invisible sense of added weight. There is, however, a training period to get accustomed to the rocking support of these braces. Significantly advantageous, the Toe-off AFO fits into the shoe like an insole and accommodates most shoes without having to increase shoe size. New Balance sneakers are recommended for daily use.

Beyond the KiddieGAIT and the regular Toe-Off AFO, Allard has introduced the Toe-Off BlueRocker to their AFO family. BlueRocker is identical in shape and design as Toe-Off but offers more orthotic control. It is developed primarily for bilateral patients and those with more involved pathology. The extra stability will improve both balance and posture and give the wearer greater security, especially individuals with weak quadricep muscles.

It is also the most preferred orthosis to be used in conjunction with a socket and toe filler for management of partial foot amputations. Every BlueRocker should be padded on the inside towards the tibia crest. The SoftKIT padding system is designed specifically for use with BlueRocker for optimum patient comfort and product performance.

There are several other dynamic response AFO brands available for all degrees of foot drop. Helios (Helical Energy Loading Integrated Orthotic System) focuses on the category that the Toe-off BlueRocker targets. Helios is quite different as it does not use Velcro straps but requires a custom wrap-around shell for additional support. The double-helical construction is designed to correct skeletal structural deformities and provide an increase in walking function. This unique energy loading design offers the potential of normal walking. Because of its energy return in walking, the manufacturer claims there is less fatigue. Like the Toe-Off, it targets muscular dystrophy, peripheral neuropathy, CMT, Stroke, Cerebral Palsy, Polio, and many other neurological and muscular diseases that compromise function of the dorsiflexor.

If you find walking painful and your feet are consistently dragging, find a physiatrist or sports medicine doctor. These doctors study and serve patients with movement disorders. Orthopedists primarily deal with bones. A thorough exam will help form a diagnosis. Physical therapy may help most people. If it doesn’t, an AFO may be prescribed. Use a recommended practitioner.

I was advised to go to Prothotic Laboratory for my AFO orthosis. While there are hospitals and other providers, this place was highly recommended by my physiatrist. David Zwicker is their certified orthotist and was a pleasure to work with. He suggested the Toe-Off and considered the basic model as satisfactory. I must admit that, once I put the Toe-Off on, it seemed a radical improvement. As with a cane, I’d advise moving up to the Toe-Off BlueRocker for maximum strength and support, though it does require a suitable get-comfortable period. Zwicker offers seasoned experience and provides an intuitive, independent approach to help maximize comfort. When using an AFO device, your relationship with the orthotist is very important. Do not get an AFO unless you are certain that your orthotist is right for you. If you are in the New York City area, David Zwicker of Prothotics offers excellent service, although many pediatricians and physiatrists offer AFO and SMO devices.

There are varying degrees of foot drop and many reasons behind it. There’s no assurance that a dynamic AFO will get you running or even fast-walking. In cases of muscular dystrophy (and my Myotonic dystrophy), happiness comes from the ability to walk without foot drop, or the use of a wheeled scooter. The myotonia is still there and instability and weakness may dominate. Using the Toe-off offers significant help in walking from point-A to Point-B. Without the Toe-off AFO, trying to walk is a monstrous challenge. Be thankful that world technology is designing products to help the significant few sample the illusion of normalcy again.

Ultimately, an AFO or SMO is an aid to enhance mobility against foot drop due to weak muscles and nerves. Seeking medical or rehabilitation help may be advised to avoid accidents or falls is advisable.