Ankle foot orthoses (AFO’s) and foot orthoses have been used frequently to help children with Cerebral Palsy gait patterns. The use of ankle foot orthoses and foot orthoses help improve alignment of the foot, help with balance, and prevent deformity (331). When wearing ankle foot orthroses, it helps prevent toe walking, decreases gastrocnemius activity, and prevents equinus because it blocks plantar flexion past ninety degrees (331). There are three case studies of three children with Cerebral palsy. In these case studies it explains how the children compensate when they are not able to perform a heel rise because of a blocked forefoot rocker and blocking motions of the digits.
There are three-foot movements in gait the heel rocker, ankle rocker, and forefoot rocker. The heel rocker starts when the foot makes initial contact or heel strike with the ground and ends at foot flat. This is where the ankle is usually at ninety degrees of plantar flexion and it is the motion that is typically blocked by the AFO’s (331). The ankle rocker is the second movement in the gait pattern. It is when the foot is in full contact with the ground and ends at heel off. Then the forefoot rocker begins which is the third foot movement in the gait pattern. The forefoot rocker begins at heel off and it continues until the foot is off of the ground. At this point during gait the toes start to extend about fifty-five degrees before the foot leaves the ground (331). Extending the toes during gait helps allow the body to move forward over the foot. So if the forefoot rocker is blocked during gait the child may not be able to move forward. The child may compensate by shortening the foot length or doing inversion or eversion of the foot (332).
There are several different types of ankle foot orthoses, solid ankle foot orthoses (SAFO), hinged ankle foot orthoses (HAFO), and supramalleolar orthoses (SMO). The solid ankle foot orthoses blocks all three rockers mentioned earlier of the foot. It helps prevent heel rise and toe extension (332). The hinged ankle foot orthoses block plantar flexion but it allows dorsiflexion of the foot. If the metatarsalphalangeal joints are not blocked wearing this HAFO may allow heel rise and digit extension. The supramalleolar orthoses is just above the malleoli. It ends at the metatarsalphalangeal joint allowing both dorsiflexion and plantar flexion of the foot. Having free plantar flexion wearing this type of AFO controls eversion and inversion of the foot. It is recommended more to younger children because it helps the child become more mobile while going from a sitting to standing position (332). The downside to this orthoses is that it does not control the ankle or block equinus from forming so they are often not recommended (332).
In Case study one it talks about a child at the age of four with spastic displegia, Gross Motor Classification System Level 2. He received orthoses to correct his gait. The child was pronating his foot and...