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Guide to AFO Brace Selection

AFO brace selection guide to help patients/parents determine their child gait pattern and match their need for available braces.

Mild
Visible medial arch
Mild heel eversion and forefoot abduction
Can correct when prompted
Can be manually corrected with no resistance

Moderate
Reduced medial arch
Moderate heel eversion and forefoot abduction
Can improve when prompted
Can be manually corrected with mild resistance

Strong
Absent medial arch
Strong heel eversion and forefoot abduction
Cannot improve when prompted
Can be manually corrected with moderate resistance

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LOW TONE PRONATION

Foot collapses and medial arch flattens

Heel everts

Forefoot abducts

Low muscle tone allows for easy correction

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Mild
Visible medial arch
Mild heel eversion and forefoot abduction
Can correct when prompted
Can be manually corrected with no resistance

Moderate
Reduced medial arch
Moderate heel eversion and forefoot abduction
Can improve when prompted
Can be manually corrected with mild resistance

Strong
Absent medial arch
Strong heel eversion and forefoot abduction
Cannot improve when prompted
Can be manually corrected with moderate resistance

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High Tone Pronation or Supination

Pronation:
Foot collapses and medial arch flattens
Heel everts and forefoot abducts

Supination:
Foot bears weight on lateral side, high medial arch
Heel inverts and forefoot adducts

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Mild
Lands heel first
No obvious compensations of the knee and hip
Occurs almost never (less than 80% of the time)
Can control when prompted

Moderate
Lands foot-flat, accompanied by pronation/supination
Some compensations of the knee and hip
Occurs almost always (80% of the time)
Can improve when prompted

Strong
Lands forefoot-first, accompanied by pronation/supination
Marked compensations of the knee and hip
Occurs consistently (100% of the time)
Cannot control when prompted

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Swing Phase Inconsistency

The foot tends to be toe down and slightly inverted as the leg is advancing through the air

Ankle position is weak and not reliable

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Mild
Ankle plantarflexion: 0°
Occurs occasionally (less than 50% of the time)
Can correct when prompted
Can be manually corrected with mild resistance

Moderate
Ankle plantarflexion: 0–2°
Occurs frequently (more than 50% of the time)
Can improve when prompted
Can be manually corrected with moderate resistance

Strong
Ankle plantarflexion: 2° or more
Occurs constantly (100% of the time)
Cannot correct when prompted
Can be manually corrected with strong resistance or cannot be corrected

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Excessive Plantarflexion/Toe walking

Bears weight primarily on forefoot

Toes point downward and heel does not touch ground when walking

Excess muscle tone, range of motion, or habit results in toe walking

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Mild
Gentle excess dorsiflexion and knee flexion: 5–10°
Occurs occasionally (less than 50% of the time)
Can correct when prompted
Can be manually corrected with mild resistance

Moderate
Marked excess dorsiflexion and knee flexion: 10–15°
Occurs frequently (more than 50% of the time)
Can improve when prompted
Can be manually corrected with moderate resistance

Strong
Significant excess dorsiflexion and knee flexion: 15° or more
Occurs constantly (100% of the time)
Cannot correct when prompted
Can be manually corrected with strong resistance or cannot be corrected

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Excessive Dorsiflexion/Crouching

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Knees, and sometimes hips, remain flexed when standing or walking

Posture may be due to weakness or low muscle tone

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