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An ankle foot orthosis (AFO) is a biomechanical device that provides support to the foot and ankle, especially when walking. AFOs are prescribed for a variety of conditions; in the case of ALS, their primary function is to help provide sufficient toe clearance while walking.
AFOs are available in different types and can be either purchased off-the-shelf or custom-made. Custom-made AFOs generally cost more than off-the-shelf options but provide a better fit. Off-the-shelf AFOs usually need minor adjustments, such as heating to reshape or adding small pads to alleviate pressure points.
For individuals with ALS who experience considerable muscle wasting in their hip flexors, the weight of AFOs can be problematic. While AFOs help reduce the effort required to lift the knee and prevent a foot from dragging, the additional weight of the AFO itself counteracts this benefit. Thus, it is preferable to use lightweight AFOs for ALS patients to minimize this burden.
An individual with very fast progressing lower limb muscle atrophy may consider avoiding the expense of AFOs if they lack comprehensive insurance coverage for them.