Ankle–Foot Orthosis (AFO) for Children with Cerebral Palsy
Ankle orthoses are commonly prescribed in CP to improve alignment, stability, gait efficiency, and functional mobility. The type depends on tone, motor control, and gait pattern.
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Common Types of Ankle -Ankle–Foot Orthoses
1. Solid AFO (SAFO)
Indications
• Spastic diplegia or hemiplegia
• Severe plantarflexor spasticity
• Equinus -equinovarus deformity
Benefits
• Prevents toe walking
• Provides maximum ankle stability
• Improves standing balance
Limitations
• Limits ankle movement
• Less suitable for stair climbing or running
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2. Hinged -Articulated AFO
Indications
• Mild–moderate spasticity
• Adequate knee control
• Needs dorsiflexion during gait
Benefits
• Allows controlled ankle motion
• Improves gait pattern & push-off
• Better functional mobility
Contraindication
• Severe spasticity or knee instability
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3. Posterior Leaf Spring (PLS) AFO
Indications
• Mild CP
• Foot drop
• Good postural control
Benefits
• Assists dorsiflexion during swing phase
• Lightweight and flexible
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4. Ground Reaction AFO (GRAFO)
Indications
• Crouch gait
• Weak quadriceps
• Excessive knee flexion
Benefits
• Improves knee extension in stance
• Enhances walking efficiency
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5. Dynamic AFO -SMO (Supra-Malleolar Orthosis)
Indications
• Mild hypotonia
• Medial–lateral ankle instability
• Flat foot
Benefits
• Improves foot alignment
• Allows more ankle mobility
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How to Choose the Right Orthosis
Selection depends on:
• Type of CP (spastic, dyskinetic, hypotonic)
• GMFCS level
• Muscle tone & contractures
• Gait pattern
• Functional goals (standing, walking, school activities)
👉 Orthosis selection should always be done with a physiotherapist + orthotist + pediatrician-PM& R specialist.
⸻
Wearing Schedule (General Guide)
• Start: 1–2 hours-day
• Gradually increase to 6–8 hours-day
• Always check for skin redness or pressure marks
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Combined Therapy for Best Results
• Stretching (gastroc–soleus, hamstrings)
• Strengthening (tibialis anterior, core, hip muscles)
• Gait training
• Functional activities (stairs, sit-to-stand)
⸻
Ankle orthoses are commonly prescribed in CP to improve alignment, stability, gait efficiency, and functional mobility. The type depends on tone, motor control, and gait pattern.
⸻
Common Types of Ankle -Ankle–Foot Orthoses
1. Solid AFO (SAFO)
Indications
• Spastic diplegia or hemiplegia
• Severe plantarflexor spasticity
• Equinus -equinovarus deformity
Benefits
• Prevents toe walking
• Provides maximum ankle stability
• Improves standing balance
Limitations
• Limits ankle movement
• Less suitable for stair climbing or running
⸻
2. Hinged -Articulated AFO
Indications
• Mild–moderate spasticity
• Adequate knee control
• Needs dorsiflexion during gait
Benefits
• Allows controlled ankle motion
• Improves gait pattern & push-off
• Better functional mobility
Contraindication
• Severe spasticity or knee instability
⸻
3. Posterior Leaf Spring (PLS) AFO
Indications
• Mild CP
• Foot drop
• Good postural control
Benefits
• Assists dorsiflexion during swing phase
• Lightweight and flexible
⸻
4. Ground Reaction AFO (GRAFO)
Indications
• Crouch gait
• Weak quadriceps
• Excessive knee flexion
Benefits
• Improves knee extension in stance
• Enhances walking efficiency
⸻
5. Dynamic AFO -SMO (Supra-Malleolar Orthosis)
Indications
• Mild hypotonia
• Medial–lateral ankle instability
• Flat foot
Benefits
• Improves foot alignment
• Allows more ankle mobility
⸻
How to Choose the Right Orthosis
Selection depends on:
• Type of CP (spastic, dyskinetic, hypotonic)
• GMFCS level
• Muscle tone & contractures
• Gait pattern
• Functional goals (standing, walking, school activities)
👉 Orthosis selection should always be done with a physiotherapist + orthotist + pediatrician-PM& R specialist.
⸻
Wearing Schedule (General Guide)
• Start: 1–2 hours-day
• Gradually increase to 6–8 hours-day
• Always check for skin redness or pressure marks
⸻
Combined Therapy for Best Results
• Stretching (gastroc–soleus, hamstrings)
• Strengthening (tibialis anterior, core, hip muscles)
• Gait training
• Functional activities (stairs, sit-to-stand)
⸻
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