March 2014

Survey suggests need for simplified AFO-footwear combination tuning

In the moment: Rehabilitation

By Emily Delzell

Orthotists report time and a lack of access to 3D motion analysis as barriers to tuning ankle foot orthosis–footwear combinations (AFO-FC), findings that demonstrate a need for better instruction and simplification of the practice, according to investigators who conducted a survey of UK clinicians.

Tuning AFO-FCs can produce optimum gait kinematics and kinetics, while failure to optimize can result in immediate and long-term detrimental effects on function, according to investigators at Staffordshire University in Stoke on Trent, UK, who sent a questionnaire to registered orthotists in the UK to determine current practice patterns.

Of the 41 respondents, all reported being aware of AFO-FC tuning. Only 50%, however, reported using it as standard clinical practice.

Not having access to 3D gait analysis was the most common barrier reported (34%). Staffordshire investigators noted this demonstrates a lack of understanding of AFO-FC tuning, which can be accomplished with simpler methods, such as superimposing a force vector on a video sequence.

The study was epublished in February by Prosthetics and Orthotics International.


Eddison N, Chockalingam N, Osborne S. Ankle foot orthosis–footwear combination tuning: An investigation into common clinical practice in the United Kingdom. Prosthet Orthot Int 2014 February 24. [Epub ahead of print]

One Response to Survey suggests need for simplified AFO-footwear combination tuning

  1. Harvey Johnson says:

    Call me old school but any orthotist worth their salt should be able to evaluate tuning of an AFO-FC without 3D analysis. Are we so removed using our God given brains that we cannot evaluate our own designs without a computer? Application of common gait parameters before and after AFO-FC intervention would be a starting point: stride length, speed,/velocity, subjective visual/non-computerized balance assessment including visual assessment of lower extremity joints in the sagittal plane, energy consumption e.g. walking the patient with and without AFO-FC and also after modifications to AFO-FC, timing the distance covered to name just a few things that and orthotist can apply in the real world without a 3D computer. Maybe it’s time orthotists spend some simple time watching unimpaired people walking the streets to understand normal gait. Are they not teaching normal and pathological gait in our educational institutions? How can we justify the fees we charge and not take the time to assess our work? After nearly 40 years I have seen more than my fair share of poorly designed and or poorly fitted/fabricated orthoses. I remember a former supervisor once complained to me of taking too much time during my evaluations/measurements/casting procedures. My reply to him was I spent my time getting it right in the front end. I spent far less time having to adjust and change my work after it was completed and my outcomes were excellent. If as clinicians we expect to be faster and more efficient then we have to first spend some time improving our clinical and technical skills. Accomplishing the task faster comes with experience. How many facilities have 3D computerized gait analysis in house? Call me old school but I’ll take my eyes and my brain and knowledge over a computer ever time.

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