Question:I'm supposed to go see an orthotist tomorrow and get fitted for a brace to help reduce my arthritic ankle pain. I went on-line and saw many different types of orthotics. How do I know which one to ask for?
Most of the heavy leather and metal braces of years past have been replaced by more modern braces called orthotics. They are made of lightweight plastic (polypropylene) and slip inside a standard shoe. When the patient wears long pants, no one can even see the orthotic.
There are three main types of orthoses to help reduce ankle pain. They work by putting the ankle and/or foot joint(s) in good alignment. Holding them in place during walking activities helps reduce pain. Some restrict ankle and foot motion. Others only keep the ankle from moving while still allowing forefoot motion.
The standard or solid ankle foot orthosis (AFO) fits over the back of the calf, heel, and bottom of the foot. It is inflexible or rigid and doesn't allow ankle or foot motion. A strap around the top of the calf helps hold it in place.
The second type is the rigid hind-foot orthosis (HFO-R). The upper part of the calf is free but the ankle is held stable. The orthotic ends where the heel ends and doesn't support the forefoot at all.
The third ankle orthosis is the articulated hindfoot orthosis (HFO-A). It fits around the lower one-third of the calf, heel, and forefoot but it has a hinged joint to allow ankle motion when walking.
In a recent study at the Mayo Clinic Motion Analysis Lab, patients were tested wearing each type of orthotic. They walked on different ground surfaces to see how much ankle and forefoot motion was allowed by each orthotic. Patients walked on level ground, went up and down ramps, and walked on a side-slope.
The researchers found that the HFO-R gave the best overall results over all surface types. The HFO-R restricted ankle and hindfoot motion reducing joint pain. At the same time it allowed forefoot movement to navigate various ground conditions.
Your doctor may have already prescribed a specific kind of orthotic for you. The orthotist will advise you further. With a team approach, you should be able to get the orthotic that's best for your situation.Yu-Chi Huang, MD, et al. Effects of Ankle-Foot Orthoses on Ankle and Foot Kinematics in Patient with Ankle Osteoarthritis. In Archives of Physical Medicine and Rehabilitation. May 2006. Vol. 87. No. 5. Pp. 710-716.
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