Hi everyone!
I hope you all had a fantastic Thanksgiving holiday and are ready to tackle December head-on! Today, I want to revisit a fascinating discussion from the recent Utah Physical Therapy Association conference. The topic? Orthotic Interventions for toe walkers, specifically the use of the "super solid" ankle AFO (ankle-foot orthosis) for treatment.
This topic raised a lot of questions during the conference, and I wanted to take a moment to break down the rationale behind this intervention. While traditional approaches like SMOs (supramalleolar orthoses) with high-back support or articulated AFOs still have their place, I think the case for a stiffer AFO is worth exploring.
Why Consider the Super Solid Ankle AFO as a Brace for toe walking?
Here are two key reasons why this intervention is gaining traction:
1. Range of Motion Gains
When it comes to non-surgical methods for improving range of motion, serial casting is often seen as the gold standard. But why is it so effective? It’s not just about the position the cast holds; it’s about the lever arm it creates with every step the child takes.
The super solid ankle AFO works similarly. By locking the foot in place, it creates:
A longer lever arm, which facilitates a true stretch of the Achilles tendon and gastrocnemius complex.
Knee extension moments: This is critical because a proper stretch requires the knee to be extended. By limiting knee flexion, the AFO ensures that the stretch translates into the upper musculature, where gains might be most likely to occur.
This approach mimics the benefits of serial casting while allowing the child to remain active, which is crucial for functional development.
2. Addressing Anterior Center of Mass
Many toe walkers develop an anterior center of mass, meaning their posture and movement patterns are forward-oriented. While most interventions ensure heel contact and proper toe-off during walking, they may not address the underlying issue: the forward shift of the tibia (shin).
The super solid ankle AFO helps:
Pull the tibia back, shifting the center of mass posteriorly.
Encourage proximal muscle activation. Many toe walkers struggle with proximal muscle weakness, making it difficult for them to handle a neutral center of mass. The stiffer AFO forces these muscles to engage, retraining and strengthening them.
Beyond the Brace: Long-Term Benefits
The ultimate goal of any brace for toe walking is to help children walk efficiently without bracing. The super solid ankle AFO not only promotes proper gait patterns in the brace but also helps build the strength and control needed to transition out of it.
Is This the Right Approach for Every Toe Walker?
Not necessarily. Each child is unique, and interventions should be tailored to their specific needs. However, for many toe walkers—especially those with long-standing patterns or significant anterior center of mass issues—the super solid ankle AFO offers a compelling option.
Let’s Keep the Conversation Going
I hope this sheds some light on the rationale behind using super solid ankle AFOs for toe walkers. Whether you agree, disagree, or have lingering questions, I’d love to hear your thoughts. Let’s continue the discussion and explore how we can best support our patients together.
Thanks for reading, and I’ll talk to you soon!
Dave
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