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If you are having difficulty walking because your foot is dragging or catching on the ground, an ankle foot brace, usually referred to as an AFO (ankle foot orthosis), can make a big difference. Foot drop is common with ALS, and AFOs can help stabilize your foot to create a safer and more efficient gait.
AFOs have thin footplates that insert into your shoes and connect with support struts that wrap around your calf and/or shin. When you step with an AFO, it helps lift your foot to clear the ground and land back on your heel. These braces support your gait and can allow you to stay safe, conserve energy, and continue to walk independently. |
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“I've had people walk out of my office in tears because
they can't believe what a difference it makes.”
they can't believe what a difference it makes.”
– Reese Evans, Certified Prosthetist-Orthotist
There are many different types of AFOs. Although you can find AFOs online and in stores, we suggest starting with your physical therapist, who can evaluate your individual needs and recommend the best brace for you. Your physical therapist may recommend an AFO made from carbon fiber because it is light, strong, supportive, and dynamic. Before getting your AFO from either a physical therapist or orthotist, you will first need to get a prescription from your neurologist.
Here are the three types of AFOs most commonly used by people living with ALS:
Here are the three types of AFOs most commonly used by people living with ALS:
Standard AFOs
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This premade brace, sometimes called a posterior leaf spring AFO, wraps around the back of your calf and helps if you have foot drop but no knee or hip issues.
Carbon graphite is the material of choice, though your physical therapist might recommend that you buy an inexpensive plastic AFO to start so you don’t end up using your insurance benefit on this brace if you may ultimately need more support. Medicare will only pay for one AFO per leg every five years. |
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AFOs with Knee SupportThis premade carbon fiber brace, also referred to as a ground reaction AFO, provides knee support as well as foot and ankle support. It is also helpful if you have foot drop combined with weak thigh or hip muscles.
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Custom AFOs for More SupportIf you need more support than the off-the-shelf options above, your occupational therapist or orthotist can fabricate a custom AFO that covers your foot, prevents ankle movement, and provides greater overall support and stability.
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Is it hard to walk with an AFO?
Walking with an AFO may feel strange at first, but people find that it begins to feel natural very quickly. Your physical therapist or orthotist can offer tips and suggest a wearing schedule to gradually break it in. If you notice pressure points or irritated skin, the professional who fitted your brace can make adjustments.
If you have an AFO on one foot, you may be able to walk with or without a cane or walker. If you have AFOs on both feet, you may want to use a walker for greater stability.
It is a good idea to wear your AFO(s) whenever you are on your feet. Even though you may think you do not need to wear braces at home where you are most comfortable, most falls occur in or around the home. AFOs will reduce your risk of falling and getting injured.
If you have an AFO on one foot, you may be able to walk with or without a cane or walker. If you have AFOs on both feet, you may want to use a walker for greater stability.
It is a good idea to wear your AFO(s) whenever you are on your feet. Even though you may think you do not need to wear braces at home where you are most comfortable, most falls occur in or around the home. AFOs will reduce your risk of falling and getting injured.
Can stretching help?
Stretching can help reduce stiffness and pain in your hips, knees, and ankles. Even though walking will help your legs stay stretched out, it is still a good idea to do seated and standing stretches, which can help you maintain your flexibility and help with muscle cramping.
Once you start using a wheelchair, your hips, knees, and ankles can tighten and lose their range of motion. If your ankle gets tight and your foot stays pointed down, for example, transfers that involve standing and pivoting can become very difficult. Range of motion exercises, whether you do them independently or with the help of a caregiver or professional, can help you maintain your flexibility.
Once you start using a wheelchair, your hips, knees, and ankles can tighten and lose their range of motion. If your ankle gets tight and your foot stays pointed down, for example, transfers that involve standing and pivoting can become very difficult. Range of motion exercises, whether you do them independently or with the help of a caregiver or professional, can help you maintain your flexibility.
What types of shoes can I wear?Your best option is supportive athletic shoes with laces. The shoes you wear should have a solid base, back on the heel, and ideally removable insoles so you can insert the footplate into your shoe and then place the padded insole on top of it. Because you are adding volume to your shoe, you may find that you need to go up in size.
It may be challenging to find a pair of sandals that will work well with an AFO. Your sandals would need to have secure straps and a way to insert the footplate under the sole of your foot. |
Fashion vs FunctionIf you are worried about sacrificing fashion in the name of stability, Dagmar Munn addresses this issue in her ALS News Today article, How My AFOs Helped Me Learn to Live with ALS. |
Can I drive with AFOs?
It may be challenging—and possibly dangerous—to drive while wearing an AFO, especially if it is on your right foot. Before trying to drive with an AFO, consult with your occupational therapist, who will determine if you will be safe.
Some ALS clinics can conduct a driving screening, including a toe tap test and reaction time test. They may also be able to do an on-the-road evaluation. If your clinic or doctor cannot assess your driving, ask where you can get evaluated. If you are deemed safe to drive, your occupational therapist can give you tips for staying safe. Learn more about driving with ALS.
Some ALS clinics can conduct a driving screening, including a toe tap test and reaction time test. They may also be able to do an on-the-road evaluation. If your clinic or doctor cannot assess your driving, ask where you can get evaluated. If you are deemed safe to drive, your occupational therapist can give you tips for staying safe. Learn more about driving with ALS.
How much will I have to pay?If you get a prescription from your doctor, Medicare should cover 80% of the cost of your AFOs. Medicaid, supplemental plans, and secondary private insurance should pay for the remaining 20%.
If you have Medicare but do not have Medicaid, a supplemental plan, or secondary private insurance, you will likely have to pay the remaining 20% out of your own pocket. |
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If you need an AFO for each foot, Medicare will pay for both. But keep in mind that Medicare will only pay for one type of brace for the same body part once every five years, based on the logic that a brace should last you five years.
If you do not qualify for Medicare—but have Medicaid and/or private insurance—find out what your durable medical equipment (DME) benefits will cover. If you have a Medicare Advantage Plan, be sure to ask about your DME benefits.
If you are facing out-of-pocket expenses that you cannot afford, ask your local ALS organization if they can lend you an AFO from their loan closet. If not, talk with your DME provider and/or local ALS organization about financial assistance options.
Military veterans: Your coverage for equipment, including AFOs, is different than what is listed here. Learn more.
If you do not qualify for Medicare—but have Medicaid and/or private insurance—find out what your durable medical equipment (DME) benefits will cover. If you have a Medicare Advantage Plan, be sure to ask about your DME benefits.
If you are facing out-of-pocket expenses that you cannot afford, ask your local ALS organization if they can lend you an AFO from their loan closet. If not, talk with your DME provider and/or local ALS organization about financial assistance options.
Military veterans: Your coverage for equipment, including AFOs, is different than what is listed here. Learn more.
