This decision tree is intended to be a resource for physical therapists to facilitate their clinical decision making when considering AFOs to address acquired foot drop in the adult population.

A few notes about the decision tree:

• • • This decision tree is intended to guide physical therapists in selecting the first Ankle Foot Orthosis (AFO) to trial with their patient, not certified orthotists, as the orthotists will use their additional advanced training and deeper knowledge of available devices and material science to guide their prescriptions.
  • • Intentional vagueness of terms like mild/moderate/severe leaves room for other factors beyond gait deviations to influence prescription, including patient preferences and other relevant phenotypic variations.
  • • Assumes all plantar flexor spasticity will impact the knee during stance.
  • • Assumes this decision tree would be a starting point for initiating the trial-and-error process, with ultimate device selection occurring as a highly collaborative process between the patient, orthotist, and PT.
  • • Knee instability will primarily refer to sagittal plane deviations, assuming that significant varus, valgus, or multiplanar instability at the knee can only be effectively managed with a device that crosses the knee joint, and therefore is outside of the scope of this tool. Brief discussion of the possibility of affecting very mild varus or valgus is included in the tuning decision tree.
  • • Custom AFO decision tree is meant to indicate biomechanical plausibility and possibility of clinical
      appropriateness, not that the indicated choice is the only possible way to correct those deviations.

Some notes about terminology:

• • • Custom AFOs could be made from thermoplastic, carbon fiber, or other materials – at the discretion of the
      orthotist.
  • • Mission Gait Foundation has no financial relationship with any of the following mentioned companies, and
      mentioning these products does not imply endorsement.

Types of AFOs: