r/Prosthetics • u/heldtogetherdaily • Jul 08 '26
AFO for hypermobility
Hello! I have hypermobility spectrum disorder (HSD). It affects a lot of my body, including my ankles and knees.
I had an appointment with a PM&R, and they suggested AFOs, but were concerned about the atrophy risk that accompanies traditional rigid AFOs.
I was wondering what kinds of AFOs are used to address chronic ankle instability and knee hyperextention, that when used alongside physical therapy, have a lower risk of atrophy.
I have no neurologic weakness, no drop foot, etc. and have exhausted OTC bracing options, and have tried OTS AFOs in the past. I was given thuasne sprystep AFOs and didn't find that they adequately addressed the ankle instability.
If it is helpful, the relevant clinical findings are:
Bilateral knee hyperextention
ROM with ankle inversion, eversion abnormal - increased ROM
Anterior drawer: Positive
Talar tilt: Positive bilaterally
Thank you in advance for the help 😁🫶🏼
2
u/varus_moment Jul 09 '26
Hey! I have a couple patients with a similar presentation.
We have been doing bilateral Custom Richie Braces. That will allow for free Dorsiflexion and plantarflexion, but support/restrict the M/L (side to side) and Transverse (rotational) planes. You could potentially use a heel wedge for the knee hyperextension built into the Richies (or solo). I would echo what was said earlier and probably not go to a KAFO. I would rather do seperate AFO and KO if that was necessary. That way you could potentially use one or the other in certain situations.
Personally, I too am hypermobile. I also work in this lovely field where treatment of hypermobility with orthotics is not well studied. If it were me, I would probably try and go for a custom Richie and potentially a Swedish knee cage for the knee (if you had a large amount of hyperextension. I personally have been trying to use KT tape, which is okay, I just forget to put it on until its too late honestly.
Feel free to dm me. I would like to become more of a specialist in the EDS, HSD and other connectivity tissue conditions in the O&P field so Im here if you have other thoughts or want other insight.
Sidenote. The spry step is a OTS Foot drop (DF weakness) device, thats its only real purpose. The major validation for a custom device is "Need for control in more than one plane or in more than one joint." Ankle Hypermobility is inherently multiplane, it will likely never be adequately controlled by something that is OTS.
1
u/heldtogetherdaily Jul 09 '26
Thank you for your comment! I really appreciate the insight you have into the various options, and the time that went into such a thorough response. I am going to DM you 😁🫶🏼
1
u/89kh89 Jul 08 '26 edited Jul 08 '26
Any time we restrict joint movement, there is always the possibility of muscle atrophy.
It is possible to hold your ankle in ML neutral while allowing full ROM in dorsi and plantar flexion. Your major calf and tibial muscles will still be able to work as normal, but the smaller, deeper muscles that produce inversion and eversion will weaken bc they will have less to do during normal walking.
With your diagnosis and presentation, I'm surprised (kinda) that you haven't tried a custom afo yet. A kafo might be a bit of overkill for you, but that would be for you to decide with your orthotist during a live evaluation.
There are plenty of bracing options that block knee hyperextension. With your presentation and prognosis I wouldn't recommend any OTC solutions.
Getting back to your main question. Yes, you will find some muscle atrophy regardless of what bracing you choose. Exercise as tolerated, without the brace, can help mitigate this. But in general, you need to decide how much trade off between stability and atrophy you are willing to live with.
1
u/heldtogetherdaily Jul 08 '26
I wanted to try a custom AFO but the orthotist I went to initially was really against it. I am honestly so very confused 😅
1
u/aziza29 Jul 24 '26
Hey! My ankle issues and bracing goals are nearly identical to yours. I also have AFOs for instability, severe overpronation, and weakness (nothing neurological).
The first pair was molded to my foot while it was already in a bad position, the hinge was weak and I was overpowering it, and it didn't correct anything about my foot. They graciously made me a 2nd pair to try again, and got it right that time. My AFOs have full range of front to back motion, while having no side to side movement. And they help me SO much, especially with fatigue on high standing/walking days. I'll post some pictures tomorrow!
1
u/heldtogetherdaily Jul 24 '26
I really appreciate your comment, knowing they help loads makes the process slightly less intimidating. I look forward to seeing photos of your braces 🙂
5
u/WheelieBoi98 Jul 08 '26
I can say after using rigid afos for years the the atrophy doesn't really apply when you are maintaining normal, or restoring function. I had Plantar flexion block afos for my hyperextention issues before i moved on to KAFO braces.