In a double action AFO for a patient with good hip muscle strength but poor quadriceps and plantar flexors, which setting is most appropriate?

In the context of a double action ankle-foot orthosis (AFO) for a patient who has good hip muscle strength but experiences weakness in the quadriceps and plantar flexors, setting the anterior pins to maintain a few degrees of plantar flexion is particularly beneficial.

Maintaining a slight degree of plantar flexion helps to keep the ankle in a more functional and stable position during the stance phase of walking. This position allows for proper alignment of the tibia over the foot, which can support the knee joint, especially in individuals with quadriceps weakness. By allowing a slight plantar flexion, the AFO can also contribute to better biomechanical efficiency by utilizing gravity to assist in forward progression during ambulation.

This setting takes advantage of the patient’s hip strength, enabling effective propulsion while minimizing the risk of knee buckling, which is a concern in the presence of quadriceps weakness. Hence, this approach promotes better overall gait mechanics and stability during movement while compensating for the deficiencies in ankle motion control due to the weak plantar flexor muscles.