Year-Long Use of Ankle-Foot Orthosis–Footwear Combination with Talar Flange Modification in an Adult Poststroke

ABSTRACT Introduction There are limited examples in the literature of detailed orthotic management related to triplanar control of the ankle-foot complex. The aim of this case report was to describe year-long use of an ankle-foot orthosis–footwear combination (AFO-FC) augmented with a talar flange that aimed to stabilize the subtalar joint during gait in an individual with poststroke hemiplegia who presented with both knee hyperextension and an unstable subtalar joint. Materials and Methods A 40-year-old woman 1-year poststroke with right hemiplegia presented with right equinovarus and knee hyperextension, with complaint of pain in the ankle and knee. Her right talocrural joint measured 15° plantarflexion with clinically significant inversion instability. Results A right solid AFO-FC, designed using published algorithms, was provided. In addition, a talar flange modification was incorporated to control subtalar inversion. During year-long use of the AFO-FC, the patient was able to return to community ambulation without pain. Successful orthotic intervention required that the device met not only biomechanical goals but also broader patient goals, which changed over time. Therapy with the device was also important for successful orthotic intervention. Conclusions This case illustrates use of a talar flange in an AFO-FC to provide triplanar control of the ankle-foot complex and improve gait in a person poststroke.