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Lower Limb Orthotic Management in Stroke Population: a Multi-disciplinary Approach


Stroke, in general terms, is attributed to vascular injury of a person’s nervous system. It is the leading cause of acquired disability in adults (1). Stroke can compromise vision, speech, sensory and motor, and cognitive functions. This disruption in daily functions then lead to the visible signs of having experienced a stroke. In this blog, we will focus on the effect of a stroke on a person’s lower limbs and mainly looking at the physical therapy perspective, and the orthotic management of post-stroke patients.


Using orthotic devices early on after a patient experiences a stroke can help prevent and correct deformities and treat potential muscle and joint problems. Using an orthotic device is also an effective rehabilitation tool for improving both motor function and compensatory abilities that may be experienced after a stroke. Not only can orthotics provide stability and alignment for a post stroke patient, but they can also provide pain relief, aid in compensation for the loss of sensation in the limb, and at times help with swelling.

In the post-stroke population, a patient may experience weakness of the lower limb muscles, loss of range of motion at the joints, and contracture or spasticity of the muscles. These changes cause gait deviations and introduce instability during ambulation. Thus, requiring the patient to use compensations techniques that will require more energy expenditure. The goals in physical therapy include restoring mobility, improving strength and range of motion, and enhancing functional abilities. There are different approaches in rehabilitation process. One example is the repetitive facilitative exercises or RFE. In their study, Tomioka found that it has beneficial therapeutic effects on improving functional ambulation and motor performance of the lower limb in chronic post-stroke patients (2). They also found that a combination of the RFE and AFO brace use showed significant functional and ambulatory improvements.


Orthotic management for post-stroke patients aims at supporting weight-bearing movement, aligning joints, compensate for muscle weakness, control spasticity, and prevents further deformity. A combination of early rehabilitation and the use of an AFO (Ankle Foot Orthosis) brace has been documented to significantly improve gait parameters (3). After a thorough evaluation of the patient, orthotic management may look similar to the following: The patient starts with a convertible AFO brace to support weight-bearing and re-align joints. As the patient shows improvements in physical therapy, the brace can be converted into an articulated AFO brace with a dorsi-assist ankle joint. This compensates for the weakness in the dorsi-flexors of the ankle and provides additional stability. A patient may be weaned out of the AFO brace as they are making progress and use their brace only when needed.                  

This multi-disciplinary approach in the treatment of lower limb weakness and/or spasticity resulting from a stroke has been documented to provide the patient the best outcome possible. Use of an AFO helps to improve walking speed, cadence, step length, and stride length, particularly in patients having suffered a stroke. Use of an AFO is considered beneficial in enhancing gait stability and ambulatory ability.

Tillges Custom Carbon AFO Brace
Tillges Convertible AFO Brace


If a traditional AFO brace option does not fit the needs of a post-stroke patient, there are other orthotic options available. The C-Brace from Ottobock is a microprocessor-controlled leg orthosis that helps the wearer respond to everyday movements in real-time. This provides the patient the safety, stability, and confidence to continue living their life with confidence. For a post-stroke patient, the C-Brace allows someone with paralysis in their legs to walk on uneven terrain, go up and down slopes, inclines and stairs one foot at a time, step-by-step. (4)

Also, depending on the severity of the symptoms a post-stroke patient is experiencing, a knee-ankle-foot orthosis (KAFO) is sometimes used for gait training in stroke patients with severe motor paralysis. A KAFO brace main function is to provide stability to the knee joint by locking the knee during gait for the patient to provide confidence in each step.

Tillges KAFO Brace

Early intervention after a stroke coupled with the patient’s compliance with rehabilitation and AFO brace wear, are key to success. Team Tillges is here to help you with your recovery – contact us today at 651-772-2665 to schedule a consultation and regain your mobility!



  1. Murphy, S. and Werring S. “Stroke: causes and clinical features.” Elsevier Medicine vol. 48, issue 9, 2020
  2. Tomioka, K.; Matsumoto, S.; Ikeda, K.; Uema, T.; Sameshima, J.; Sakashita, Y.; Kaji, T.; and Shimodozono, M. “Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients.” The Journal of Physical Therapy Science, 29:212-215, 2017
  3. Sankaranarayan H, Gupta A, Khanna M, Taly AB, Thennarasu K. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study. J Neurosci Rural Pract 2016;7:544-9.
  5. Google Photos 2024.

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