Choosing the Right Ankle-Foot Orthosis in the Middle East and Africa

For orthotists and prosthetists across the Middle East and Africa, selecting the most appropriate ankle-foot orthosis (AFO) can be both a challenge and an opportunity. With diverse patient populations, resource considerations, and evolving clinical expectations, the decision goes far beyond simply choosing a brand or following what colleagues use.

Key factors to consider include:

• Diagnosis – neurological vs. musculoskeletal conditions

• Patient activity level – mobility goals, daily environment, and gait demands

• Footwear tolerance – cultural preferences and footwear availability

• Device durability & access – important in regions where follow-up visits may be limited

This complexity underscores why clinical judgment, combined with a clear understanding of device categories, is vital in patient care.

Over-the-Counter (OTC) AFOs

OTC AFOs are widely available from multiple manufacturers and offer a quick solution in acute cases. Common clinical indications include:

• Acute drop foot following stroke, spinal injury, or illness

• Short-term support (generally <6 months)

• Patients with average build (height <183 cm, weight <115 kg), unless otherwise indicated

Design variables include uprights, footplates, and hinge systems. Short uprights, for example, may be suitable for average-height patients, while lightweight construction can support easier mobility.

OTC AFOs are often provided upon discharge from hospitals or rehabilitation centers. They are cost-effective and easily dispensed, but come with limitations:

• Limited adjustability

• Durability concerns for long-term use

• Insurance — the regular complexities of prescribing

In some cases, CAM walkers are also categorized as OTC AFOs.

Custom-Fitted AFOs

Custom-fitted AFOs bridge the gap between mass-produced OTC devices and fully custom-made orthoses. These devices begin as prefabricated models but can be modified extensively to meet individual patient needs. Adjustments may include:

• Heating and bending uprights

• Altering footplates for pressure redistribution

• Adding or adjusting padding for comfort

Such modifications require the technical expertise of an Certified Orthotist Prosthetist, . The benefit is a more tailored fit and greater patient comfort compared to OTC devices.

However, challenges remain:

• From a coding and reimbursement perspective, custom-fitted AFOs, like OTC AFOs, are billed under a single parent code — no additional modifications can be separately coded.

• Durability may still be a concern, particularly in high-demand environments common in the Middle East and Africa, where patients may use the same device for longer periods due to access or financial constraints.

Key Considerations for the Region

1. Patient Access & Affordability

   • In many parts of the Middle East and Africa, availability of advanced devices may be limited. Providers must balance cost with durability and patient outcomes.

2. Environmental Demands

   • Devices must withstand hot climates, dust, and in some areas, rough terrain — raising durability requirements compared to standard Western contexts.

3. Cultural & Lifestyle Factors

   • Footwear compatibility is crucial. Patients may prefer sandals, traditional footwear, or barefoot walking in some communities, requiring thoughtful AFO selection and design.

4. Follow-up & Maintenance

   • Limited access to rehabilitation centers may mean devices need to be more durable and user-friendly, as frequent adjustments are not always feasible.

Clinical Takeaway

When prescribing AFOs in the Middle East and Africa, orthotists and prosthetists must weigh:

• The clinical indication (acute vs. chronic condition)

• The patient’s lifestyle and environment

• The balance between affordability, durability, and functionality

OTC AFOs may be suitable for short-term interventions, while custom-fitted devices offer a middle ground where resources allow. Understanding these categories — and tailoring them to the realities of local practice — enables clinicians to optimize patient outcomes while navigating regional challenges.