Can An AFO Reduce Trips And Falls?
A suitable ankle-foot orthosis may help reduce trips caused by inadequate foot clearance.
During walking, the foot must lift sufficiently while the leg swings forwards. With foot drop, the toes may remain pointed towards the floor and catch on obstacles or uneven surfaces.
An AFO may help by:
- Lifting or holding the forefoot
- Improving toe clearance
- Reducing foot slap
- Positioning the ankle more consistently
- Limiting unwanted inward or outward movement
- Improving the stability of the foot and ankle
- Reducing the need to lift the knee excessively
- Making steps more predictable
NICE recommends considering an AFO after stroke where poor swing-phase clearance causes problems such as tripping and falling, or where poor ankle and knee control affects walking.
However, an AFO cannot guarantee that someone will not fall.
Why Does Foot Drop Cause Tripping?
Foot drop makes it difficult to lift the front of the foot and toes.
This can cause the foot to catch on:
- Rugs
- Door thresholds
- Steps
- Kerbs
- Uneven pavements
- Loose flooring
- Electrical cables
- Small household objects
- Long grass
- Changes in surface height
The NHS states that people with foot drop have a higher risk of tripping and falling.
The risk may increase when the person is:
- Tired
- Walking quickly
- Distracted
- Carrying something
- Walking in poor lighting
- Using unsuitable footwear
- Managing uneven ground
- Turning
- Going up or down stairs
How Does An AFO Improve Toe Clearance?
An AFO supports the foot during the swing phase of walking.
Depending on its design, it may:
- Pull the forefoot upwards through elastic tension
- Hold the ankle close to a neutral position
- Prevent the foot pointing excessively downwards
- Resist the foot turning inwards
- Provide a more stable position for heel contact
- Control how the foot lowers onto the ground
The Boxia® uses an adjustable elastic strap to assist dorsiflexion and lift the forefoot during the swing phase.
A rigid or semi-rigid AFO may provide more control where the person also has ankle instability, spasticity or unwanted side-to-side movement.
Does Better Foot Clearance Always Prevent A Fall?
No.
Improving toe clearance addresses one particular mechanism of tripping, but falls may have several causes.
A person may still be at risk because of:
- Poor balance
- Weakness at the hip or knee
- Reduced sensation
- Dizziness
- Vision problems
- Medication side effects
- Low blood pressure
- Reduced reaction speed
- Unsafe footwear
- Environmental hazards
- Cognitive or attention difficulties
- Fatigue
- Fear of falling
NHS falls guidance recommends a broader approach that may include strength and balance training, medication review, home adaptations, suitable footwear, vision checks and walking aids.
An AFO should therefore be one part of a wider falls-prevention plan where several risks are present.
What Is The Difference Between A Trip And A Fall?
A trip occurs when the foot catches an obstacle or fails to clear the ground.
A fall is the final event where balance cannot be recovered and the person lands on the ground or another lower surface.
An AFO may reduce toe catching without eliminating every circumstance that could cause a fall.
For example, someone may achieve better foot clearance but remain unstable because of:
- Poor balance
- Weak knee control
- Reduced sensation
- Vertigo
- Unsafe stairs
- A loose rug
- A slippery surface
The aim is to reduce avoidable risk rather than promise complete protection.
Who May Benefit From An AFO?
An AFO may be considered where a person:
- Has diagnosed foot drop
- Frequently catches the toes
- Uses a high-stepping gait
- Has reduced swing-phase foot clearance
- Experiences foot slap
- Feels less confident walking
- Trips on small changes in surface height
- Has difficulty positioning the foot for heel contact
- Requires ankle stability
- Has been advised to use one by a clinician
NICE advises assessing whether the person can put the AFO on and evaluating its effectiveness according to comfort, speed and ease of walking.
Who May Need More Than A Lightweight Foot-Lifting Brace?
A lightweight elastic support may be insufficient where there is:
- Significant spasticity
- Strong inward turning of the foot
- Severe ankle instability
- A fixed deformity
- Knee collapse
- Knee hyperextension
- Marked weakness elsewhere in the leg
- Significant sensory loss
- Complex bilateral symptoms
- Poor balance unrelated to toe clearance
A more structured AFO, custom device, knee-ankle-foot orthosis or walking aid may be needed.
Guy’s and St Thomas’ NHS Foundation Trust explains that an AFO can support the foot and ankle while also influencing movement at the knee and hip, helping with standing, balance and walking.
Can AFOs Improve Balance?
An AFO may improve the stability of the foot and ankle and provide a more consistent base during standing and walking.
This may help some users feel:
- More secure
- More confident
- Less concerned about toe catching
- Better supported at the ankle
- More consistent from step to step
However, balance depends on several systems, including:
- Vision
- Inner-ear function
- Sensation
- Muscle strength
- Joint movement
- Coordination
- Reaction speed
- Attention
An AFO cannot correct every balance impairment.
Someone with continuing unsteadiness should receive a broader mobility or falls assessment.
Can An AFO Help After A Stroke?
It may help selected people after stroke.
Stroke can cause:
- Weakness lifting the foot
- Spasticity
- Poor ankle control
- Knee collapse
- Knee hyperextension
- Reduced balance
- Difficulty clearing the toes
NICE recommends considering an AFO where swing-phase foot clearance or stance-phase control affects walking after stroke. It also states that assessment and treatment should be carried out as part of a stroke rehabilitation programme by qualified professionals.
The most appropriate device depends on the person’s:
- Muscle tone
- Strength
- ankle movement
- Knee control
- Sensation
- Balance
- Ability to fit the brace
- Rehabilitation goals
Can An AFO Help With Peroneal-Nerve Foot Drop?
A lightweight dorsiflexion-assist brace may be useful where common peroneal nerve weakness causes flaccid foot drop and the ankle remains reasonably stable.
The brace may:
- Lift the forefoot
- Reduce toe catching
- Reduce excessive knee lifting
- Improve walking confidence
- Provide temporary support during nerve recovery
The Boxia® is indicated for flaccid-paralysis foot drop and uses elastic assistance to improve foot clearance.
A brace supports function but does not repair the injured nerve.
Can An AFO Help With Multiple Sclerosis?
Some people with multiple sclerosis may benefit where foot drop affects toe clearance.
However, the response may vary because symptoms can be influenced by:
- Fatigue
- Heat
- Spasticity
- Balance
- Sensory changes
- Walking distance
- Weakness elsewhere in the leg
An AFO or functional electrical stimulation may be considered following specialist assessment.
The NHS includes braces, splints and electrical stimulation among recognised treatments for foot drop.
Does An AFO Stop Foot Slap?
Some AFO designs can reduce uncontrolled lowering of the forefoot after the heel reaches the ground.
This may help:
- Reduce the slapping sound
- Improve control after heel strike
- Make walking smoother
- Reduce sudden loading through the forefoot
- Improve consistency between steps
A soft elastic foot-lifting support may primarily assist during swing, whereas a rigid or semi-rigid AFO may provide greater control as the foot contacts the ground.
The required design depends on whether the main problem is:
- Toe clearance
- Foot slap
- Ankle instability
- Spasticity
- Knee control
- A combination of these
Can The Wrong AFO Increase Fall Risk?
Potentially.
An unsuitable or poorly fitted AFO may make walking less stable if it:
- Provides insufficient toe clearance
- Holds the ankle at an unsuitable angle
- Restricts movement excessively
- Pushes the knee backwards
- Allows the knee to collapse
- Moves inside the footwear
- Causes pain
- Creates numbness
- Does not fit the shoe
- Is difficult to fasten correctly
NICE recommends assessing the effectiveness of an AFO according to comfort, walking speed and ease of walking.
The person should not assume that an AFO is helping solely because it feels supportive while sitting.
How Do You Know Whether The AFO Is Helping?
Useful signs may include:
- Fewer episodes of catching the toes
- Better clearance over the floor
- Less need to lift the knee excessively
- Reduced foot slap
- More consistent step length
- Improved confidence
- Easier ordinary walking
- Fewer near-trips
- Improved stability during turning
- Less concentration required to clear the foot
The brace should be assessed during actual walking rather than only while standing still.
NICE advises evaluating comfort, walking speed and ease of walking.
How Should Walking Be Tested?
Begin in a controlled environment.
A practical assessment may include:
- Standing with support nearby.
- Walking several metres on a clear, level floor.
- Checking toe clearance.
- Checking whether the foot turns in or out.
- Observing the knee.
- Turning in both directions.
- Sitting and standing.
- Walking at an ordinary pace.
- Checking the brace and footwear afterwards.
- Inspecting the skin.
More demanding activities such as stairs, slopes, uneven ground and longer distances should only be attempted once basic walking is safe.
A physiotherapist or orthotist may assess the person’s walking pattern and adjust the support accordingly.
Should A New AFO Be Worn All Day Immediately?
Not normally.
Guy’s and St Thomas’ advises beginning with small amounts of wear at home and following the orthotist’s instructions.
A gradual introduction allows the user to check:
- Comfort
- Skin tolerance
- Toe clearance
- Balance
- Shoe fit
- Fatigue
- Whether the brace changes knee movement
- Whether the straps remain secure
A conventional AFO may require a longer break-in period than a lightweight textile support.
Can The Boxia® Be Worn Indoors And Outdoors?
NHS Orthotics guidance for the Boxia states that it is commonly worn while walking both indoors and outdoors and may be unclipped while sitting for comfort.
Its suitability still depends on:
- Correct fitting
- Secure footwear
- Adequate ankle stability
- Skin tolerance
- The underlying movement pattern
- Professional advice where required
Walking barefoot with the standard shoe attachment is not appropriate because the lifting strap requires a secure connection to compatible footwear.
Does Footwear Affect Trip Prevention?
Yes.
The brace and shoe must work together.
Suitable footwear helps:
- Keep the foot secure
- Prevent the AFO moving
- Maintain heel position
- Provide enough space
- Support the ankle
- Reduce slipping
- Allow the fastening to be adjusted
East Lancashire Hospitals NHS Trust recommends footwear for foot-drop splints that is:
- Closed at the toe
- Fastened with laces or hook-and-loop straps
- Flat
- Stable at the heel
- Comfortable and well fitting
- Structured around the front of the ankle
It warns that unsuitable footwear may allow the orthosis to move, increasing the risk of slips, trips or falls and reducing the brace’s effectiveness.
Which Shoes Should Be Avoided?
Footwear that may be unsuitable includes:
- Slip-on shoes
- Backless shoes
- Shallow shoes
- High heels
- Loose slippers
- Poorly fitting shoes
- Unstructured fabric footwear
- Slippery soles
- Damaged footwear
- Pointed toe boxes
East Lancashire Hospitals specifically advises against slip-on, high-heeled, shallow, damaged or poorly structured footwear for foot-drop splints.
The requirements may vary according to the type of AFO.
Should The Existing Shoe Insole Be Removed?
For an AFO that sits inside the footwear, removing the shoe’s original removable liner may provide additional depth.
Guy’s and St Thomas’ advises choosing footwear that is wide and deep enough and removing the original liner where necessary to make space for the AFO.
The Boxia® sits mainly outside the footwear and therefore does not occupy the same in-shoe space as a traditional plastic AFO.
Does The Boxia® Work With Every Shoe?
No.
The standard Boxia® system requires a secure shoe connection.
East Lancashire Hospitals advises using low-heeled shoes or trainers and fitting the attachment through the shoe tongue or selected lace eyelets.
The shoe should:
- Fasten securely
- Hold the heel
- Remain stable
- Allow the attachment to sit centrally
- Avoid excessive heel height
- Fit comfortably
Loose slip-on footwear may prevent the brace from functioning safely.
Can An AFO Help On Stairs?
Improved toe clearance may make it easier to avoid catching the foot on a step, but stairs remain a higher-risk activity.
When using stairs:
- Use a handrail
- Take one step at a time where needed
- Ensure the whole foot is placed securely
- Avoid rushing
- Keep the stairs well lit
- Remove clutter
- Follow physiotherapy advice
- Use assistance where required
An AFO cannot compensate for severe weakness, poor balance or unsafe stair design.
The NHS recommends considering safety rails and reducing trip hazards for people at risk of falls.
Can An AFO Help On Uneven Ground?
It may improve toe clearance, but uneven terrain also challenges:
- Balance
- Ankle adaptation
- Sensation
- Knee control
- Reaction speed
- Vision
A rigid AFO may provide greater stability but reduce the ankle’s ability to adapt to the ground.
A lightweight support may allow more movement but provide less side-to-side control.
Use caution on:
- Gravel
- Grass
- Slopes
- Broken pavements
- Wet surfaces
- Sand
- Woodland paths
A walking aid may be appropriate where the AFO alone does not provide sufficient stability.
Does Fatigue Affect Foot Clearance?
Yes.
A person may clear the foot adequately at the beginning of a walk but catch the toes more often as muscles tire.
Signs of fatigue may include:
- More frequent scuffing
- Shorter steps
- Greater knee lifting
- Reduced balance
- Slower reactions
- More reliance on furniture or walls
- Loss of concentration
A brace may help maintain clearance, but it cannot remove all effects of fatigue.
Plan rest breaks and avoid continuing once walking becomes visibly less safe.
Can A Walking Aid Be Used With An AFO?
Yes, where clinically appropriate.
A stick, crutch or walking frame may provide additional support for:
- Balance
- Weight transfer
- Weakness
- Confidence
- Uneven ground
- Longer distances
NHS falls guidance advises considering a walking aid where appropriate.
The correct aid and height should ideally be assessed by a physiotherapist or another qualified professional.
What Other Changes Can Reduce Trips At Home?
AFO use may be combined with practical environmental changes.
These include:
- Removing loose rugs
- Securing trailing cables
- Keeping walkways clear
- Improving lighting
- Using non-slip mats
- Installing handrails
- Avoiding clutter on stairs
- Keeping frequently used items within easy reach
- Wearing secure footwear indoors
- Carrying a phone or personal alarm
The NHS specifically recommends reducing clutter and trip hazards, wearing well-fitting footwear with good grip, considering handrails and using a walking aid where appropriate.
Should Slippers Be Worn With Foot Drop?
Loose or backless slippers may increase instability and are unlikely to provide a secure connection for many foot-drop supports.
Safer indoor footwear should generally:
- Fit securely
- Have a closed heel
- Have a good grip
- Avoid slipping off
- Accommodate the brace correctly
The NHS recommends shoes or slippers that fit well, have good grip and do not slip off.
Can Strength And Balance Exercises Help?
They may form an important part of a broader treatment plan.
Physiotherapy may address:
- Remaining dorsiflexor strength
- Hip and knee strength
- Balance
- Walking technique
- Ankle flexibility
- Confidence
- Safe transfers
- Reaction strategies
The NHS lists physiotherapy among the common treatments for foot drop and recommends strength and balance activity for people at risk of falls.
Exercises should be selected according to the underlying cause and the person’s ability.
Can Functional Electrical Stimulation Reduce Trips?
Functional electrical stimulation may assist foot lifting in selected people with foot drop caused by a central neurological condition.
It works by stimulating nerves involved in lifting the foot during walking.
It may be considered particularly following:
- Stroke
- Multiple sclerosis
- Other central neurological conditions
It requires specialist assessment and is not suitable for every cause of foot drop.
The NHS lists electrical stimulation among recognised treatments, especially following stroke or in multiple sclerosis.
What Skin Checks Are Needed?
Check the skin whenever the AFO is removed.
Look for:
- Persistent redness
- Blisters
- Broken skin
- Rubbing
- Swelling
- Bruising
- Numbness
- Pressure over ankle bones
- Moisture irritation
Guy’s and St Thomas’ advises contacting the orthotics service if redness lasts longer than approximately 30 minutes or if sores, blisters, pain or increased rubbing develop.
East Lancashire Hospitals similarly advises wearing the Boxia over a sock and checking the skin thoroughly after use.
Why Should The Boxia® Be Worn Over A Sock?
A sock helps reduce direct rubbing between the brace and skin.
It should be:
- Smooth
- Long enough to cover the brace-contact area
- Free from wrinkles
- Clean and dry
- Not excessively thick
East Lancashire Hospitals advises wearing the Boxia over a sock to protect against rubbing that could lead to an open wound.
What If The Brace Causes Numbness?
Remove it and reassess the fit.
Numbness may indicate:
- Excessive strap tension
- Pressure over a nerve
- Swelling
- Poor positioning
- A brace that is too small
- Reduced circulation
- An existing sensory problem
Do not continue tightening a brace that is causing altered sensation.
Seek professional advice where numbness continues after the device is removed.
What If The Person Still Trips While Wearing The AFO?
Possible reasons include:
- Insufficient dorsiflexion assistance
- Incorrect fitting
- The brace moving
- Unsuitable footwear
- Fatigue
- Ankle instability
- Spasticity
- Knee weakness
- Poor balance
- Reduced sensation
- Environmental hazards
- A change in the underlying condition
The response should not automatically be to increase strap tension.
The brace and overall walking pattern should be reviewed.
Can An AFO Make Walking More Tiring?
It can initially feel different and may change how the leg moves.
A poorly selected brace may increase effort if it:
- Restricts useful movement
- Is too heavy
- Holds the ankle incorrectly
- Interferes with knee motion
- Fits poorly inside the shoe
- Causes pain
- Requires excessive compensatory movement
NICE recommends judging an AFO by comfort, speed and ease of walking rather than only by how much support it provides.
Can You Drive Wearing An AFO?
Driving safety depends on:
- Which foot is affected
- The type of brace
- Vehicle controls
- Reaction speed
- Ability to perform an emergency stop
- Medical and licensing requirements
- Insurance conditions
Guy’s and St Thomas’ recommends contacting the vehicle insurer to confirm cover while wearing an AFO.
Do not drive unless you can control the vehicle safely.
When Should An AFO Be Replaced Or Repaired?
Check regularly for:
- Worn straps
- Weak elastic
- Loose fastenings
- Cracked plastic
- Damaged padding
- Frayed stitching
- Reduced lifting assistance
- Movement during walking
Guy’s and St Thomas’ advises checking AFOs regularly for damage and contacting the orthotics service rather than attempting repairs or modifications independently.
The Boxia fastening and elastic components may wear over time and require replacement.
Why Choose The Boxia® Drop Foot AFO?
The Boxia® Drop Foot AFO is a lightweight dynamic support for flaccid foot drop.
Its features include:
- Adjustable elastic dorsiflexion assistance
- Improved forefoot clearance
- External positioning that does not occupy shoe space
- An ankle cuff
- A secure shoe attachment
- Breathable perforated material
- Gel-padded areas
- Multiple sizes
- Black and beige options
- Adaptability for left- or right-foot use
- A low-profile design
The Boxia® is intended primarily for walking and everyday mobility. It contains latex.
Who May Find The Boxia® Suitable?
It may be considered where:
- Foot drop is flaccid
- Toe catching is a principal walking problem
- The foot remains flexible
- The ankle retains sufficient stability
- Lightweight assistance is adequate
- A suitable lace-up or secure shoe can be worn
- The wearer can adjust the tension safely
- The skin can be monitored
Who May Need A Different Brace?
A more structured or custom AFO may be needed where there is:
- Significant spasticity
- Strong inward turning of the foot
- Severe ankle instability
- Fixed deformity
- Knee collapse or hyperextension
- Significant sensory loss
- Fragile skin
- Complex bilateral weakness
- Poor control from an elastic support
- A latex allergy
A full orthotic assessment may be required where the person continues to trip despite appropriate use.
What Should You Do After A Fall?
If you fall:
- Stay calm
- Check for pain or injury
- Do not rush to stand
- Use a phone or personal alarm where available
- Call for help if you cannot get up safely
- Keep warm while waiting
- Seek medical advice where injury is suspected
The NHS recommends seeing a GP if you have had a fall or are worried about balance or mobility.
Call 999 for a serious injury, loss of consciousness, severe pain or where the person cannot be moved safely.
When Should Repeated Tripping Be Assessed?
Seek professional assessment where:
- Trips are becoming more frequent
- A fall has occurred
- The foot is becoming weaker
- The brace no longer clears the toes
- Balance is worsening
- Both feet are affected
- New numbness has developed
- The person is avoiding activity through fear
- The walking pattern has changed
- The current AFO makes walking less stable
The NHS advises medical assessment for foot drop and a falls review where mobility or balance is a concern.
The Key Takeaway
A suitable AFO may help reduce trips caused by foot drop by improving forefoot clearance and positioning the ankle more consistently during walking.
It may help:
- Prevent the toes catching
- Reduce foot slap
- Improve step consistency
- Reduce excessive knee lifting
- Improve confidence
- Support the ankle
- Make ordinary walking easier
It cannot guarantee that falls will stop.
Falls may also be influenced by:
- Balance
- Strength
- Sensation
- Fatigue
- Vision
- Medication
- Footwear
- Environmental hazards
The best results usually come from combining the correct brace with suitable footwear, skin monitoring, strength and balance rehabilitation, home-safety changes and professional review where instability continues.
