How To Put On a Foot Drop Brace Correctly

A foot drop brace must be positioned correctly before it can assist walking safely and comfortably.

The fitting method depends on the type of support you use. A rigid ankle-foot orthosis fits around the lower leg and beneath the foot, while a textile support such as Boxia® or StepUp® uses adjustable straps to assist the forefoot upwards.

Although the products look different, the main fitting principles remain the same:

• Sit somewhere stable
• Use the correct brace and side
• Keep straps flat
• Position the heel or cuff correctly
• Avoid excessive tightness
• Use appropriate footwear
• Check the skin
• Test the brace before walking further

Do not rush the fitting process. A brace that is slightly twisted, incompletely fastened or worn with the heel out of position may rub, move or provide unreliable foot clearance.

Identify Which Type of Foot Drop Brace You Have

Before fitting the device, identify its basic design.

Rigid or leaf-spring AFO

A rigid or semi-rigid AFO normally includes:

• A plastic or carbon section behind the lower leg
• A calf strap
• A section passing around the ankle
• A footplate positioned beneath the foot
• Separate left- and right-foot versions in many designs

This type normally fits inside supportive footwear.

Boxia-style foot drop support

Boxia uses:

• A cuff positioned above the ankle
• A fastening around the lower leg
• An adjustable elastic tension strap
• A hook or attachment connected to suitable footwear

It does not use a conventional full-length rigid footplate.

StepUp-style textile support

StepUp uses:

• A soft calf band
• A textile foot component
• Adjustable lifting straps
• Touch-close fastenings
• Anti-slip silicone features

It can be used with or without footwear when correctly assembled.

Do not use the fitting method from one design for a completely different product.

Prepare Before You Begin

Choose a stable chair with:

• A supportive back
• A firm seat
• Enough room around your feet
• No wheels
• A height that allows both feet to reach the floor

Avoid fitting the brace while:

• Standing on one leg
• Sitting on the edge of a bed
• Balancing against furniture
• Rushing to leave the house
• Wearing loose clothing that hides the straps

Place the brace, sock and footwear within easy reach before sitting down.

People with limited mobility, balance difficulties or reduced hand function may need assistance from a carer or healthcare professional.

Check the Brace Before Every Use

Inspect the device before putting it on.

Look for:

• Cracked plastic
• Split or frayed straps
• Loose stitching
• Worn touch-close fastening
• Damaged hooks
• Flattened padding
• Stretched elastic
• Peeling silicone
• Sharp edges
• Loose rivets
• Parts that no longer remain secure

Do not wear a structurally damaged brace simply because it can still be fastened.

A worn tension strap may no longer lift the foot reliably, while damaged plastic or carbon may fail during walking.

Confirm the Correct Left or Right Side

Many rigid AFOs are supplied as separate left- and right-foot versions.

Check:

• The product label
• The footplate shape
• The calf section
• The manufacturer’s markings
• Your order confirmation

The foot should follow the shape of the footplate naturally.

Do not turn a left AFO around or attempt to wear it on the right foot.

Textile devices may be bilateral or configurable for either side, but the straps and footwear attachment must still be arranged for the foot being treated.

How To Put On a Rigid Foot Drop AFO

Rigid AFO designs vary, so follow the fitting instructions provided by your orthotist or manufacturer. The following sequence applies to many common plastic and leaf-spring AFOs.

1. Apply a smooth sock

Wear a thin, long sock beneath the brace unless you have been instructed otherwise.

The sock should:

• Extend above every brace edge
• Lie smoothly against the skin
• Have no wrinkles
• Avoid thick seams
• Be clean and dry
• Fit securely without being excessively tight

Do not place the rigid brace directly against bare skin unless the specific device and clinician’s instructions permit it.

2. Bend your knee

Sit with the knee bent to approximately a right angle.

This helps bring the foot backwards and allows the heel to reach the rear and bottom of the AFO.

3. Position the foot inside the AFO

Guide the toes and forefoot into place.

Make sure:

• The foot is centred
• The toes follow the direction of the footplate
• The sock has not gathered
• The foot is not turning over the edge
• No strap is trapped beneath the foot

4. Push the heel fully back and down

The heel should make firm contact with the rear and bottom of the AFO.

You should not see or feel a large gap:

• Behind the heel
• Beneath the heel
• Between the ankle and the back of the brace

A heel that remains lifted can cause pressure around the ankle, alter strap position and push the toes too far forwards.

Official NHS fitting guidance consistently advises fully seating the heel before the AFO is secured.

5. Fasten the heel-retaining or ankle strap

Where the brace has an ankle or heel-retaining strap, secure this while maintaining the heel position.

The strap should:

• Lie flat
• Have its pad centred
• Hold the heel back
• Feel snug
• Avoid cutting into the front of the ankle
• Avoid trapping the sock

Do not pull it tighter merely because the heel was not correctly seated. Reposition the foot first.

6. Fasten the calf strap

Close the upper strap around the calf.

It should stabilise the brace without causing:

• Pain
• Tingling
• Numbness
• Swelling below the strap
• Deep pressure lines
• Skin pinching

Make sure the strap passes through any intended loops and does not twist.

7. Secure any additional straps

Some AFOs may also include:

• A forefoot strap
• An instep strap
• An ankle-control strap
• Additional padding
• A separate liner

Fit these in the order shown by your orthotist or manufacturer.

Do not assume every strap should be pulled as tightly as possible. Each component has a specific purpose.

Putting the Rigid AFO Into the Shoe

Some rigid AFOs are easiest to position inside the shoe before the foot is inserted. Others are fitted to the leg first and then worked into the footwear.

Follow the method recommended for your particular brace.

Where the AFO is fitted into the shoe first:

1. Loosen the laces or straps fully.
2. Remove the shoe’s insole where authorised and necessary.
3. Position the AFO footplate flat inside the shoe.
4. Push the rear of the AFO against the back of the shoe.
5. Bend your knee.
6. Place your toes into the shoe.
7. Slide your heel down and backwards.
8. Confirm that the heel reaches the bottom.
9. Fasten the footwear.
10. Secure the AFO calf strap.

Guy’s and St Thomas’ NHS guidance describes a similar shoe-first method for AFOs without heel-retaining straps.

How To Put On a Boxia® Drop Foot AFO

The Boxia® uses an ankle cuff and adjustable elastic tension strap rather than a rigid footplate.

The standard product is intended for use with suitable footwear. A separate shoeless attachment is available when support is needed without shoes.

1. Prepare the footwear attachment

The Boxia tension strap needs a secure attachment point at the front of the shoe.

Depending on the supplied component, this may involve:

• A hook connected to the shoe laces
• A tongue insert positioned beneath the laces
• Another Boxia-compatible attachment

The attachment should be:

• Centred at the front of the shoe
• Securely held by the laces
• Free from twisting
• Positioned where the lifting strap can pull upwards evenly

Do not connect the strap to a fragile decorative lace, loose eyelet or unsuitable part of the shoe.

2. Open the Boxia cuff

Release the fastening and inspect the inside of the cuff.

Check that:

• The gel-padded areas are flat
• No material has folded
• The tension strap is not twisted
• The touch-close section is free from debris
• The cuff is the correct size

3. Position the cuff above the ankle

Wrap the cuff around the lower leg, just above the ankle.

The exact position should follow the supplied instructions, but it should not sit directly:

• Across the ankle bones
• Over the heel
• Behind the knee
• On broken or irritated skin

The cuff should remain level rather than sloping sharply around the leg.

4. Fasten the cuff

Secure the cuff firmly enough to prevent it slipping down.

It should:

• Lie flat against the leg
• Feel secure
• Avoid pinching the skin
• Avoid restricting circulation
• Avoid pressing painfully over the Achilles area
• Remain stable when you move the ankle

The Boxia includes breathable perforated material and gel-padded sections around sensitive tendon areas. It is available in X Small through Large and in black or beige.

5. Put on and fasten the shoe

Place the foot fully into the shoe.

Confirm that:

• The heel is secure
• The shoe fits properly
• The laces or fastening can close normally
• The footwear attachment remains centred
• The shoe is not loose or backless

Do not leave the shoe loose to make attaching the Boxia easier.

6. Connect the tension strap

Attach the elastic strap to the footwear hook or compatible attachment.

The strap should run centrally between the cuff and the front of the shoe.

Check that it:

• Is not twisted
• Does not pull strongly to one side
• Does not rub the ankle
• Remains clear of the shoe opening
• Connects securely

7. Adjust the dorsiflexion assistance

Shorten or lengthen the tension strap until it provides useful upward assistance.

The correct tension should:

• Help lift the forefoot
• Improve toe clearance
• Avoid pulling the foot sharply upwards
• Avoid lifting the heel from the shoe
• Avoid making standing unstable
• Allow a controlled foot position when it returns to the ground

Start with moderate assistance rather than maximum tension.

The Boxia product is designed for flaccid foot drop and uses an adjustable elastic strap to provide dorsiflexion assistance during the swing phase of walking. It contains latex.

How To Put On a StepUp® Drop Foot Support

StepUp uses a soft calf band, textile foot component and adjustable lifting straps.

The exact strap pathway should follow the instructions supplied with the product.

1. Open all touch-close fastenings

Lay the support out so you can identify:

• The calf band
• The foot section
• The lifting straps
• The anti-slip areas
• The fastening surfaces

Remove any twists before beginning.

2. Position the calf band

Place the calf component at the intended height on the lower leg.

It should:

• Sit below the knee
• Lie flat
• Remain level
• Avoid the narrowest part of the ankle
• Avoid pressing into the back of the knee

Secure it firmly enough to remain stable without causing painful compression.

3. Position the foot component

Apply the foot section according to the manufacturer’s fitting arrangement.

Check that:

• It is centred
• The fabric is smooth
• The toes are not restricted
• No edge cuts into the side of the foot
• The anti-slip areas contact the intended surface
• The support does not bunch inside the shoe

4. Attach the lifting straps

Follow the correct pathway between the foot and calf sections.

Each strap should:

• Lie flat
• Avoid twisting
• Remain clear of the ankle bones
• Avoid cutting into the skin
• Pull in the intended direction

Where the strapping is used to provide some medio-lateral assistance, the tension may not be identical on both sides.

5. Adjust the tension gradually

Increase the tension until the toes clear more easily during walking.

Do not continue tightening if:

• The foot is pulled inwards
• The foot is pulled outwards
• The heel lifts
• The straps cut into the skin
• The ankle becomes painful
• Balance becomes worse

StepUp is a latex-free textile support designed for flaccid foot drop, with touch-close fastenings, a calf band and adjustable strap tension. It can be used with or without footwear.

Put the Brace On While Seated

Whether using a rigid AFO, Boxia or StepUp, fitting should normally be completed while seated.

This reduces the risk of:

• Losing balance
• Falling
• Placing the heel incorrectly
• Missing a twisted strap
• Pulling the support on unevenly
• Standing on an unsecured footplate

Do not stand until:

• Every fastening is secure
• The footwear is fastened
• Loose straps are contained
• The heel is correctly positioned
• You feel stable enough to rise

Use a walking aid where prescribed.

How Tight Should the Straps Be?

Straps should generally feel snug enough to prevent movement but not painfully tight.

A correctly adjusted strap should not cause:

• Numbness
• Tingling
• Throbbing
• Swelling
• Deep indentation
• Skin discolouration
• A cold foot
• Increasing pain

Do not use simplistic finger-gap rules for every brace. Strap width, material, position and support design all differ.

Judge the fit by:

• Stability
• Skin response
• Comfort
• Walking control
• Whether the brace moves
• Whether circulation or sensation changes

Check That No Strap Is Twisted

A twisted strap creates a narrow pressure area and may also change the direction of support.

Before standing, run your fingers along each strap and check that:

• The full width contacts the body
• Padding is centred
• The strap has not doubled over
• Clothing is not trapped beneath it
• The fastening surface is fully engaged

Do not cover a twisted strap with trousers and hope that it will flatten during walking.

Use Suitable Footwear

A foot drop brace normally works best with secure, supportive footwear.

Look for:

• An enclosed heel
• An enclosed toe
• Laces or touch-close fastening
• Sufficient width
• Sufficient depth
• A stable sole
• A wide-opening tongue
• A removable insole where extra depth is needed

Avoid:

• Backless slippers
• Loose slip-on shoes
• Shallow pumps
• Very high heels
• Unstable soles
• Shoes that cannot fasten around the brace

NHS AFO guidance recommends wide, deep footwear with secure lace or touch-close fastening and advises removing a removable insole where appropriate to create room.

Do Not Assume You Need a Much Longer Shoe

A rigid footplate may require additional width or depth, but automatically buying a much longer shoe can allow the foot to slide forwards.

Instead, look for:

• Your correct foot length
• A wider fitting
• Additional internal depth
• Adjustable fastening
• A removable insole
• A wider shoe opening

Take the brace with you when trying footwear.

Stand Up Carefully

When the support is completely fitted:

1. Place both feet flat where possible.
2. Move towards the edge of the chair.
3. Use the chair arms or prescribed walking aid.
4. Stand slowly.
5. Pause before walking.
6. Check your balance.
7. Confirm that the brace remains secure.

Do not immediately walk across a busy or uneven area.

Test the Brace Over a Short Distance

Begin on a familiar, level surface.

Walk several steps and check:

• Are the toes clearing more easily?
• Is the heel staying inside the shoe?
• Is the brace rotating?
• Are the straps remaining flat?
• Is the foot being pulled to one side?
• Does the knee feel stable?
• Is the shoe fastening secure?
• Is there any new pain?
• Is your balance improved or worsened?

Stop and sit down before making adjustments.

Do not bend down or balance on one leg to alter the brace while standing.

Recheck the Brace After Several Minutes

Straps and footwear may settle after you begin walking.

Recheck:

• Cuff position
• Calf strap tension
• Heel position
• Footwear fastening
• Elastic strap tension
• Side-to-side alignment
• Sock wrinkles
• Any rubbing or pressure

A correctly fitted device should not need constant adjustment.

Check the Skin After Removal

Inspect every area touched by the support.

Common areas include:

• Ankle bones
• Heel
• Achilles area
• Calf
• Front of the ankle
• Top of the foot
• Sides of the foot
• Toes
• Areas beneath straps

Mild temporary redness can occur with a close-fitting AFO, but it should fade after removal.

Stop using the brace and seek fitting advice if you notice:

• Redness that does not fade
• Blisters
• Broken skin
• Increasing tenderness
• Swelling
• Numbness
• Changes in colour
• Unusual warmth or coldness

Different NHS orthotics services commonly advise review when redness remains for approximately 20 to 30 minutes after the device is removed.

Take Extra Care if You Have Reduced Sensation

People with neuropathy or reduced sensation may not feel developing pressure or rubbing.

Use:

• A mirror
• Good lighting
• Regular skin inspections
• Help from another person where necessary
• Shorter initial wear periods
• Professional reviews

Do not rely on pain as the only warning sign.

How To Remove the Brace Safely

Sit before removing the brace.

Removing a rigid AFO

1. Loosen the footwear fully.
2. Release the calf strap.
3. Release the heel or ankle strap.
4. Slide the foot and brace out without forcing them.
5. Remove the sock.
6. Inspect the skin.

Removing Boxia

1. Sit down.
2. Disconnect the tension strap from the shoe.
3. Release the ankle cuff.
4. Remove the cuff without dragging it over the skin.
5. Inspect the ankle and tendon areas.

Removing StepUp

1. Sit down.
2. Release the lifting straps.
3. Open the calf band.
4. Remove the foot component.
5. Inspect all strap contact areas.

Do not pull a device off by one strap.

Common Fitting Mistakes

The heel is not fully seated

This may cause rubbing, toe crowding and poor control.

The straps are twisted

This concentrates pressure and may alter support.

The brace is fitted over a wrinkled sock

Sock folds can create painful pressure points.

The wrong left or right AFO is used

This can distort alignment and place pressure over the ankle bones.

The footwear is too loose

The foot and brace may move independently.

The footwear is too tight

The shoe may compress the foot or distort the AFO.

Textile lifting straps are overtightened

This can lift the heel, pull the foot sideways or make walking less stable.

A brace is put on while standing

This increases the risk of poor positioning and falls.

The user walks before checking every fastening

Loose components can catch or move unexpectedly.

Outer clothing is allowed to move the brace

Tight trouser legs may pull down a cuff or catch a strap.

What if You Cannot Put the Brace On Independently?

Difficulty fitting the support does not necessarily mean that you have chosen the wrong clinical category, but it may mean the design is impractical for you.

Consider:

• Whether you can reach the foot
• Whether you can bend safely
• Hand strength
• Finger dexterity
• One-sided weakness
• Vision
• Balance
• Memory and sequencing
• Whether a carer is available

The Boxia® Plus, SKU AB100, is a separate Boxia design intended to support easier one-handed fitting. It may be worth considering where standard Boxia fastenings are difficult because of weakness affecting one arm or hand.

An occupational therapist or orthotist may also suggest fitting aids, footwear changes or a more manageable brace design.

Do Not Alter the Brace Yourself

Do not:

• Cut rigid plastic
• File an edge
• Heat the brace
• Drill new holes
• Shorten straps with pins
• Glue cracked sections
• Replace parts with ordinary elastic
• Trim StepUp components unless the product instructions specifically identify them as trimmable
• Modify Boxia hooks or straps

NHS guidance advises users not to cut, file, adjust or repair an AFO themselves.

Contact the supplier, orthotist or manufacturer where a component needs replacing or modification.

Simple Rigid AFO Fitting Checklist

Before walking, confirm that:

• You have the correct side
• The sock is smooth
• The heel is fully back and down
• The ankle strap is centred
• The calf strap is flat
• Additional straps are secure
• The footplate lies flat
• The shoe is wide and deep enough
• The shoe fastening is secure
• The toes have room
• There is no pain or numbness
• The brace is not cracked

Simple Boxia Fitting Checklist

Before walking, confirm that:

• The cuff is the correct size
• The cuff is level
• Padding lies flat
• The shoe attachment is centred
• The shoe is securely fastened
• The tension strap is connected
• The strap is not twisted
• The tension improves toe clearance
• The heel remains inside the shoe
• The foot is not pulled sideways
• Latex is suitable for you

Simple StepUp Fitting Checklist

Before walking, confirm that:

• The calf band lies flat
• The foot component is centred
• Every strap follows its intended pathway
• No strap is twisted
• The tension feels balanced
• The toes clear more easily
• The foot remains stable
• The support does not cause pressure
• Footwear remains secure where used
• The skin is comfortable

Recommended Textile Foot Drop Support

The Boxia® Drop Foot AFO, SKU BOX / BBOX, is designed to assist toe clearance in people with flaccid foot drop.

Its features include:

• An adjustable elastic tension strap
• A supportive cuff above the ankle
• Breathable perforated material
• Gel-padded tendon areas
• No full rigid in-shoe footplate
• Black and beige options
• X Small through Large sizing
• Left- or right-side configuration
• Compatibility with a separate shoeless attachment

The product contains latex and should not be used where latex exposure must be avoided without appropriate professional advice.

Can a Foot Drop Brace Cure Foot Drop?

No.

A brace helps position or lift the foot while it is being worn. It does not repair the nerve, muscle, brain or spinal condition causing the weakness.

Treatment may also involve:

• Physiotherapy
• Treatment of nerve compression
• Functional electrical stimulation
• Management of an underlying neurological condition
• Surgery in selected cases
• Falls assessment
• Walking aids
• Footwear changes

When Should Foot Drop Be Assessed?

See a GP if you are finding it difficult to lift the front of your foot or toes.

Obtain further advice if:

• The weakness is new
• It is worsening
• Both feet are affected
• You have increasing numbness
• You are falling
• The brace no longer controls the foot
• Other parts of the leg are becoming weak
• Symptoms followed surgery or injury

Call 999 for sudden weakness with possible stroke symptoms such as facial drooping, arm weakness or speech difficulty.

Seek urgent medical assessment when back or leg symptoms occur with new numbness around the genitals or buttocks, or changes in bladder or bowel control.