Podcast Summary: The MSing Link – Episode 273 Ankle Braces vs AFOs for MS: What’s the Difference? Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Date: February 25, 2026

Episode Overview

In Episode 273, Dr. Gretchen Hawley tackles the frequently asked—and often misunderstood—topic of ankle braces and AFOs (Ankle Foot Orthoses) for people with Multiple Sclerosis (MS), with a special focus on managing foot drop. Sparked by a recent surge of marketing claims, Dr. Gretchen passionately clarifies the differences, appropriate uses, and potential misconceptions about these assistive devices. The episode empowers MS listeners with practical advice on device selection, use, and exercises to maintain mobility and strength.

Key Discussion Points & Insights

1. Defining AFOs and Ankle Braces

(02:35–14:55)

• AFO = Ankle Foot Orthosis: A specific orthotic device worn on the lower leg and foot, typically used to reduce foot drop by limiting ankle movement, not by providing active support.
• Dr. Gretchen explains:
  • Materials: Historically plastic, now more commonly lightweight carbon fiber; sometimes leather or metal (older designs).
  • Customization: "Most [AFOs] are custom molded to your leg…custom fitted to that mold." (03:45)
  • Purpose: "These specific braces reduce foot drop by limiting the amount of movement in your ankle, which is very different from…other ankle braces." (04:16)

2. Why People Use AFOs:

• For MS-related foot drop—when toes drag or scuff the ground, leading to falls, fatigue, and loss of mobility.
• "By using an AFO, it can make walking safer, it can prevent tripping and falls, it can help you maintain your ability to walk…but independence…" (07:21)

3. Custom vs. Off-the-Shelf Devices

• Custom AFOs: Molded by an orthotist/preferred for tailored support.
• Off-the-Shelf AFOs: Ready-made, more accessible and affordable, but not customized.
  • Popular brands: Saebo Step, Ottoboc Walk On, Allard ToeOFF, TurboMed Xtern, Össur AFOs.
  • "[Off-the-shelf AFOs] tend to be pretty popular…I do personally think that professional fitting is ideal…" (09:40)

4. Types of AFOs

• Rigid AFOs: Immobilize ankle completely; best for zero ankle strength.
• Hinged AFOs: Allow limited movement; level of support varies.
• Positioning (front, back, or side of leg) can address issues like knee buckling or hyperextension.

5. AFO Alternatives: Ankle Braces (Assist Devices)

(17:15–21:50)

• Key Difference: "AFOs prevent foot drop by stopping ankle movement; ankle braces assist with lifting your ankle."
• Common devices: Dictus band, Elevate360 Drop Foot Brace, Saebo Foot Drop Band, Foot Up brace, Dosh, etc.
  • "With these ones, you are getting assistance to lift…so you need some strength still in your ankle…" (20:30)
• Best for: Mild–moderate foot drop; less expensive and easier to start.
• Dr. Gretchen’s clinical preference is to use assistive ankle braces when some movement remains.

6. Debunking Marketing Claims

(22:00–25:35)

• Dr. Gretchen addresses misleading claims that AFOs "increase ankle strength." She is “feeling a little spicy” about these advertisements.
  • "That statement is just not true…none of them are designed to increase your ankle strength." (23:31)
• Wearing an AFO does not build muscle strength. In fact, continuous use can cause weakness due to disuse.
  • "If you're wearing it all the time, those muscles are now no longer working, and they can get weaker." (24:41)

7. When and How to Wear Your AFO or Ankle Brace

(26:17–29:55)

• Golden Rule: "Wear your AFO or your ankle brace as often as you personally need to remain safe, but not any more than that." (26:33)
• Overuse leads to more weakness and compensations (e.g., hip or knee issues).
• Flexibility: Some days/situations don’t require use—adjust accordingly for safety and muscle preservation.
• Memorable example: "I've worked with people who…after using their AFO less and exercising, were able to use it much less, or even not at all." (28:56)

8. Exercising with (or without) AFOs/Braces

(30:00–33:14)

• Best to exercise without the device if safe, to engage and strengthen muscles/neural pathways.
• Two options:
  • Use device when unstable/unsafe.
  • Exercise without device (preferred), perhaps with supports (seated, using aids), progressing as strength/balance allows.
• Regular targeted ankle exercises can reduce dependence on devices ("combination approach").
  • "AFOs don’t build strength… exercises do." (32:46)

9. Essential Exercises for Foot Drop

(32:50–34:30)

• Ankle dorsiflexion/toe lifts
• Marching (hip flexor strengthening)
• Hamstring curls
• Single-leg balance
• These exercises target muscles key to reducing foot drop and improving walking safety.

Notable Quotes & Memorable Moments

• On misleading marketing:

  • “This claim that AFOs can increase your ankle strength just by wearing it is very misleading.” (24:12)

• On device use frequency:

  • "Use it as often as you need to remain safe, but not any more than that." (26:33)

• On safety:

  • “Safety is the number one thing. If…you think, ‘if I don’t wear it, I’m falling,’ then this advice is not for you.” (29:13)

• On potential for improvement:

  • "Some people…can reduce their AFO use or ankle brace use, or eliminate it entirely." (33:12)

Frequently Asked Questions (Q&A Segment)

(34:45–40:45)

• How do I know if I need an AFO?

  • Signs: frequent tripping, foot slapping, toe drag/scuff marks or holes in shoes.
  • Tip: Check your shoe soles for unusual wear.
  • Dr. Gretchen advises trying ankle braces first if some strength remains.

• Will using an AFO make me weaker?

  • Only if overused. Strategic use (as little as needed for safety) can maintain strength.

• Can exercise help me avoid needing an AFO?

  • Yes, if you have some ankle strength. Preventative and maintenance exercises can help.

• What if I’ve been wearing my AFO all day, every day for years—is that bad?

  • Not too late to change. Start weaning off (in safe contexts), begin with seated ankle exercises and assess gradually.

Practical Takeaways & Recommendations

• Custom vs Off-the-Shelf: Get a professional fitting if you can (via orthotist/clinic/PT); if not, research reputable off-the-shelf options.
• Device Selection: Choose based on your specific symptoms, movement needs, and strength.
• Be Cautious with Marketing Claims: No device builds muscle; only exercise can.
• Optimize Usage: Use braces/AFOs for safety, NOT convenience—remove when safe/possible.
• Exercise, Exercise, Exercise: Incorporate targeted ankle and balance exercises to maintain/improve strength and possibly reduce device dependence.
• Consult Professionals: Always work with an orthotist or specialty PT to determine what’s best for your unique case.

Important Timestamps

• 02:35 – What is an AFO? Materials and fitting explained.
• 07:21 – Foot drop and indications for AFO use.
• 09:40 – Custom vs. off-the-shelf AFO options.
• 17:15 – Ankle braces as AFO alternatives explained.
• 22:00 – Debunking strength-building claims.
• 26:17 – Optimal device usage: when, how often, and why.
• 28:56 – Example: reducing dependence on AFO through exercise.
• 30:00 – To exercise with or without an assistive device?
• 32:50 – Key exercises for foot drop.
• 34:45 – Q&A: deciding on, using, and transitioning off AFOs.

Final Advice

“Don’t fall for those marketing claims that [an AFO] builds strength…[they] are tools for safety and function, but not strength builders. We can use them strategically along with exercises to maintain and build strength.” (40:35)

If you’re experiencing MS-related foot drop, start with ankle-strengthening exercises, consult a PT or orthotist, and use assistive devices wisely for optimal safety and long-term mobility.

For more resources, exercise demonstrations, and Dr. Gretchen’s book (“The Missing Link”), see the show notes for links and detailed support.