Ankle Bracing in ALS A common symptom in people with ALS is weakness of the ankle muscles resulting in floppy movements most commonly referred to as “foot drop.” Foot drop is when the muscles of the front of the lower leg are no longer able to lift the forefoot up while walking. Signs that may indicate ankle weakness are frequent tripping or “catching your toes” while walking, particularly on uneven or carpeted surfaces, having to spend more energy and attention to “get the foot to cooperate” and possibly a slapping noise when you walk. With foot drop you may also experience low back or hip pain as a result of compensating or altering your walking pattern to accommodate the muscle weakness. Not only is this uncomfortable, it can make walking more effortful. This results in fatigue, which may decrease the amount of walking you, can do each day or even cause a fall. Clearly foot drop is a symptom that necessitates immediate evaluation. It is important to be evaluated by your doctor and physical therapist if any of these signs or symptoms occurs. If present you will have your strength tested and your walking (gait) evaluated to determine if an ankle foot orthosis (AFO) is necessary. An AFO can provide support to your ankle and assist in lifting your foot while you walk. It can help you resume your usual walking pattern and reduce your risk for falls. Additionally, it helps make walking less effortful and allows you to walk for longer periods of time and possibly longer distances with less fatigue. Once it is determined that an AFO would be of help, an orhtotist may become involved. Orthotists are brace specialist; the professionals who know the latest styles and materials that are used. They work in free standing or hospital based Prosthetic and Orthotic Clinics. The orthotist is responsible for measuring the client for the orthosis and ensuring its proper fit once it is made. Choices of AFO's: There are both stock (typically called a PLS) and custom-made orthoses. They are both made of lightweight plastic that has a footplate, which goes into your shoes, which extends to the ball of your foot. There is a thin portion that goes up the back of your lower leg ending just below your knee. A custom-made AFO is necessary when the muscles on the sides of your ankles are weak because more support is needed to prevent “rolling over” or twisting your ankle. Sometimes a custom-made AFO can also address knee or calf weakness or include a full foot-plate to support the entire foot. In order to fabricate a custom AFO the orthotist will take a plaster cast or mold of your leg. After the AFO is fitted, the orthotist or physical therapist should instruct on the following: •  Checking the skin for pressure areas •  How to apply and remove the orthosis easily •  The best type of shoe to use with an orthosis •  A wearing schedule; i.e., how often to wear the orthosis on the first day, the second day, etc. For further information, kindly contact Jackie Montes, PT, (212) 305-3632.