What You Really Need to Know About AFOs After Stroke: Insights from Dr. Jennifaye V. Brown
An AFO can be a game-changer in stroke recovery or a major obstacle. In this powerful interview, Dr. Jennifaye V. Brown, a physical therapist, researcher, and author of Brace Yourself, breaks down everything stroke survivors and caregivers need to know about AFOs, ankle foot orthoses, and why the standard approach often fails.
🎧 If you’ve ever wondered what AFO stands for in medical terms or felt like your brace just doesn’t work for you, this episode is essential listening.
🦶 What Is an AFO?
An AFO, or Ankle Foot Orthosis, is a brace that supports the lower leg and foot, often used after a stroke to treat foot drop, instability, or weakness. While you may hear it described in clinical settings, many stroke survivors find themselves asking:
What are AFO braces?
What are AFO braces used for?
What is ankle foot orthosis, really, and why does mine feel wrong?
Dr. Jennifaye V. Brown’s answer is both simple and radical:
An AFO should work for you, not force you to change your lifestyle, shoes, or goals.
⚙️ What Are AFO Braces Used For?
AFOs are primarily used to:
- Support weak or paralyzed foot and ankle muscles
- Prevent tripping or dragging caused by foot drop
- Improve gait and walking stability
- Enable stroke survivors to walk safely and build endurance
But too often, they’re prescribed using a one-size-fits-all model that ignores comfort, clothing choices, and recovery potential.
👣 Why Most AFOs Are Failing Stroke Survivors
In her clinical and research work, Dr. Brown noticed a disturbing pattern. Many stroke survivors weren’t wearing their braces consistently, not because they didn’t need them, but because:
- The AFO didn’t fit into their existing shoes
- It looked bulky or unattractive
- It made walking uncomfortable or caused back pain
- It didn’t allow their knee to move naturally
- It actually prevented functional recovery
If your ankle foot orthosis is holding you back instead of helping you walk better, it might not be your fault. It might be the brace.
🧠 The Smarter Way to Approach AFOs
Dr. Brown’s approach is deeply personalized and functional. She considers:
- The lesion location and severity of the stroke
- Shoe preferences, lifestyle, and cultural norms
- Gait mechanics and muscle strength
- Whether the goal is short-term support or long-term weaning off the device
She even designs AFOs to match skin tone and fit into preferred footwear from sandals to golf shoes to formal dress shoes, because comfort and dignity matter.
💡 What to Ask Before Getting an AFO
If you’re wondering what ankle foot orthosis is going to do for your recovery, Dr. Brown encourages you to ask:
- Where was my stroke? (Cortical vs. brainstem makes a difference.
- What specific muscles are weak or spastic?
- Will this AFO let me practice functional walking, or will it limit movement?
- Can it fit into my everyday shoes, or will I need to buy a new pair?
- What’s the plan to reduce my dependency on the brace over time?
You have the right to ask these questions. And you don’t need a medical degree — just the right information.
💰 Ankle Foot Orthosis Price: What You’re Really Paying For
The price of an ankle foot orthosis can vary from $300 to over $1,000, depending on whether it’s custom-molded, adjustable, or off-the-shelf. But the real cost isn’t just financial.
If you’re using the wrong AFO, the price may include:
- Slower recovery
- Unnecessary pain or falls
- Missed opportunities to regain muscle function
- Reduced independence
Dr. Brown’s philosophy is: If you’re going to wear a brace, make sure it supports both your function and your freedom.
📘 About
Brace Yourself by Dr. Jennifaye V. Brown
Dr. Brown’s book, Brace Yourself: Everything You Need to Know About AFOs After Stroke, is a practical guide designed for:
- Stroke survivors and caregivers
- Physical therapists and orthotists
- Anyone tired of one-size-fits-all solutions
It includes:
- Visuals showing custom brace designs
- Questions to ask your healthcare provider
- Functional exercise ideas
- Real-world tips for comfort, recovery, and confidence
This isn’t a technical manual; it’s a recovery companion.
💬 Final Thought: Don’t Just Accept the Brace. Make It Yours.
An AFO should help you walk with more confidence, not less. If it doesn’t feel right, it probably isn’t. And as Dr. Jennifaye V. Brown makes clear, it’s never too late to ask for something better, something that fits your foot, your life, and your goals.
The AFO You Deserve: How to Reclaim Your Walk and Your Worth After Stroke
Most AFOs don’t fit your life or your recovery. Here’s how to take back control, walk stronger, and feel seen again in your healing journey.
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Highlights:
00:00 Introduction
02:46 Dr. Brown’s Personal Experience and Book Introduction
06:05 Challenges of Standard AFOs
12:11 Dr. Brown’s Career Path and Educational Background
15:00 The Importance of Customized AFOs
19:27 Common Issues with Standard AFOs
27:00 How AFOs Affect Balance and Movement Strategies
39:33 The Role of Physical Therapists and Orthotists
40:11 Empowering Stroke Survivors with Information
46:55 Conclusion and Call to Action
Transcript:
Introduction – Dr. Jennifaye Brown
Bill Gasiamis 0:00
Before we get into today’s episode, I just want to say thank you. Whether you’ve shared this podcast with someone who needed it, left a comment, supported the show on Patreon, hit that super thanks button, or simply listened quietly from your hospital bed. This community exists because of you. You helped stroke survivors feel seen. You helped this message reach someone at a turning point, someone who might be wondering if recovery is still possible, and today’s conversation is for exactly that moment, because this episode isn’t just about braces.
Bill Gasiamis 0:34
It is about reclaiming movement, identity and dignity. My guest is Dr. Jennifaye V. Brown, a physical therapist and author of Brace yourself, a guide for stroke survivors, navigating the often overlooked world of AFOs or ankle foot orthosis. She spent her career asking a powerful question, what if your brace could fit your life, not the other way around.
Bill Gasiamis 1:03
In this conversation, we explore how the right AFO designed with your needs, your goals and your lifestyle in mind, can support real recovery, not just walking, but walking towards something that matters. If you’ve ever felt like your AFO was holding you back, or like no one asked you what you wanted from your recovery. This episode is for you. Let’s dive in. Jennifaye V. Brown, welcome to the podcast.
Dr. Jennifaye Brown 1:32
Thank you.
Bill Gasiamis 1:36
Sometimes people try to reach me through the various ways that they can these days, LinkedIn, messenger, YouTube, Instagram messenger, Facebook Messenger, and, and I’m not on top of all of the messengers and all the way that people can reach out and you contacted me quite a while ago, and shock horror, I was going through all of my messages because sometimes I do the whole let me check and see if there’s any old messages to any of my inboxes to see in case I’ve missed anyone and I haven’t responded, and I don’t want to be rude.
Bill Gasiamis 2:18
And I noticed that I had missed your email and hadn’t got back to you about joining me on the podcast, and I think it was over a year ago or something.
Dr. Jennifaye Brown 2:27
Yes.
Bill Gasiamis 2:28
So I’m so glad that you’re here and that we finally managed to make it happen.
Dr. Jennifaye Brown 2:34
Thank you so much for this opportunity. I’ve learned that persistence is the name of the game in all things that we do, we don’t have to be perfect. We just need to keep trying.
Dr. Brown’s Personal Experience and Book Introduction
Bill Gasiamis 2:46
Yeah, I love it. That’s a going to be something we should discuss during the interview as well. For certain now, you’re the author of a book, and we’ll talk about that as well in the interview, but for the people watching and listening, can you put the book up into the screen just for a moment, just so we can talk about it. It is called brace yourself. Tell us a little bit about the book, what it’s about, and then we’ll refer back to it as we have the conversation.
Dr. Jennifaye Brown 3:18
So I have abnormally large feet that are narrow, and I’ve always had a problem finding shoes, and then I become a physical therapist, and person has a stroke, and they have foot drop, and now they have to get a brace, and the braces often made such that it requires a larger shoe in length and in width. Then now person has to buy two pair of shoes because the shoe for the other fit is too big, and they always recommended the sneaker.
Dr. Jennifaye Brown 3:58
And I’m from the south, and women don’t wear sneakers everywhere they go, and they don’t wear them to church. And I was really challenged when I had an Atlanta socialite and she told me, I don’t own sneakers, I don’t play tennis. I think the term she used, I do alter means that she goes to watch the match, she goes dressed up. And it really challenged me to look at people individually and make a brace that suits their personality so that they will engage in functional activities and walk for exercise.
Dr. Jennifaye Brown 4:43
The best thing post stroke a person can do, because if you want to get better in walking, you have to practice the task of walking. So if you have a foot drop, you need a brace to hold your foot up so that you can walk better and that. Race should represent you in terms of the color of your skin, fit in the shoes that you want to wear, go with the clothes that you want to wear, etc. And I started looking at my research and asking people, why aren’t you wearing your brace? You come into therapy and I need it doesn’t fit in the shoe that I want to wear. It’s uncomfortable.
Dr. Jennifaye Brown 5:23
It prevents me from doing X, Y and Z. So I did some research, and I put it all together, and then that research became the impetus for this book. And so the brace itself is not always at fault. I think we need to look at the physical therapist, the orthotist, and the person with stroke or the stroke survivor. It takes a team, and communication is the key. And so that’s how the book came about.
Bill Gasiamis 5:55
Well, that is an amazing introduction. So let’s go back a little bit. You started by saying, abnormally large and narrow fit. What size?
Challenges of a Standard AFO
Dr. Jennifaye Brown 6:05
Well, we’re a size 12 quad A so my heel is very thin and my forefoot is thin, but it it opens up. And so I it’s a hard time for me finding shoes now. So some of my shoes in Charleston, there’s this famous store called Bob Ellis, and they’ve closed. And before them, I used to go to Cass’s brothers because they had the kids type shoes, but they didn’t have the dressy, fancy shoes. So until about five years ago, I could get Salvador fairgamos.
Dr. Jennifaye Brown 6:44
I could get, oh, I can’t the says, I think I have a pair Jimmy choose. I could get all these brand name shoes in my size. And it’s getting harder and harder to find shoes in my size, so I’ve been taking my shoes now from 20 years ago to a man named Mr. Peter here in Charleston. He’s reselling them and doing everything for me.
Bill Gasiamis 7:10
Excellent. So what was it like growing up then and being in a situation where your foot is a little bit different, and I imagine kids shoes are not that easy to to sort of service to support somebody like you that’s got a different foot, right?
Dr. Jennifaye Brown 7:30
So I went to Cass’s brothers, and he was a petios, so I had a long, narrow and flat foot. So I remember wearing these brown shoes that had a weighted heel, and I didn’t understand why it had the weighted heel. And I remember always scratching the opposite foot at the medial malleoli, and that’s the inside of your ankle. And then after that, I just remember in about the fifth grade, going to Bob Billis because I had an abnormally large foot to get some sandals.
Dr. Jennifaye Brown 8:09
So that’s when I started this empathy thing, when I went to college and I placed a sorority and we all had to wear the same shoe. So imagine my line sisters. There were eight of us. I they had to get what could fit me, basically. And I just remember us being in, you know, kids, back in the day, we got green pears because that was the name that was the color for our sorority. So kids and that was the color of our sorority.
Dr. Jennifaye Brown 8:43
So the first thing, if I had that much difficulty, imagine with what my patient or client would have, number one, affordability is the key. Now that’s the main issue. So my thing is, why can’t we make a brace to fit in the shoe that they already wear, and the shoe gives us a hint of their walking pattern. If you take the inner sole out, I see all the weight bearings of the foot. So now the bottom of the AFO should replicate what the looks like, and then I can look at the outside of the sole of the shoe and see if the heel is worn on the outside or the inside.
Dr. Jennifaye Brown 9:28
And that tells me if they’re a supinator with the high arch or pronator with the low arch. You don’t want to change the dynamic of their foot, but you want to change the propensity of them to use what they have and supplement what they don’t have in order to propel the body forward. So then my AFOs had to be made narrower.
Bill Gasiamis 9:56
So did you have to wear AFOs as a result of. Your feet?
Dr. Jennifaye Brown 10:01
No, I just had to get orthotics, and I have some in my shoes now, at about $300.
Bill Gasiamis 10:08
A pop for the pair of orthotics on top of the cost of the shoes.
Dr. Jennifaye Brown 10:14
Yes, $300 plus. And then we take some of the liner out, and then my petty orthotist put some stuff in. And this is why I think I spend so much time and attention to the ankle, foot orthoses, the AFOs for my clients. And if you look in the book, like maybe in the 50s, the late 50s, I have maybe a dozen pictures or so of every custom AFO that I’ve done the prototype for, and then the orphan is finishes up with the nice plastic, and we collaborate on that everyone is different.
Dr. Jennifaye Brown 10:51
I’m not the girl. You don’t come to me to get a small, medium and large from Amazon or off the shelf. You come to me to get the AFO to fit in your shoe that you want to walk down the aisle when you’re getting married, or if you’re going to play nine holes of golf, or if you want it to fit in your boot for duck hunting.
Bill Gasiamis 11:10
Let’s pause for a few moments. You’ve just heard Dr Brown describe what happens when a brace is designed without taking the whole person into account, your strength, your gait, your shoes, your style, your soul. And if you’re sitting there thinking, that’s why I stopped wearing mine, I want you to know you’re not the problem the system might be. You deserve a recovery that fits your body and your life. If you’ve ever felt like your brace wasn’t made for you, drop a comment on YouTube and tell me what’s been the hardest part about using an AFO after stroke also.
Bill Gasiamis 11:45
Thank you to everyone who keeps this show going, those of you supporting on Patreon, those of you reading and sharing the book, and those of you who’ve hit the super thanks button on YouTube. All right, back to Dr. Brown as we dive into the hidden emotional toll of wearing the wrong brace and how the right one can change everything. Okay, so let’s continue to go back a little bit.
Dr. Brown’s Career Path and Educational Background
Bill Gasiamis 12:11
How did you get into the field, the career that you found yourself in? Was it out of the frustration of what you had to deal with, with the challenges regarding your feet, was it just one of those things that happened, because it seems like you had a problem, and then you focused on it a lot, and then you came up with a solution. You thought, let me get educated in this space, and then, therefore, let me offer the problem solutions to people. It seems like a beautiful, seamless path towards where you are now. So tell me about your background, educationally, and your schooling.
Dr. Jennifaye Brown 12:50
We’ll start off at college. Bill. I got a full scholarship to go to Georgetown University with the I think, biology, because I was going to be a pediatric surgeon, I was going to be a doctor, and my Daddy took me up to visit, and I told daddy, it looked like Gotham City from Batman, and it really did. It really did. Now I’m a Southern Bell, so I made him pay, and I went to Emory in Atlanta, and then I took all the pre med courses, and I wasn’t really good at them, strong at them, but I was much better in the life sciences, anatomy, kinesiology, social psychology. I was really good with those.
Dr. Jennifaye Brown 13:32
So by the end of the spring of my freshman year, I knew I wasn’t going into medicine, and I went to the Allied Health Fair and physical therapy was at the table, so I talked with the person, and she said, why don’t you come to the hospital and volunteered? I started volunteering, I would say, in March of that year, and volunteered until I graduated. I got into physical therapy school. Duke was my number one choice. I didn’t get in. I got into the University of Miami, and we started school before my graduation from Emory.
Dr. Jennifaye Brown 14:12
So I went on to Miami and came back and graduated, and I did really well at the University of Miami. My GPA was higher there than it was in undergrad, and we learned a lot of great skills. Most of my professors were board certified in something, and that challenged me to become board certified, and it also challenged me to get a PhD, which I did later on in life. So when I looked at my faculty, they were board certified and had a PhD. So they research things, the only difference, I would say, between me and most of my PhD classmates from that class of 1990 My research is in quality.
The Importance of Customized AFOs
Dr. Jennifaye Brown 15:00
TATIVE methodology. I want to know what the people say and what the people think. The statistical key value doesn’t mean that much to me, and I am everybody wants to be able to walk again and know if their strength is going to come back. Well, the AFO does two things. It helps your walking come back, but the way it’s made it, it decreases the chance of your strength coming back, if it has the potential to come back. So that’s when I knew I had to start making my braces differently.
Bill Gasiamis 15:38
So there’s a potential for the AFOs to what do they do? Because I haven’t had one, and I know some people who have them, and most people that I know who have them will have some complaint about it, the way that it feels, the way that it fits, and sometimes even people are concerned that it’s going to change their posture, or that’s going to change their gait. And sometimes they’re also concerned that as a result of the AFO, they have some issues, you know, in other parts of the spine, on the back, etc, because of the way that it fits and feels, etc.
Bill Gasiamis 16:14
So what are some of the things that you’ve found that, and before we get to that, actually, is it generally a standard AFO that everyone gets when they go to a hospital and they have foot drop after stroke. How do they actually get assessed for an AFO?
Dr. Jennifaye Brown 16:36
Funny, you should say that the normative model, the normative model is that, oh, the orthotist is coming to cast you for an AFO. And I was like, No, the orthotist needs to get data about the person’s strength, range of motion, sensation, tone, spasticity, the ability to generate force to stand and to walk. That’s a whole lot of data that we should be giving the orthotist and discussing.
Dr. Jennifaye Brown 17:09
It depends on where the lesion location is, how large it is, and the time without oxygen, for the severity of the what we call the cortical spinal tract, particularly the lateral cortical spinal tract, because it goes to the leg and the foot. And so you have to take all of that into consideration. The AFO that I make for a mother postpartum who’s had a stroke.
Dr. Jennifaye Brown 17:40
Maybe up in the cortex, where fewer of the motor neurons are damaged is very different than the AFO that I’m going to make for someone in the in the subcortical region, or down towards the brainstem, where all the nerves are bundled together and they get input from other tracks, and so I have to look at where the lesion is, how large it is, and the extent of which it’s damaged. Because if it was just a little bit of damage, I can depend on motor neurons surrounding the damaged area to take over for those damaged neurons.
Dr. Jennifaye Brown 18:23
But I have to feed into that, and we don’t feed into that. So that’s the first thing you have to do. You have to know lesion location, the severity and how large it is. The second thing is that we as physical therapists, we need to do a thorough examination, and the critical part that we’re missing in this, in the examination, I’ve already mentioned about five or six things we don’t talk to the patient. What is it that you like to do? Did you exercise beforehand? Were you what physical activity that you engaged in what do you do for fun? What do you wear on a normal basis?
Dr. Jennifaye Brown 19:07
Everybody in Charleston wants to wear a sandal so that they can go to the beach. So I gotta make a different AFO for that. And if it’s a lady, I had a secretary, she says, I wear skirts all the time. I don’t want that. I can’t I’m not going to that’s not going to look good with the skirt going to work.
Common Issues with Standard AFOs
Dr. Jennifaye Brown 19:27
And this is another thing I have to pay attention to people, because there’s this appearance on the outside that they find more valuable. But I have to tell them you are who you are from the inside, and I need that to shine through. And that’s a hard concept for people to gather because first of all, they’ve already had a stroke. Now they look funny. I’m hobbling on one side. I can’t lift my arm up. I got a jewel on my face. And then. Now you gonna make me wear this brace that doesn’t look good with the skirt or dress on?
Dr. Jennifaye Brown 20:04
The men really didn’t have any problems. You know why? You don’t have to see it in some pants when you wear long pants, but when it’s shorts, the men really didn’t have an issue, compared to the ladies, and they’re used to wearing sneakers or men’s shoe that either had some, you know, ties, and it’s easier for the ties in the men’s shoe to change than the intricacies of a woman’s shoe that usually doesn’t have any ties or anything like that, you know, you wear espadrilles shoe or something like that, or a sandal sling back, or something like that.
Dr. Jennifaye Brown 20:43
So again, lesion, location, severity and size, the actual examination. And then let’s turn to the patient themselves. Okay, there may be things, tone, specificity, issues like that. And the reason why they don’t wear the brace because, number one, the way the brace is made, it doesn’t fit like a glove. When I do my braces, I want them to fit like a glove. Number two, the brace does stop them from doing certain movements. The most important when you go from sit to stand, your knee moves forward. The traditional brace has a velcro strap that’s rigid.
Dr. Jennifaye Brown 21:29
It goes through a metal piece, a loop through a metal piece, and then it comes back and stick to the loop. If you stop forward progression from sit to stand, you stop forward progression, and walking that brace that has the strap at the calf is the number one culprit. The second strap are the two straps across the ankle to keep the heel seated in the brace. If you have a strap that keeps the heel seated in the brace. There’s a problem when the measurements were made, they weren’t made adequately to adjust for ankle range of motion in different positions.
Dr. Jennifaye Brown 22:12
Under different contexts, different positions, supine, laying down, sitting and standing. I take measurements for my ankles in all three positions in school, I was taught to do it laying down when I went to my continuing education courses, most of which were orphans, because I like to work in a team. We started the sitting with the knee bent and the knee straight. Never was I taught in an advanced class to take the measurement of the ankle in standing, and that’s so important. So there after those two straps cause two different things.
Dr. Jennifaye Brown 22:57
If your knee can’t bend and you’re trying to walk, you have to hike your hip. In the hiking of the hip causes low back pain. So I had people coming to me, Oh, I heard you. The Walking spread. They come the gate specialist, you’re the one. I have this back pain. Can you help me? I said, we need to start at the toes and move on up. What does your brace look like? So when the brace is stick like this at the bottom, your foot’s not like this. Your foot is like this. It’s rounded and have arches. There are three of them.
Dr. Jennifaye Brown 23:30
So the bottom of the foot should look like the weight bearing sole of your shoe. And if you want to walk, you have to roll over your toes. So the portion of the AFO needs to be nice and flexible. If not just take it off. You don’t need it. I believe in an ankle where your ankle, the leg part, the tibia part, can move forward, but you don’t have the rubbing of your what we call the male eyes, so your your outside ankle and your inside the little bones that stick out, and all you have to do is flush that out, shave it off, or put something there to prevent the rubbing, if it’s not needed, remove it.
Dr. Jennifaye Brown 24:18
And what allows the tibia to move forward and backwards. I use spandex strap, and the spandex strap tension depends on how strong or how weak the person is. In PT school, we learn to measure people from zero to five. You raise this segment up, hold it there. Don’t let me push on you, but muscles are strong three ways, concentric on the shortening part, isometric on the holding part, and then eccentric on the lengthening part. Okay. I began testing muscles all three ways.
Dr. Jennifaye Brown 25:04
I went against the grain, and when I started going against the grain, I determined which type of band they needed at the calf muscle, off the top of their leg, below the knee, and then up their ankle. I never crossed over like this. Why? Because you have a tendon on the inside top of the ankle that pulls your foot up. If I press down on it, it won’t work. So if your foot is rolling up, if it’s rolling up, I start from the outside of the foot and bring a strap down towards your big toe.
Dr. Jennifaye Brown 25:45
In order for you to get your leg forward and do it forward progression, I need the foot to come down and I need the tibia to go forward. And I solved two problems, and that’s the main way. My AFOs were different, and people were happy. Number one, they fit in the shoe that people needed. Number two, they were flexible where they needed to be, but then stiff where they needed to be. And number three, I changed the whole concept of this strapping. And I would say, my first five or six years of therapy, I was making hinged AFOs after I started going to specialty courses.
Dr. Jennifaye Brown 26:32
And I knew the price of those hinged AFOs and how they made for you to buy a wider shoe, and they Didn’t encapsulate the heel, I stopped making them. And guess what, all of my, about 90% of my clients, were able to walk better, and they weaned out of their ankle, foot orthosis. And they didn’t have a whole bunch of falls. Actually, I had quite a few who went back to running.
How AFOs Affect Balance and Movement Strategies
Bill Gasiamis 27:00
So the AFO is responsible for a lot of falling as well.
Dr. Jennifaye Brown 27:04
Yes, because you can’t move the tibia. If it’s stuck like this with the band here and stuck at the ankle down here, you can’t do this. So if I want to maintain my balance, I have to have what we call an ankle synergy, so your tibia has to move forwards and backwards. I have to have a hip synergy, where I move at the hip, or I have to have a suspensory synergy, which is, you lower your trunk towards your feet. Or I have to do a stepping strategy.
Dr. Jennifaye Brown 27:37
Well, most people can’t do a stepping strategy because you can’t bend at the ankle and bend at the knee to take a nice step forward when you’re walking.
Bill Gasiamis 27:50
So what you’re telling me is that when most people get fitted for an AFO, they don’t go through all of that detail. Somebody just turns up and says, give me your leg. Let me take some measurements, let me cast it and let me get something back for you that in that next stage where they get back the first cast of the AFO, for example, is there tweaks? Do they try and fit it anymore or or not? How does it kind of work?
Dr. Jennifaye Brown 28:22
They do, okay, so I gotta preface this, when they’re casting, they tend to bend the knee and bend the foot up to get the best range so that the cast can be set in neutral. But when are you walking? Where is your knee bent at 90 degrees and your ankle is at neutral and your foot is on the ground? Never. So that’s the first thing, and then the second thing, most people are scanning the foot now.
Dr. Jennifaye Brown 28:57
And when I was at Ohio University, I was in the midst of writing a grant, and we were going to do an algorithm for scanning the foot and how to make changes in the CAD CAM model so that the AFO could better fit the foot. And we wouldn’t have to do all these changes on the back end. If you went through the full process on how an AFO is made, you wouldn’t believe why it doesn’t fit properly. So now I can get back to the question that was asked, Are there tweaks? Yes, and the number one tweak is, you have too much space someplace and not enough the other place, and it rubs.
Dr. Jennifaye Brown 29:43
So they tend to rub on the balloon here, and then the foot goes out like this, and it tends to rub on the lateral part of the ankle, on the bone that sticks out there. And the reason why is because the heel is not seated down. Or when they took the cast. So if you see this, AFO is curved in this person was coming in at the heel, and it needs to be a little bit more neutral.
Dr. Jennifaye Brown 30:13
Now, if they have a contracture here at their heel cord and it doesn’t move, I would add a lift right here on the outside, so that now they’re like doing this, and over time, I could get that contracture to stretch out. But if it’s a true construct contracture, the doctor has to go in and put holes, because I don’t they very rarely. Or do they do the Z lengthening, they go in and punch the holes, and then they put you in a cast and reset. So I think that the major problem is that they heat it up, they move it away from where it’s rubbing, and they add a pad, but then it doesn’t fit in the shoe.
Dr. Jennifaye Brown 31:00
And I tell all my clients to get a deep toe box. And if they widen the brace, you put the brace in, and then the top of the toe part goes down, and then your knuckles are rubbing on top of the shoe. So I tend to see that problem. So yes, there is some tweaking done, and this is when a lot of tweaking had to get done. There came a part point in time in the United States where you couldn’t get your AFO while you’re in inpatient rehab. Personally, I think that’s too early to get one because insurance has changed. People rush to inpatient rehab.
Dr. Jennifaye Brown 31:39
You can only stay there for so many days, and then you’re to outpatient or home or the depending on the severity of your stroke, you’re at a subacute like a nursing home. There’s something called the cascading effects of stroke. Your brain is healing after stroke six to eight weeks later, at eight weeks you’re already home, so there’s no need to give you a brace that early in the process. We need to give you something to pull your foot up. So for everybody listening, if you’re in inpatient rehab, you haven’t been discharged. They don’t have an AFO for you, use an ace bandage, use theraband.
Dr. Jennifaye Brown 32:24
Tell them to come up with a mechanical way to hold your foot up. Or, when I was at one of the facilities where we worked, and I developed a book and a protocol, we were able to use pastor of Paris material, whatever you want to call it now, fiberglass, and we could make an A training ankle, foot orthosis 45 minutes to an hour. And we had people up and walking, and we made it so that it accommodated their foot, fit in their shoe as is. Don’t go out and get a larger shoe, fit in your shoe as is.
Dr. Jennifaye Brown 32:58
And they were walking better, and they were training in this ankle foot orthosis made out of fiber fiberglass. I started, it was Plaster of Paris, and then we went to fiberglass. And so the tweaks happen at that point in time. The issue is no longer making the ankle foot orthoses in house. They were sending them out. And I the last time that happened to me in Charleston, I said, Had I known you were going to send it to North Carolina, I would have just made I would have come in the shop with you and made it here in Charleston.
Dr. Jennifaye Brown 33:32
And I did have some orphans who worked with me that did that with me. But you know, you have to use who the insurance tells you to use. And they sent that one off. When it came back, I said, we need to change this, this, this, this, and this, and and so we the changes were made that person because of the seriousness of their stroke and their impairments, they did not wean out of their ankle foot orthosis. Did their walking look prettier and normal? No. Was there walking faster and safe? Yes.
Dr. Jennifaye Brown 34:11
Did I train him to get up off the floor in case he had a fall? Yes, and he could do that with men to mod assistance, unless if there was a sturdy chair or a mat, and I taught him how to crawl and how to put the chair against the wall, and his wife was taught how to help him get up off the floor. Now that it was a lot of work, but he came to me a year after his stroke and not walking a year, and we were able to get him walking with a better fitting AFO. The AFO came to me and I said, this is not going to work. And we made all of these changes.
Bill Gasiamis 34:50
So he had that AFO for a year, that first one.
Dr. Jennifaye Brown 34:54
He didn’t even have an AFO. He came to me and he was not walking period. Ah. Are. They gave him a Hemi Walker, and he just started standing when he came to me.
Bill Gasiamis 35:05
So there’s a lot to it, because I haven’t come across one and I haven’t needed to. There’s a lot to it. There’s also the AFO, how it impacts the persons being able to get up off the ground if they happen to find themselves on the ground?
Dr. Jennifaye Brown 35:19
Yes, because when you get up off the ground, you want your foot in front of you and your knee towards your toes. That’s about 20 to 30 degrees of what we call ankle dorsiflexion. It’s hard to get up from the ground with your leg like this. You got to get your knee forward, and then the other leg in the back on your toes, and you have to push off. I always tell people to put the weaker leg from the stroke first, because if you put the stronger leg in the back, and if you have something, what we call extensor tone, your leg will be locked like a board, and you cannot bend it to get up.
Dr. Jennifaye Brown 35:57
So I train people both ways, but predominantly I put the weak leg in front. Why? Because load and weight bearing send sensory information back up to the brain to get better motor output.
Bill Gasiamis 36:13
So people listening to this podcast, there’ll be a number of them who have foot drop and who wear some kind of device, be it the stock standard one that you get when you get fitted, or another one where they’ve tried to find the right person to help them. Yes, are there? You know, your United States is massive, and you can’t possibly service everybody. So do you guys have some kind of a organization?
Bill Gasiamis 36:44
Is there a group of people who have similar thoughts in the way that AFOs should fit? Is there a community where people can reach out to and understand and learn more about how to solve their own personal AFO challenges.
Dr. Jennifaye Brown 37:04
The answer is “No”, and that’s why I did the research and came up with the book. And I would tell someone who got an off the shelf AFO that’s just a plastic one and their knee cannot come forward, go to a company called 3m or I think Smith and Nephew has been bought and it’s rolling Preston, I would get the two type of tensions, a rigid, more rigid tension, and then, if you’re not that weak, this is by a company called Med flex, and this is vel stretch.
Dr. Jennifaye Brown 37:41
It has 55% tension. But then this one is really stiff. So that’s if you’re really, really weak, I would that’s the first thing I would do. I would tell them to allow the tibia, their knee, their leg, to come forward and sit, to stand, and when you’re walking, that’s the first thing I would say, allow that leg to come in from sit to stand, so because you’re driving the force backwards, this is why people’s knees are hyper extended. Hyper extension is not always a problem of increased tone. It’s an ankle plant reflection you from a contracture.
Dr. Jennifaye Brown 38:24
It is from weakness at the gluteus Max and proximal hamstring muscle, and then the ground reaction force is in front of the ankle, because we’ve put a AFO on with a solid strap that prevents the knee from coming forward. So where can it go? Courts? If you’re trying to go forward, you can’t. And so that’s the first thing I suggest. The second thing is, if you don’t have a toe curling problem, make sure your AFO the foot part is flexible.
Dr. Jennifaye Brown 38:58
And then talk to your orthotist about where should we shave it down or make it flexible by heating it up and spreading it out so that you don’t get what we call abnormal foot reflexes? That’s a whole different story on itself, because people aren’t accessing, aren’t assessing for pathological reflexes of the foot, and that’s a sensory input issue. And again, I have some pictures in the book where the foot plate looks a little odd. It looks like a roller coaster.
The Role of Physical Therapists and Orthotists
Dr. Jennifaye Brown 39:33
Well, I have a little bump on the lateral end, under the toe, so if you feel that, you feel that bump, you’re going to go, oh, gotta go like this, and you’ll pronate. So I do. I’ll put little sensory things down in the soul of the AFO so so it stimulates an opposite motor reaction. So that’s what I would tell people. Get a different strap, a tension strap, and if you. Find these. Everybody has white, theraband, yellow, theraband, green, theraband, blue, theraband, let the theraband be your tension strap.
Empowering Stroke Survivors with Information
Bill Gasiamis 40:11
So the book, is it a technical book? Is it a book for other therapists? Is it a book for stroke survivors? You know, who is it for? Who can pick this up? Read through it, some of the stuff that you’ve said today kind of makes sense in a overall scheme of things, you know. But I don’t know all the anatomy and all the other fancy words, but I get the whole entire conversation like, I totally get it. So is the book an easy read? Who will benefit from reading the book.
Dr. Jennifaye Brown 40:43
It is an easy read. I had a person with a stroke read two versions, the versions that was made for Jennifaye, talking to another therapist, and the book that Jennifaye made, talking to an individual with stroke and their caregiver. The second one won out, because I wanted to address the caregiver and the individual with stroke, and for every paragraph, probably on the same page or within a few pages, there’s a picture to go with the paragraph. Second, there is a chapter for the physical therapist.
Dr. Jennifaye Brown 41:28
This is what you should be doing, and this is the right of the individual with stroke to ask you if you’re doing this right after that chapter, I have a cheat sheet. I said. Now when you go see the physical therapist, you ask them all these questions, and if they’re taking a little back, just use my name. Just say Dr. Jennifaye Brown said, I have a chapter in there for the orthotist, what the orthotist should be doing.
Dr. Jennifaye Brown 41:55
And then I have a a the next chapter is what you should be asking the orthotist to do? So it’s written to empower the individual with stroke, but the physical therapist said, I should be doing all of this. Yes, it’s right in the chapter, this is what you should be doing to get the person the best ankle, foot orthosis.
Bill Gasiamis 42:17
I can imagine I’m 12 months down the track, and I needed an ankle foot orthosis, and I didn’t know anything about it in in month one. How could I possibly so you start those conversations in a clinical setting, and you can’t contribute to the conversation 12 months down the track, after a difficult and challenging 12 months of trying to get up and about and and improve your walk. You might have more information, you might be more informed, and you might be able to contribute better and tell people what you need and where my channel.
Bill Gasiamis 42:50
But it’s, I think it’s really important at the very beginning, because that is going to create quality of life, that is going to improve recovery, that is going to improve walking and independence and all those things, and we need to decrease the time that it takes for people to get on their feet. And that’s where why I got excited when I discovered your book the first time you reached out, which was, you know, a year ago.
Bill Gasiamis 43:18
And thought, wow, this is exactly what we need to do, we need to give people information early on in the task, I have had the pleasure and the benefit of learning that people are listening to the podcast in hospital, and that is just unbelievable.
Bill Gasiamis 43:35
So hopefully some of the people watching and listening well, hopefully anybody who’s watching and listening in is on the path to recovery, and also as early on we’ve got them as early on in their recovery as we can, just so that we can give them another tool that they can look into and then start their own education about what they Yes, specifically need, about their foot.
Dr. Jennifaye Brown 44:03
You’re absolutely right. So in America here, I was very proactive for every major inpatient stroke rehabilitation hospital, I sent a card, just like a paper card to the rehab director about the book. So 218 or so to encompass health, the top 100 stroke certified hospitals with the inpatient rehab they got card if they were a chain like Jim Thorpe rehabilitation, they, all of them got a chain, every stroke rehab unit in a VA Center, VAMC, they got a car. So I was very proactive. And you’re right. They need to be empowered and educated early.
Dr. Jennifaye Brown 45:00
Early, and I wanted them to get this information in inpatient rehab, and most of those centers have an outpatient component, and so now most of the stroke support groups are at the outpatient centers. Well I probably could have done a little bit more better marketing for the stroke support groups, and a lot of those emails went to spam. But guess what? I’m calling all 800 and something of them now, one by one. We’re calling them now and letting them know about the book.
Bill Gasiamis 45:35
It’s sometimes you have to do the hard, yes, the hard work. You know, the cold calling so to speak and just speak to people and try and get them where you can. I I agree with that, and I love the I just love that the book exists and that it’s such a specific niche topic and subject, you know, you just often you hear people talking generalizing about a lot of things about stroke and stroke recovery, and it’s and it and it makes for people feeling like, well, that doesn’t apply to me, or it makes for people feeling like You’re not taking anything else into consideration.
Bill Gasiamis 46:22
It’s just too wide and broad, and that makes it really difficult. You feel like you’re falling in the in the cracks you know, between where there is information and where where there isn’t. And your book brace yourself has the subheading which says, you know everything you need to know about AFOs after stroke. I mean, it’s a very specific niche, and I just love that it’s so specific, and that people will be able to have this resource, this tool.
Conclusion and Call to Action
Dr. Jennifaye Brown 46:55
So let me tell you a secret. I had a client who had MS and her son, who’s in another state, found me online here in Charleston, and I did the evaluation, looked at the AFO, which was one of those off the shelf ones. We made one or two changes to that brace, which included the strap, and this is where we can get back to exercise. And then I said, What were your exercises for your leg to improve it so your foot doesn’t drop, because you have potential here? Oh, now they just told me to wear the brace. I said, Well, what is it that you want?
Dr. Jennifaye Brown 47:41
Well, I really would want to go without the brace and wear the shoes. And she had two different type of shoes that she really wanted to wear all the time in light. And you know, they are at this point in life where they do philanthropic things, so they’re going to these type of dinners and stuff like that. I said, No problem. Within a month, we had her out of the ankle, foot orthosis, couple of things that we did with her that she hadn’t had any training on. She started walking backwards.
Dr. Jennifaye Brown 48:10
She had to get eccentric lengthening of her anterior tip muscle to pull the leg up, and she had to get eccentric lengthening of her calf muscle so we could get the dynamics of the muscles to move in different ways, in different patterns. Not only was she told to walk backwards in her home after I trained her, she could loosen the strap on the brace when she felt weak, but keep it on inside a shoe, and she had to bend forwards, bend side to side, and then bend backwards and get something behind her. Well, we do those motions all the time.
Dr. Jennifaye Brown 49:00
Don’t you lean backwards when you’re going to squat on a toilet, don’t you lean forward, but you got to reach backward to wipe when something falls on the floor. You stabilize with one hand and you squat either in stride or with your feet together. She wasn’t doing any of these, any of those things, so I was doing two things. I was working the muscle in a shortened position, an elongated position, and then she had to hold it, which was an isometric position. And then I was loading the leg. She was getting sensory input. So when she decided, Oh, I think I can go without the brace.
Dr. Jennifaye Brown 49:41
Now, I said, okay, the minute you walk 10 feet in your house and your foot starts dragging, you need to put the brace back on. Well, guess what? She didn’t want to put the brace back on. So guess what? She started doing the exercises, and then I taught her how to advance the exercise with Thera band. And you pull the leg up. You hold it, hold it, hold it, and let it drop down slowly against the resistance of the Thera band. People are not doing isometric, eccentric or concentric exercises of the ankle, open chain and closed chain in order to get that proprioceptive input.
Dr. Jennifaye Brown 50:20
And that’s another reason why I think some of my clients are getting better. Now, does this work for everybody? No, it depends on where the lesion location is, how severe it is and how large it is. So someone that has tone, their leg is very straight and their foot is pointed down. They’re walking around their house in a crouched position. They’re loaded in flexion all the time, and once that normalizes to their brain. Well, Jennifaye, I was able to walk down the hall, and my leg didn’t get stiff, but it took us three months to get there.
Dr. Jennifaye Brown 50:58
That just tells me he had a large lesion down in the subcortical region in his what we call the lateral vestibular spinal tract is doing all this work because so much of his critical spinal tract that goes to his leg is damaged, but he’d rather do the work of walking in a big position and not having to hike his hip and drag his foot all the time or wear an obtrusive brace that he has to add a inch to one heel and an inch on the other side to walk.
Dr. Jennifaye Brown 51:32
So it just depends. It just depends. And I don’t think we’re we’re not doing therapeutic interventions based on the lesion type we’re giving everybody the protocol, okay? The protocol depends on social determinants of health.
Bill Gasiamis 51:50
Yes, that’s the thing. It’s not you people do not get personalized care and treatment, and that’s the biggest challenge. And I understand that there’s a there is an issue for that, and maybe it’s also part of the responsibility of the stroke survivor and the caregiver to say, Okay, you guys have done what you can. You’ve given me this stock, standard solution, and now we need to adjust it to fit our needs, our requirements. So it’s a bit of a two way thing, and let’s not just give the system a hard time, even though it probably deserves it.
Bill Gasiamis 52:26
We’ll we’ll give the system a bit of grace, and then we’ll just say to stroke survivors, now you have a little bit more information about some of the things you might be missing, and you could start that conversation with your own physical therapist, with somebody that can work. I suppose it’s like working with the AFO. It’s not just allowing the AFO to do all the work, is it? It sounds like some people get the misunderstanding that here’s an AFO, it’s going to help you walk, stay upright, not fall over whatever, and that’s it. Job done.
Bill Gasiamis 53:03
You don’t have to do anything else, and you can just accept that. Now find yourself 10, five weeks down the track, 510 weeks on the track, and the AFO is not working, and then it’s like, I’m not using this thing anymore. I don’t like it anymore. Okay? Well, you also haven’t done those other things, and you’re maybe giving yourself, you’re creating a situation where you’re learning, you’re creating learned non use, and that learned non use is what’s more likely to be getting in the way than the initial injury and the AFO, clearly, there’s a lot of problems that can be solved here.
Bill Gasiamis 53:45
And I think that’s what you are doing. You’re just going, let’s tweak this. Let’s look at that. Let’s just pay attention to the larger picture. Even though the book sounds very niche and focused in one spot, it actually is. It sounds like your idea and your thoughts and your concept is actually far more greater reaching.
Dr. Jennifaye Brown 54:09
You’re absolutely right. In the very last chapter, there’s something I call clinical pearls of wisdom, and I set the picture for the long term, your goal should be able to wean out. If you cannot wean out, you should be doing these things, not just because it’s good for your walking. It’s good for your heart health. It’s good for your brain health. If you don’t get back to normal walking, I still want you out walking. I love it, and I need you to break a little sweat, because when you walk at a faster yet safe pace, you release what we call brain derivative, neurotrophic factors.
Dr. Jennifaye Brown 54:56
And that’s that’s the vitamin that you. Need. That’s the good stuff. But guess what? You ain’t gonna get it if you work in 30 to 40% of your heart rate, it’s okay. We done checked you out. We know you on a medication. They done checked out your heart for AFib and everything else. It’s good for you. Heart Health is good for brain health. Let’s walk a little faster, break a little sweat.
Bill Gasiamis 55:21
I love that, and I often talk about the importance of exercise, but yeah, kind of I didn’t get I couldn’t get my head around that thing that you just said, which was that if your AFO is not supporting you, then you’re missing out on good quality exercise, even if it looks strange and that’s decreasing the health of your brain and your heart and the rest of your body, and we need to make sure that we maintain the entire system and and we’re supporting you.
Bill Gasiamis 55:52
And that’s what an AFO, a good AFO, can do. It can support the entire system and get you healthier. I love it. Yes. What a great and that I was gonna say, What a great conclusion to get to.
Dr. Jennifaye Brown 56:05
Yes, it is, and that’s why I want the AFO to be the best thing for that person. I want it to be the color of their skin. I want it to be able to fit in the shoes that they like to wear. Because even though they’re quote, unquote not walking normal, they are out walking, and that’s what’s important.
Bill Gasiamis 56:25
I love that. Where can people go and get some further information on yourself and the book?
Dr. Jennifaye Brown 56:32
So I have a website, J, V, B, neuro, P, t.com, I am on LinkedIn. I the YouTube channel is coming. It’s up. We’re going to be adding videos there about exercise the book. If you’re out of the United States and want to get the ebook, you have to go to my website to get the ebook. If not, if Amazon is where you are. You can order it from Amazon. I do signed copies from my website.
Bill Gasiamis 57:07
Fabulous. Obviously, the links will be in the show notes. People will be able to find out. They’ll also be able to reach out to you via the contact tab in your website, if that’s if they have specific questions, etc. And I just really appreciate you reaching out, letting me know about your book, giving me an insight into your process of helping and supporting people with AFOs. It’s absolutely fabulous. And thank you for being on the podcast.
Dr. Jennifaye Brown 57:35
Thank you so much for having me. My pleasure.
Bill Gasiamis 57:40
Well, what if the goal wasn’t just walking but walking your way? Dr. Jennifaye V. Brown reminds us that recovery isn’t about standard-issue solutions. It’s about honoring the complexity of your life, your body and your spirit, and choosing tools that support you. I’d love to hear from you in the comments. Have you ever felt like your AFO didn’t fit physically or emotionally?
Bill Gasiamis 58:05
Let’s keep this space a space where stroke survivors can speak freely, without judgment and feel deeply supported, and if something in this episode lit a spark for you, here are a few ways you can go deeper my book, The Unexpected Way That A Stroke Became The Best Thing That Happened, is a tool that helps give you insights and hope. After stroke, you can go and find it a recoveryafterstroke.com/book, and if this episode moved you, consider hitting the super thanks button on YouTube.
Bill Gasiamis 58:37
Every bit helps keeps these conversations alive. Stroke Recovery doesn’t happen in a straight line, but every step counts, even the ones that don’t look pretty. You’re not walking backward, you’re rebuilding forward. See you in the next one.
Intro 58:51
Importantly, we present many podcasts designed to give you an insight and understanding into the experiences of other individuals, opinions and treatment protocols discussed during any podcast are the individual’s own experience, and we do not necessarily share the same opinion, nor do we recommend any treatment protocol discussed all content on this website and any linked blog, podcast or video material controlled this website or content is created and produced for informational purposes only and is largely based on The personal experience of Bill Gasiamis.
Intro 59:22
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Intro 59:46
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Intro 1:00:13
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