During a fitting of a ground reaction AFO, if the patient struggles to initiate swing on the side with the orthosis, what modification is most appropriate?

The most appropriate modification when a patient struggles to initiate swing phase while wearing a ground reaction ankle-foot orthosis (AFO) is to add a 1/4 inch heel wedge.

In the context of a ground reaction AFO, the goal is to facilitate an appropriate gait pattern by promoting adequate dorsiflexion and reducing any potential rigidity in the ankle joint during the stance phase. When a patient has difficulty initiating the swing phase, it often indicates that there may not be optimal foot placement or clearance during walking.

By adding a heel wedge, the angle of the foot can be adjusted slightly, which may help in enhancing dorsiflexion at the ankle and improving foot clearance. This modification can promote better swing initiation by allowing the foot to reposition itself more efficiently for the swing phase, thus improving gait dynamics.

This approach not only assists in achieving more efficient movement but also ensures that the overall gait mechanics are supported appropriately by the orthosis without necessitating more drastic changes, such as switching the type of orthosis or removing components that provide essential support.