A recent article in Rosalind Franklin Medical School Fall/Winter 2025 edition, sparked my interest. Entitled, “This boot is made for walking” was written by a health care provider who sustained an ankle/foot fracture themselves and had to wear one to “those boots’ for a period of time in order to heal. While most of the articles submitted for this column have to do with provider compliance, this one will concentrate on patient compliance and what we as health care providers can do to do a better job at that.
This article got me to thinking about patients who suddenly had an acute injury necessitating an AFO. Most of us have even faced the wrath of patients who are now facing the need to change all their footwear. How well do we counsel them? Do these patients become resistant to care and/or howe can we get them to become more compliant?
For those who must wear an AFO for a short period of time, encourage them by speaking with them about how much better these AFOs are than wearing a closed cast for six weeks. It’s certainly a small period of time, which they should be able to get through, allowing them to return to their pre-injury ADLs much sooner than allowed by traditional casts. Let them know by being more mobile they are far less likely to suffer a DVT, muscle atrophy, etc.
As for those who must wear an AFO for the longer haul (a year) or more again encourage them by telling them this may help them avoid surgery. Or its simply part of the transition from post-surgery or acute injury to foot orthotics. The AFO is a tool by which may allow them to fully recover without permanent disability.
For sure some patients who have suffered devastating illnesses (stroke) or injury, an AFO becomes their lifeline by which to return some semblance of independence.
Show patients photos and educational materials from shoe manufacturers, some of which are normal in appearance. Allowing patients to helicopter directly into the shoe with the AFO already on, fosters self-confidence and reduces patient frustration. Fostering donning (applying) and removal (doffing) especially for the elderly, will enhance compliance.
Perhaps the three actions you and your office staff can take are:
- Consider the design for custom AFO and how the patient will secure the device. If the patient has upper extremity or back issues, how will they apply the device. Consider closures which are more user friendly and perhaps less reliant on Velcro straps which “fly and stick”.
- Establish a relationship with a physical and occupational therapist. Having such a relationship can be invaluable. Having their input on the closure design on a custom AFO is invaluable.
- Upon dispensing, refer the patient to OT and PT where they can practice donning and doffing and further enhance their gait training with the device. Most physicians and their staff do not have the time or patience to deal with these issues. Thus, referring patients to health care providers who will encourage them is perhaps the single best thing you can do to improve patient compliance.
A quote from my medical training rings true here: “Share the wealth”
