HARP

If ground based resistance to heel rise is too high, then swing phase initiation (which is NOT toe off) FAILS. It is an energy hemorrhage.

An unyielding ankle with even 90 degrees is an impediment to heel rise. A rocker shoe sole will back thrust and kill hip flexion. Hinged AFOs that do not ASSERT a small degree of dorsiflexion will not get the needed range from the ankle by magic. Hinges are passive. They do not assure heel rise. Toe walking is far better than planted plantar-flexion. Too soft a heel will collapse backward – not good. The center image is measuring the oxygen consumption and energy use of a volunteer in AFOs which have precise angular adjustment. Hills matter. Toe plates – if stiff – kill hip flexion. Foot roll-over (heel rise) is on the ball of the foot, NOT the toes. Toe plates kill walking. Those with enough intact proprioception quickly learn to rotate their legs inward or outward to bypass toe plate rollover resistance. If you are a strong advocate of AFO toe plates then you are part of the problem. Hinges are not magic. They only allow dorsiflexion if reactive reflexes are asleep. Flexible SOLID AFOs had better dorsiflexion range than did hinged AFOs as the solid AFO blunted the abnormal overflow heel strike reflexes that trigger plantar-flexion. Hinges & toe places can kill hip flexion and defeat the transition into swing.