Abstract:
A customizable ankle-foot orthotic for treating foot drop and steppage gate that that enables a wearer to adjust the fit of the orthotic against the wearer&#39;s ankle for the purpose of reducing pressure points while ensuring adequate support. The orthotic includes an ankle brace which has a first wing defining a first and second tab which are independently configurable to overlap and selectively couple to the second wing enabling the wearer to customize the fit of the interior face against the wearer&#39;s ankle.

Description:
RELATED APPLICATION 
       [0001]    The present application claims the benefit of U.S. Provisional Application No. 62/059,600 filed Oct. 3, 2014, which is hereby incorporated herein in its entirety by reference. 
     
    
     FIELD OF THE DISCLOSURE 
       [0002]    The invention relates generally to treating steppage gait in persons suffering from a foot drop condition, and more specifically, to an apparatus and related methods for supporting the front portion of the foot to prevent foot drop and alleviate the steppage gait caused by the foot drop. 
       BACKGROUND OF THE DISCLOSURE 
       [0003]    Foot drop, also commonly known as drop foot, is a common condition in which a person is unable to lift the front portion of one or both feet during walking or running due to a neurological or muscular condition which weakens the muscles of the foot. The condition causes the front portion of the person&#39;s foot to slap down on the floor or drag across the floor during walking or running. Persons suffering from foot drop often compensate by lifting the afflicted foot higher than normally necessary when moving to prevent the dropping foot from dragging or slapping on the floor. The irregular gait caused by the foot drop and the compensating movement by the person is known as a steppage gait. 
         [0004]    Foot drop is typically treated by ankle-foot orthotics that either lock the person&#39;s ankle in place or support the front portion of the person&#39;s foot. However, the currently available ankle-foot orthotics often restrict the natural flexing motion of the ankle and foot during normal movement to prevent the foot drop motion, replacing the steppage gait with a different irregular gait. Ankle locking orthotics, such as the one described in U.S. Pat. No. 3,916,886, herein incorporated by reference, typically comprise rigid L-shaped members fitted against the back of the ankle and the underside of the foot to prevent the entire foot from flexing downwardly at the ankle. However, because the L-shape member completely prevents downward flexing of the ankle at the foot, the foot cannot make the slight downward flexing movement that naturally occurs during walking or running. Ankle-foot orthotics which provide support to the front portion of the foot also impede the natural flexing of the foot and ankle during a natural gait. These orthotics typically comprise straps anchored to the person&#39;s calf or ankle at one end and anchored to the person&#39;s foot or shoe at the other end as disclosed in U.S. Pat. Nos. 4,817,589 and 7,458,950, both of which are herein incorporated by reference, to provide a tensile force preventing downward motion of the foot. However, the straps used are often static or only have a limited elasticity to ensure sufficient tensile force is applied to support the front portion of the foot. The inelasticity of the straps also prevents the natural flexing of the foot and ankle during normal movement. The limited flexibility of presently available ankle-foot orthotics effectively replace the irregular steppage gait with an irregular gait. 
         [0005]    In addition to being overly restrictive, currently available ankle-foot orthotics are often too bulky to fit easily into shoes. Similarly, currently available ankle-foot orthotics often require numerous straps or anchors to properly secure the orthotic to the person&#39;s ankle or foot increasing the difficulty of putting the orthotic on or taking it off. For example, the L-shaped members of ankle locking orthotics are often large and do not easily fit into shoes without extensive modification of the shoe. In addition, the rigidness of the L-shape member prevents wearers from pointing their toes to ease putting on or taking off of the shoe. Similarly, strap orthotics often employ a plurality of straps and anchors that must be attached to the shoe or foot to properly fasten the orthotic to the person&#39;s ankle and foot. The straps and the anchors may be difficult to remove from the shoe if the person wants to remove or change shoes. The complexity and the difficulty of putting on and taking off the currently available orthotics often cause wearers to spend considerable time putting on or taking off the orthotic or forgoing the orthotic altogether. 
         [0006]    An additional problem for strap orthotics is the positioning of the straps and locating where the straps are to be anchored on the wearer. Typically, the anchor locations for the straps are placed as high up on the calf as possible and as far down the foot or shoe as possible to achieve the maximum tensile force. However, the higher up the calf or further down the foot the anchor points are placed, the more visible and cumbersome the orthotic becomes for the user. Similarly, the greater the number of straps, the more support is provided for the foot. As with the positioning of the anchor locations, the greater the number of straps, the more visible and cumbersome the orthotic becomes for the wearer. Similarly, the positioning of the straps may be uncomfortable for users if the straps are pressed against the person&#39;s foot or ankle. The straps may rub against the person&#39;s legs or feet during movement causing chaffing or other discomfort. 
       SUMMARY OF THE DISCLOSURE 
       [0007]    An embodiment of the present invention is directed to an ankle-foot orthotic for applying a pulling force to a wearer&#39;s shoe to counteract the effects of drop foot and prevent steppage gait. More specifically, the ankle-foot orthotic anchors the top of the wearer&#39;s shoe to an ankle brace around the wearer&#39;s ankle with an elastic strap. The elastic strap applies a tensile force to the top of the wearer&#39;s shoe to prevent steppage gait while still providing the necessary flexibility to enable the wearer to flex their foot and ankle naturally during walking or running. The ankle-foot orthotic also comprises a highly customizable engagement system for linking the orthotic to the wearer&#39;s shoe allowing the wearer to customize where the tensile force is directed and the amount of tensile force applied, while at the same time allowing the wearer&#39;s foot or shoe to flex normally when walking. 
         [0008]    An ankle-foot orthotic for treating steppage gait according to an embodiment of the present invention generally comprises an ankle brace and an elastic strap. The ankle brace further comprises wings for wrapping around a wearer&#39;s ankle and also defines an exterior face and an interior face contacting the wearer&#39;s ankle. In an embodiment of the present invention, an ankle pad can be positioned between the wearer&#39;s ankle and interior face of the ankle brace to prevent discomfort to the wearer while wearing the ankle-foot orthotic. A primary strap loop for receiving the elastic strap is positioned on the exterior face of the ankle brace between the first and second wings. In operation, wrapping the ankle brace around the wearer&#39;s ankle positions the primary strap loop at the rear of the wearer&#39;s ankle. 
         [0009]    According to an embodiment of the present invention, the ankle-foot orthotic includes an ankle brace, a tension assembly, and an elastic strap. The ankle brace is adapted for installation around a wearer&#39;s ankle. The ankle brace can include an exterior face and an interior face, wherein the interior face is positionable against the wearer&#39;s ankle. The ankle brace can further include a first wing and a second wing, wherein the first wing defines a first tab and a second tab that are independently configurable to overlap and selectively couple to a portion of the second wing to enable the wearer to customize the fit of the interior face against the wearer&#39;s ankle. The tension adjustment assembly can be positioned on the exterior face of the ankle brace so as to protrude outwardly from the rear of the ankle brace when the ankle brace is wrapped around the wearer&#39;s ankle. The tension adjustment assembly can include one or more strap loops. The elastic strap can operably link the ankle brace to the wearer&#39;s shoe for applying an upward resistive force to the wearer&#39;s shoe to prevent inadvertent downward movement of a wearer&#39;s foot. The elastic strap can be threadable through the one or more strap loops such that the elastic strap wraps around the exterior face of the ankle brace and extends at a downward angle to engage the wearer&#39;s shoe. 
         [0010]    The elastic strap defines a first end and a second end and is adapted to engage the wearer&#39;s shoe. The elastic strap can further comprise a hook fastener disposed at each end for engaging any looped structures on the wearer&#39;s shoes such as shoe laces or eyelets for receiving shoe laces. The hook fasteners enable for easy engagement of the shoe and customization as to the exact location that the tensile force provided by the elastic strap will be applied. Alternatively, the elastic strap can further comprise a strap adjustment mechanism having a first buckle and a second buckle positioned on the elastic strap. In this configuration, the first and second ends of the elastic strap are threaded through the looped structure on the shoe and looped back to the first and second buckle respectively. The strap adjustment mechanism enables the wearer to change the effective length of the elastic strap and correspondingly the tension applied by the elastic strap to the wearer&#39;s shoe. 
         [0011]    According to an embodiment of the present invention, in operation, the elastic strap is threaded through the primary strap loop and wrapped around the wearer&#39;s ankle to engage the wearer&#39;s shoe. In this arrangement, the elastic strap can be angled at an ideal angle to provide the correct tension force for maintaining the wearer&#39;s shoe in the correct position. Alternatively, the ankle brace can be wrapped around the wearer&#39;s ankle such that the primary strap loop is disposed at the front of the wearer&#39;s angle. In this configuration, the elastic strap is not wrapped around the wearer&#39;s ankle and instead directly engages the wearer&#39;s shoe. 
         [0012]    According to an embodiment of the present invention, the ankle-foot orthotic can further comprise ring anchors engageable to any looped structure on the wearer&#39;s shoe, including the shoe lace eyelets. The ring anchors can be easily engaged by or disengaged from the hook fasteners of the elastic strap. Consequently, the ring anchors can significantly reduce the time necessary to put on and take off the ankle-foot orthotic and the customization in that wearers can quickly try out a plurality of positions and arrangements for engaging the wearer&#39;s shoe with the elastic strap. 
         [0013]    According to an embodiment of the invention, the orthotic can further comprise a support fitted to the exterior of the ankle brace. The support is adapted to protect the rear of the user&#39;s ankle from chaffing or other discomfort from the elastic strap rubbing against the user&#39;s ankle during movement. The ankle support can comprise a rigid polymer to provide support for the user&#39;s ankle and to prevent the user from feeling any discomfort from the shifting or stretching of the elastic strap while walking. The ankle support is countered to protect the user&#39;s ankle without inhibiting the user&#39;s flexibility so as to enable the user to walk without hindrance. 
         [0014]    According to an embodiment of the present invention, the support can further comprise a strap adjustment assembly having an adjustable primary strap loop and two secondary strap loops positioned within cutouts in the support. The elastic strap can be threaded through the primary and secondary strap loops to form a U-shaped portion in the elastic strap. The length of the adjustable primary strap loop can be adjusted to increase or decrease the size of the U-shaped portion, which correspondingly changes the effective length of the elastic strap and the tension applied to the wearer&#39;s shoe. Alternatively, the strap adjustment assembly can comprise a fixed length primary strap loop and two secondary strap loops. In this configuration, the support comprises a plurality of cutouts for receiving the primary strap loop. Positioning the primary strap loop in the various cutouts changes the size of the U-shaped portion and correspondingly the tension applied to the wearer&#39;s shoe. 
         [0015]    According to an embodiment of the present invention, a fastener clip can comprise an anchor portion, a first longitudinal side portion, a curved end portion, a second longitudinal side portion, and an end portion. The fastener hook can be inserted and removed from an eyelet and can have a structure capable of anchoring the fastener clip in a proper position while enabling rotation and movement of the fastener clip. A hook fastener can engage with the curved end portion to provide tension force. 
         [0016]    According to an embodiment, an ankle brace can be shaped to conform to the ankle area and have a built-in conformable support fixedly sandwiched between the interior face and the exterior face of the brace. The built-in conformable support can be comprised of a plurality of longitudinal support members of varying lengths and configurations and can be comprised of a stiff yet flexible material. The length of each individual longitudinal support member is chosen so that the ankle-foot orthotic can be form fitting and provide sufficient structure and support while allowing mobility of the ankle and reducing pressure points. A strap loop is fixedly attached to the built-in conformable support. 
         [0017]    The above summary of the invention is not intended to describe each illustrated embodiment or every implementation of the present disclosure. The Figures and the Detailed Description that follow more particularly exemplify these embodiments. 
     
    
     
       BRIEF DESCRIPTION THE FIGURES 
         [0018]    The disclosure can be more completely understood in consideration of the following detailed description of various embodiments of the disclosure, in connection with the accompanying drawings, in which: 
           [0019]      FIG. 1  is a perspective view of an ankle-foot orthotic in an unrolled configuration presenting the exterior face of the orthotic in accordance with an embodiment of the disclosure. 
           [0020]      FIG. 2  is a perspective view of the ankle-foot orthotic of  FIG. 1  in an unrolled configuration presenting the interior face. 
           [0021]      FIG. 3  is an exploded view of the ankle-foot orthotic of  FIG. 1 . 
           [0022]      FIG. 4  is cross sectional view of the ankle-foot orthotic of  FIG. 1  in an unrolled configuration. 
           [0023]      FIG. 5  is a side view of an ankle-foot orthotic in accordance with an embodiment of the disclosure. 
           [0024]      FIGS. 6-10  are perspective views of an ankle-foot orthotic in accordance with an embodiment of the disclosure being attached to a user&#39;s ankle and foot. 
           [0025]      FIG. 11  is a perspective view of a fastener clip in accordance with an embodiment of the disclosure. 
           [0026]      FIGS. 12-13  are perspective views of the fastener clip of  FIG. 11  in an operational position. 
           [0027]      FIG. 14  is a side view of a grommet assembly in accordance with an embodiment of the disclosure. 
           [0028]      FIG. 15  is a perspective view of a double hooked heel holder in accordance with an embodiment of the disclosure. 
           [0029]      FIG. 16  is a perspective view of a loop heel holder in accordance with an embodiment of the disclosure. 
           [0030]      FIG. 17  is a perspective view of a hookless heel holder in accordance with an embodiment of the disclosure. 
           [0031]      FIG. 18  is a perspective view of an ankle-foot orthotic with an integrated multi-member support in accordance with an embodiment of the disclosure. 
           [0032]      FIG. 19  is a perspective view of an ankle-foot orthotic with an integrated single-member support in accordance with an embodiment of the disclosure. 
           [0033]      FIG. 20  is a perspective view of the ankle-foot orthotic of  FIG. 20  showing the exterior face in accordance with an embodiment of the disclosure. 
           [0034]      FIGS. 21-25  are perspective views of an ankle-foot orthotic with an integrated single-member support in accordance with an embodiment of the disclosure being attached to a user&#39;s ankle and foot. 
       
    
    
       [0035]    While embodiments of the disclosure are amenable to various modifications and alternative forms, specifics thereof have by shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the disclosure to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure as defined by the appended claims. 
       DETAILED DESCRIPTION 
       [0036]    Referring to  FIGS. 1-10 , an ankle-foot orthotic  2  for treating steppage gait according to an embodiment of the present invention supports the weakened muscles by providing support beneath the wearer&#39;s foot or shoe  4  or by applying a pulling force to top of the wearer&#39;s shoe  4 , while at the same time allowing the wearer&#39;s foot or shoe  4  to flex normally when walking. The pulling force is typically provided by anchoring the front or top of wearer&#39;s foot or shoe  4  to the wearer&#39;s ankle  6 . 
         [0037]    With special references to  FIGS. 1-5 , in one embodiment, ankle-foot orthotic  2  generally comprises an ankle brace  8  and an elastic strap  24 . In one embodiment, ankle brace  8  can comprise a first wing  12  and a second wing  14  and defines an interior face  16  and an exterior face  18 . Ankle brace  8  can further comprise an ankle brace fastener  20  for releasably engaging the first wing  12  to the second wing  14  such that the ankle brace  8  forms a generally cylindrical shape around a wearer&#39;s ankle  6 . Ankle brace fastener  20  can comprise, for example, VELCRO®, a hook and loop fastener, an elastic fastener, a button fastener. Similarly, ankle brace  8  can be elastic material adapted to pull against the wearer&#39;s ankle  6  to maintain the position of the ankle brace  8  on the wearer&#39;s ankle  6 . A primary strap loop  22  is disposed on the exterior face  18  of the ankle brace  8  between the first and second wing  12 ,  14 . In one embodiment, ankle brace  8  can further comprise a structural strap  23  (shown in  FIG. 5 ) for maintaining the shape of ankle brace  8  during movement and as tension force is applied to ankle brace  8 . Structural strap  23  can comprise a flexible plastic material sufficiently rigid to withstand the tension forces applied to the ankle brace  8 , but also sufficiently flexible to wrap around the user&#39;s ankle  6 . 
         [0038]    Elastic strap  24  defines a first end  27  and second end  28 . Elastic strap  24  is threadable through the primary strap loop  22  and comprises an elastic material for applying a pulling force to the wearer&#39;s shoe  4 . In one embodiment, different elastic straps  24  can be interchanged according the particular pull force required to prevent steppage gait or provide the desired flexibility for the wearer. Elastic strap  24  is sufficiently elastic to provide sufficient tensile force to prevent the foot from inadvertently dropping due to foot drop, but has sufficient flexibility to enable the wearer to flex their foot and ankle  6  as needed. As such, a wearer can walk or run using the ankle-foot orthotic  2  with the natural flexing of the foot and ankle  6 . 
         [0039]    In one embodiment, elastic strap  24  can comprise a hook fastener  26  disposed at both the first and second ends  27 ,  28 . Hook fasteners  26  are adapted to engage any looped structure on the wearer&#39;s shoes  4  to operably link the ankle brace  8  to the wearer&#39;s shoes  4 . In one embodiment, the hook fasteners  26  can be shaped such that the point of the hook is substantially parallel to the shank of the hook or points away from the shank to facilitate easy attachment and removal of the hook from the looped structures on the top of the shoe  4 . 
         [0040]    In one embodiment, ankle brace  8  can further comprise an ankle pad  30  for protecting the wearer&#39;s ankle  6  from discomfort. Ankle pad  30  can be disposed on the interior face  16  of the ankle brace  8  such that the ankle pad  30  is positioned between the ankle brace  8  and the wearer&#39;s ankle  6  when orthotic  2  is in use. Ankle pad  30  can comprise a foam, a mesh or other cushioning material to alleviate wearer discomfort. In one embodiment, the ankle pad  30  can be positioned on the ankle brace  8  such that the ankle pad  30  is positioned against the rear of the wearer&#39;s ankle  6  when the ankle brace  8  is wrapped around the wearer&#39;s ankle  6 . In this configuration, the ankle pad  30  prevents the elastic strap  24  from chaffing or causing other discomfort to the wearer&#39;s ankle  6  when the elastic strap  24  is wrapped around the wearer&#39;s ankle  6  to engage the wearer&#39;s shoe  4 . Alternatively, ankle pad  30  can further comprise a first wing  32  and a second wing  34  (shown in  FIG. 4 ) adapted to wrap around the wearer&#39;s ankle  6  to protect both the sides and rear of the wearer&#39;s ankle  6  from discomfort. According to an embodiment of the present invention, the ankle pad  30  can further comprise a shoe cushion  36  (shown in  FIG. 3 ) for preventing chaffing between the wearer&#39;s shoe  4  and the ankle pad  30 . The shoe cushion  36  similarly supports the ankle pad  30  to prevent the ankle brace  8  from sliding down the wearer&#39;s ankle  6  during use. 
         [0041]    Referring to  FIGS. 6-10 , in operation, the first and second wings  12 ,  14  of the ankle brace  8  are wrapped around the wearer&#39;s ankle  6  such that primary strap loop  22  extends outwardly from the rear of the wearer&#39;s ankle  6 . In this configuration, elastic strap  24  is wrapped around ankle brace  8  and the wearer&#39;s ankle  6  before engaging the wearer&#39;s shoes  4 . Wrapping the elastic strap  24  around the wearer&#39;s ankle  6  ensures the correct tension is applied along elastic strap  24  and properly angles the elastic strap  24  to maintain the wearer&#39;s shoe  4  in the proper position. Alternatively, the wings  12 ,  14  of ankle brace  8  can be wrapped around the wearer&#39;s ankle  6  such that the primary strap loop  22  is positioned at the front of the wearer&#39;s ankle  6 . 
         [0042]    Elastic strap  24  comprises hook fasteners  26  for engaging any looped structure on the wearer&#39;s shoe  4 . Typical shoes  4  can comprise eyelets  38  for receiving shoes laces. Hook fasteners  26  can engage either the laces, eyelets  38  or any other looped structure commonly found on conventional shoes  4 . According to one embodiment (as depicted in  FIGS. 6-10 ), at least one ring anchor  40 , threaded through at least one of the eyelets  38 , is employed to engage hook fasteners  26 . In some embodiments, ring anchor  40  can be moved to whichever eyelet  38  best suits the needs of the wearer. 
         [0043]    In another embodiment (as depicted in  FIGS. 11-13 ), a fastener clip  90  can be threaded through at least one of the eyelets  38  and can be employed to engage hook fasteners  26 . In one embodiment, fastener clip  90  is configured to be easily inserted and removed from eyelet  38  and has a structure configured to anchor fastener clip  90  in a proper position while enabling rotation and movement of fastener clip  90 . In one embodiment, fastener clip  90  can comprise an anchor portion  92 , a first longitudinal side portion  94 , a curved end portion  96 , a second longitudinal side portion  98 , and an end portion  91 . 
         [0044]    Anchor portion  92  can be configured to provide a dimension or area larger than that of eyelet  38  so that anchor portion  92  cannot be threaded through eyelet  38 . First longitudinal side portion  94  and second longitudinal side portion  98  can be substantially parallel to each other and in one embodiment are connected via curved end portion  96 . In one embodiment, first longitudinal portion  94  can be substantially straight. In another embodiment, first longitudinal portion  94  can be configured to have at least one bend  99 . First longitudinal portion  94  has a length L where the length L can be determined based on the configuration of the wearer&#39;s shoe. 
         [0045]    First longitudinal side portion  94  and second longitudinal side portion  98  are a distance D from each other that is sufficient for the material of the wearer&#39;s shoe to be encompassed within. End portion  91  connects to second longitudinal portion  98  at an end  93 . In one embodiment, end portion  91  can be configured in a “U” shape. In other embodiments, end portion  80  can be configured in “L” or “V” shapes or be provided with no bends or curves, i.e., straight or substantially straight. First longitudinal side portion  94  and end portion  91  are provided such that a gap G exists between the two portions. The gap G is dimensioned to enable material of the wearer&#39;s show to fit therebetween. 
         [0046]    Referring to  FIGS. 12-13 , in operation, fastener clip  90  is threaded through eyelet  38 , so that second longitudinal side portion  98 , then curved end portion  96 , and finally first longitudinal side portion  94  move through eyelet  38  until anchor portion  92  is in contact with eyelet  38 . Hook fastener  26  can engage with curved end portion  96 . 
         [0047]    In yet another embodiment (as depicted in  FIG. 14 ), at least one grommet assembly  42  comprising a plurality of grommets  44  releasably engageable by the hook fasteners  26  can be affixed to the shoe  4 . Grommet assembly  42  can be sewn, riveted or adhered with adhesive to the user&#39;s shoe or other conventional means of affixing the grommet assembly  42 . According to an embodiment of the present invention, the grommet assembly  42  can comprise a fabric or leather construction to flex with the user&#39;s shoe  4  during walking or running. 
         [0048]    Wearers can customize the arrangement of the elastic strap  24  to accurately direct the tension force applied by the elastic strap  24  and maximize the effectiveness of the ankle foot orthotic  2 . Foot drop can affect the various foot muscles differently from wearer to wearer and even from foot to foot, which can cause each afflicted foot to fall uniquely. For example, an afflicted foot can fall downwardly, roll or some combination thereof. A wearer can mix and match which ring anchor  40 , fastener clip  90 , or grommet  44  to engage with the hook fasteners  26 . For example, a wearer can engage both hook fasteners  26  to the same ring anchor  40 , fastener clip  90 , or grommet  44  to maximize the force applied to the same part of the shoe  4 . Similarly, the hook fasteners  26  can be positioned such that the elastic strap  24  crosses over the top of the shoe  4  or is uncrossed to properly direct the tension force. 
         [0049]    Referring to  FIGS. 15-17 , in one embodiment, ankle-foot orthotic  2  can further comprise a heel holder  70  to keep the heel  5  of the wearer&#39;s shoe  4  snug against the wearer&#39;s foot. In one embodiment, heel holder  70  can be comprised of an elastic strap  72  have a first hook  74  and a second hook  76 . For example, as depicted in  FIG. 15 , elastic strap  72  can have a first end  73  fixedly coupled to first hook  74  and second end  75  fixedly coupled to second hook  76 . Alternatively, as depicted in  FIG. 16 , elastic strap  72  can be a loop, threadedly coupled to one or more apertures  77  on first hook  74  and second hook  76 . 
         [0050]    In operation, first hook  74  can be coupled to strap loop  22 , while second hook  76  can be coupled to an aft portion  7  of the wearer&#39;s shoe  4 . The elasticity of elastic strap  72  can be selected to counteract the tension of elastic strap  24  connected to the fore portion of the wearer&#39;s shoe, thereby keeping the heel  5  of the wearer&#39;s shoe  4  snug against the wearer&#39;s foot. 
         [0051]    In another embodiment, as depicted in  FIG. 17 , heel holder  70  can comprise an elastic loop  80  threadedly coupled to an aft portion  7  of the wearer&#39;s shoe  4 . In one embodiment, a grip  82  can be coupled to one portion of elastic loop  80  to provide an easy gripping point for heel holder  70 . In operation, a wearer can insert their foot through elastic loop  80 , so that the tension created by elastic loop  80  counteracts the tension of elastic strap  24  connected to the fore portion of the wearer&#39;s shoe, thereby keeping the heel  5  of the wearer&#39;s shoe  4  snug against the wearer&#39;s foot. In one embodiment, elastic strap  24  can be threaded through elastic loop  80 , thereby retaining elastic loop  80  in desirable position on the wearer&#39;s ankle. 
         [0052]    Referring to  FIG. 18 , another ankle-foot orthotic  102  according to an embodiment of the present invention is depicted. In one embodiment, ankle-foot orthotic  102  generally comprises an ankle brace  108  and an elastic strap  124 . In one embodiment, ankle brace  108  can comprise a first wing  112  and a second wing  114  and defines an interior face  116  and an exterior face  118 . Ankle-foot orthotic  102  operates similarly to ankle-foot orthotic  2  (as described in relation to  FIGS. 1-6 ) in that ankle brace fastener  120  releasably engages the first wing  112  to the second wing  114  so that ankle brace  108  forms a generally cylindrical shape around a wearer&#39;s ankle and is shaped to conform around the ankle. Ankle brace fastener  120  can comprise, for example, VELCRO®, a hook and loop fastener, an elastic fastener, a button fastener or any other temporary fastening means. 
         [0053]    In one embodiment, ankle brace  108  is shaped to conform to the ankle area and comprises built-in support  146 . Built-in support  146  can be fixedly sandwiched between interior face  116  and exterior face  118  and can be comprised of a plurality of longitudinal support members  130  of varying lengths and configurations. In an embodiment, longitudinal support members  130  can generally define rectangles, quadrilaterals, circular segments, or any combination thereof. Longitudinal support members  130  can be comprised of a stiff yet flexible material, for example, a plastic or metal, providing structure to the built-in support  146  while allowing for movement. 
         [0054]    In one embodiment, a plurality of longitudinal support members  130  can be provided. The plurality of longitudinal support members  130  can be of different lengths, and can be positioned substantially parallel to each other, separated by a distance from an adjacent longitudinal support member  130 . The horizontal width of and distance between longitudinal support members  130  can be sufficient to enable the longitudinal support members  130  to conform around the wearer&#39;s ankle area when the ankle-foot orthotic  102  is placed around the ankle. The vertical length of each longitudinal support member  130  can be chosen so that when the ankle-foot orthotic  102  is placed around the ankle, the longitudinal support members  130  do not make contact with the lateral malleolus area of the fibula and medial malleolus area of the tibia. A benefit of this is that while the ankle-foot orthotic  102  can be form fitting and provide sufficient structure and support, it still enables mobility of the ankle and reduces pressure points. 
         [0055]    In one embodiment, strap loop  22  is fixedly attached to the built-in support  102 , for example, by stitching strap loop  22  to the exterior face  118  and the interior face  116  with thread  132 . In one embodiment, strap loop  22  is positioned on exterior face  118  and is fixedly attached between two of the longitudinal support members  130  so that strap loop  22  is positioned near the top  134  of the ankle brace  108 . Elastic strap  124  is threadable through strap loop  22 . In another embodiment, the strap loop  22  is fixedly attached to exterior face  118  only. 
         [0056]    Referring to  FIGS. 19-20 , another ankle-foot orthotic  202  according to an embodiment of the present invention is depicted. In one embodiment, ankle-foot orthotic  202  generally comprises an ankle brace  208  and an elastic strap  224 . In one embodiment, ankle brace  208  can comprise a first wing  212  and a second wing  214  and defines an interior face  216  and an exterior face  218 . In one embodiment, first wing  212  can be split into an upper tab  260  and a lower tab  262 . Upper tab  260  and lower tab  262  can include ankle brace fasteners  220   a - b . Ankle brace fasteners  220   a - b  can comprise, for example, VELCRO®, a hook and loop fastener, an elastic fastener, a button fastener or any other temporary fastening means. 
         [0057]    In one embodiment, ankle brace  208  is shaped to conform to the ankle area and comprises built-in support  246 , which can be integrated into ankle brace  208 . Built-in support  246  can be comprised of a unitary support member  230  with the unitary support member  230  being manufactured of a stiff yet flexible material that is able to wrap partially around the ankle area while still providing sufficient support. The unitary support member  230  can be molded or shaped so that when in operation, unitary support member  230  does not make contact with the lateral malleolus area of the fibula and medial malleolus area of the tibia. 
         [0058]    In one embodiment, ankle brace  208  can comprise tension adjustment assembly  254  for adjusting the effective length of the elastic strap  224 . The effective length of the elastic strap  224  is the portion of the elastic strap  224  extending from the rear of the wearer&#39;s ankle  6  to the wearer&#39;s shoe  4 . Tension adjustment assembly  254  comprises a multi-loop primary strap loop  250  and two secondary strap loops  252  for receiving the elastic strap  224 . Primary strap loop  250  comprises a plurality of sub-loops  251 . In one embodiment, primary strap loop  250  and the secondary strap loops  252  are affixed to the exterior face  218  of the ankle brace  208 . In operation, primary strap loop  250  and secondary strap loops  252  bend the elastic strap  224  into a U-shape within the tension adjustment assembly  254 . Threading the elastic strap  224  through the various subloops  251  of the primary strap loop  250  changes the size of the U-shaped portion of the elastic strap  224 , thereby changing the effective length of the elastic strap  224 . Changing the effective length of the elastic strap  224  changes the tension force applied by the elastic strap  224 . 
         [0059]    Referring to  FIGS. 21-25 , in operation, the first and second wings  212 ,  214  of the ankle brace  208  are wrapped around the wearer&#39;s ankle  6  such that the multi-loop primary strap loop  250  extends outwardly from the rear of the wearer&#39;s ankle  6 . In this configuration, elastic strap  224  is threading through one or more of the subloops  251  of the primary strap loop  250  and secondary strap loops  252 , as it wraps around the ankle brace  208  and the wearer&#39;s ankle  6  before engaging the wearer&#39;s shoes  4 . Wrapping the elastic strap  224  around the wearer&#39;s ankle  6  and bending the elastic strap  224  into a U-shape within the tension adjustment assembly  254  ensures the correct tension is applied along the elastic strap  224  and properly angles the elastic strap  224  to maintain the wearer&#39;s shoe  4  in the proper position. 
         [0060]    Ankle-foot orthotic  202  operates similarly to ankle-foot orthotic  8  (as described with references to  FIGS. 1-9 ) in that ankle brace fastener  220  releasably engages the first wing  212  to the second wing  214  so that ankle brace  208  forms a generally cylindrical shape around a wearer&#39;s ankle and is shaped to conform around the ankle. Upper tab  260  and lower tab  262  present the additional advantage of being able to tailor the fit of ankle-foot orthotic  202  to a wearer&#39;s ankle  6 . For example, upper tab  260  can be wrapped tighter around a wearer&#39;s ankle  6  than lower tab  262 , so that the top portion  264  of ankle-foot orthotic  202  fits more snuggly around a wearer&#39;s ankle  6  than lower portion  266 . Conversely, a wearer may prefer to have the lower portion  266  fit more snuggly. Upper and lower tabs  260 ,  262  can also be connected to second wing  214 , such that the angle between upper and lower tabs  260 ,  262  varies, thereby causing one portion of the ankle-foot orthotic  202  to fit more snuggly than other portions and to enable the wearer to customize the fit of ankle-foot orthotic  202  and to reduce pressure points. 
         [0061]    Various embodiments of the present disclosure have been described herein. These embodiments are given only by way of example and are not intended to limit the scope of the invention. It should be appreciated, moreover, that the various features of the embodiments that have been described may be combined in various ways to produce numerous additional embodiments. Moreover, while various materials, dimensions, shapes, configurations and locations, etc. have been described for use with disclosed embodiments, others besides those disclosed may be utilized without exceeding the scope of embodiments. 
         [0062]    Persons of ordinary skill in the relevant arts will recognize that embodiments may comprise fewer features than illustrated in any individual embodiment described above. The embodiments described herein are not meant to be an exhaustive presentation of the ways in which the various features may be combined. Accordingly, the embodiments are not mutually exclusive combinations of features; rather, embodiments can comprise a combination of different individual features selected from different individual embodiments, as understood by persons of ordinary skill in the art. Moreover, elements described with respect to one embodiment can be implemented in other embodiments even when not described in such embodiments unless otherwise noted. Although a dependent claim may refer in the claims to a specific combination with one or more other claims, other embodiments can also include a combination of the dependent claim with the subject matter of each other dependent claim or a combination of one or more features with other dependent or independent claims. Such combinations are proposed herein unless it is stated that a specific combination is not intended. Furthermore, it is intended also to include features of a claim in any other independent claim even if this claim is not directly made dependent to the independent claim. 
         [0063]    Any incorporation by reference of documents above is limited such that no subject matter is incorporated that is contrary to the explicit disclosure herein. Any incorporation by reference of documents above is further limited such that no claims included in the documents are incorporated by reference herein. Any incorporation by reference of documents above is yet further limited such that any definitions provided in the documents are not incorporated by reference herein unless expressly included herein.