You “think” that an AFO may be the solution for your child? Or someone told you that is all you need for your child who is up on their tip toes?
We receive close up photos and video of a lower leg and foot with a request to “make AFOs.” Based on the photo and / or video alone, it is possible to make an AFO if there is an impression model or cast taken of the child’s leg and foot. HOWEVER, the AFO would fit but would be NON-functional or of benefit to the child.
The design cannot be simply “biomechanics” or the pathomechanics since it is only one aspect of the problem(s) that need to be addressed.
Most anyone can make an orthosis or simply order a “one-design fits all” orthosis design specific to a common child; not yours. Typically, a child fit with type A through Z , off-the-shelf orthosis is a child who most likely does not need the AFO or orthosis for better movement or to help retain correction from recent surgery.
AFOs need to be age-based and functional-based. We have certain needs. Can these needs be addressed with a well designed orthosis? Or, do we need to consider other interventions along with the AFOs.
An AFO cannot be “neutral” when set to an engineered 90 degree tibial/lower leg angle. That might be neutral for a door frame but not a transitioning, standing or walking child.
BASIC POINTS WHEN REQUESTING AFOs :
1. What do I want the orthosis to provide and offer.
2. Did the prescriber evaluate available hip, knee, ankle and foot ranges of motion. The design must change if there is insufficient hip extension or hip rotations. Does the orthotist or brace maker consider hip, knee, ankle and foot ranges prior to making the AFO?
3. Does the AFO offer maximum contact with a well contoured base and lower leg shape that matches the child’s own leg.
The orthotist should be using Plaster of Paris to mold the leg and foot. If not, the AFO is not custom fabricated.
4. Do not add a bulky ankle hinge to the AFOs since it is one of the most common iatrogenic causes of “crouched gait” and recurrent hamstring contactures before and after hamstring lengthening and often following SDR. Foot dorsiflexion is NOT a requirement for foot Clearance during gait.
5. For children who are transitioning from floor to standing and who are walking, with or without assistance, the plastic should not extend beyond the ball of the foot or to end of toes. Why? The “block” will stop the desired hip extension – knee flexion coupling used for foot clearance.
