Ankle Foot Orthoses will be a large part of your child’s physical rehabilitation and growth but is also an expensive part.
The aim of orthotic treatment is to stabilise the ankle, help with mobility to get to the best possible functional gait, as well as to assist physiotherapy and management after surgery 1. AFO’s are classified as static or dynamic, and a proper assessment is needed to ensure that the correct style of AFO is fitted to your child.
1. AFO’s should not hurt. Make sure that the AFO’s are not pinching or pushing on bony prominences before you leave the Orthotist. This will reduce trips up and down. Your child might feel uncomfortable, and the Achilles tendon might stretch at first, so it will be helpful in some instances to wean you child into the new AFO over a couple of days.
2. Footwear “tuning”, where the soles of the shoes are adapted with the AFO’s to get the optimum walking is as important as the fit of the AFO 2. It is sometimes necessary to build a heel raise onto the AFO, or a combination of a rocker and a raise on the shoes, to ensure that the alignment of the shoes, AFO’s and hips are correct, to save energy and optimise walking.
3. Wear the AFO’s as recommended. If the AFO’s are not worn regularly, the foot may relapse, causing new stretching on the tendons every time you put it on again.
4. Do slow, passive stretches before you put the AFO’s on. Your physiotherapist will help you with suggestions 3.
5. Bend your child’s knee when you put the AFO on. This will release the tension on the ankle and make it easier to position in the AFO. Keep the knee bent while you put the shoe on as well.
6. Always wear cotton socks with the AFO’s. It keeps the skin cool and dry and prevents chafing.
7. Footwear options are not as limited as you think, but it may take some shopping around. Shoes with a wide opening front, with a long tongue, are easier to fit the AFO. Shoes should also not be flat but have a slight heel raise. This assists in toe-off and ankle stability while your child is standing. Also, look for a shoe with a deep heel cup to hold the brace in place. There are many sandals available with Velcro straps. You can ask your Orthotist to make the straps a bit longer if they do not fit over the AFO. If you cannot take your child with when shoe shopping, take the AFO’s with and try them in the shoes. Remove the innersoles of tekkies to make space for the AFO. Try not to go too many sizes up (1 size should do), otherwise the toe part gets too long, and your child may trip. Also, the shoe is likely to wear out quicker. If your child only wears 1 AFO, remove the innersole of the AFO side of the shoe and place it, upside down, underneath the innersole of the opposite side. This will help with the volume. There are a couple of no-tie options available to make it easier to put shoes on, e.g. elastic laces, magnetic shoe closures and Velcro. Ensure that the shoes are not worn out, and if there are repairs to the soles needed, have them done ASAP.
8. Clean the AFO’s weekly with a mild soap and cool water. Do not use antibacterial soaps, because it can burn the skin if not rinsed out properly. Sun dry or use a hair dryer on the cold setting.
9. If there is pressure on a bony area and you cannot get to the Orthotist, as temporary measure, use a corn plaster and let the bony part stick through the hole to reduce pressure. Never bulk up on pressure areas by adding more padding on to that area.
10. If the toes are sticking over the front part of the AFO but the ankle is still fitting, you can get another couple of weeks use out of the AFO’s.
Each child is different and the AFO’s are custom fitted to your child. Do not make physical adjustments to the AFO’s yourself. Your Orthotist should be able to adjust the AFO’s a couple of times before your child needs a refit.
1.Munoz S. The new generation AFOs. O&P Edge. November 2018. https://opedge.com/Articles/ViewArticle/2018-11-01/the-new-generation-of-afos.
2.Eddison N, Chockalingam N. The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy. Prosthet Orthot Int. 2012;37(2):95-107. doi:10.1177/0309364612450706
3.Physio-pedia. Stretching as an intervention for Cerebral Palsy. physio-pedia.com. https://www.physio-pedia.com/Stretching_as_an_intervention_for_Cerebral_Palsy. Published 2020. Accessed April 21, 2020.