So you have just come back from the physiotherapists or doctors office and they have recommended AFOs or UFOs as my daughter likes to call them. We will address some of the common questions and offer some ideas to help you through the next steps.

What are AFOs?
An ankle foot orthotic (AFO) is lightweight plastic brace in the shape of an “L”, with the upright portion behind the calf and the lower portion running under the foot, that encompass the ankle and all or part of the foot. They are attached to the calf with a strap, and are made to fit inside shoes. Some designs without hinges provides rigidity while others, with a jointed ankle provide different types of control.

Why does your child need them?
While every child is different and this is a question best directed to the prescribing physician, here are a few of the typical reasons that an AFO is prescribed.

• Control position and motion of the ankle
• Compensate for weakness
• Correct a deformity
• Position tight contracted muscles in a more typical position to allow muscles to develop appropriately in order to avoid surgery later in life
• Correct foot drop
• Offer stability

How are they made and fitted?
Typically AFOs are custom manufactured from mould made of the patients foot. In some cases an off the shelf or prefabricated AFO can be used. Your physician will tell you which is most appropriate.

At the appointment, the person making the cast will place a sock on the patients leg then put a rigid metal strip from the top of the foot, up the front of the leg. Then holding the foot in a flexed position will wrap strips of casting material around the leg and the sock. The casting material hardens in 5-10 minutes and then the cast is cut off the patient.· The whole process usually takes less than a half an hour. The cast is then sent out and a custom AFO is manufactured and you will be called back for a fitting within a few weeks.

The one fun thing at this appointment can be picking out the patterns for the orthotics. There are a many designs and colours and images that can be put on the orthotics to give them a personal touch.

When you go for your final fitting the orthotics will be put on the child with some shoes and they will check for proper position and whether there are any areas that need to be changed due to rubbing or pinching. The changes can often be done right then and there and you can take the AFOs home with you.

Note: I have heard from some mom’s that they have been splashed with the casting material. Most places will offer a towel to put on your lap if you child is sitting in it. The casting material does stain so you may want to consider what you wear to the appointment.

Shoes
Shoes can be one of the trickiest parts of the whole process, finding a shoe that fits over the AFO and stays on can be a challenge. Most AFO manufactures will offer specialized shoes made for AFOs but they tend to be a bit pricey. Some things to look for when looking for the shoe, typically you will be looking for a shoe 2 or 3 sizes bigger than the child wears without the AFO, the best bet is to take the child and the AFOs with you when you shop. Converse type shoes, have worked for us with some modification but they do still fall off from time to time and as he has become more mobile these are falling off more and more. Look for a wide shoes without seams across the toe and a tongue that comes a long way out. Sometimes it is helpful to remove the insert in the base of the shoe. Most AFO manufactures will add length to your Velcro straps if you bring them with you if you prefer Velcro to laces. Stride rite also makes a wide shoe that we have been told works well over AFOs.

Fitting issues
Make sure you are comfortable putting on the AFOs, try it a couple of times at the fitting appointment and if you have any concerns, get your PT to show you again. Once you are home keep an eye on the limbs affected and if you see any red spots that do not go away within 15 minutes, have the AFOs checked out. If the child is complaining of discomfort obviously have them checked out. If the foot does not appear to be in a “normal’ position, for example, excessive turning in, scrunched up toes... take them in to see if modifications can help, these visits are usually included in the price of the AFO.

When should my child wear them?
Your physiotherapist will give you a wearing schedule for your child. The schedule varies greatly from child to child. Some use the brace for a few hours a day only when practising standing exercises some wear them for most of the day and night, while others may wear them only at night. Work with your physiotherapist to develop a plan to work your way up to the number of hours required.

Once you are home with the AFOs try to make them as casual and fun as you can. We are lucky that right now Carter uses his mostly for standing so he is more than happy to hop into his because he knows that he is going to get to do his favourite activity, standing or using his walker. Most cases won’t be that easy but try to see what you can do to make if fun and not a negative experience.