First Day with Ankle Foot Orthotics (AFO’s)

As we continue aggressively (yes, aggressively) removing oxygen from our lives, we are adding in some new equipment for Owen.  This morning, Kellen, Owen and I went to Gillette and had the final fitting for Owen’s Ankle Foot Orthotics (AFOs).  If you’re not familiar with this type of brace, I’ve taken a lot of pictures from different angles so you can see what they look like and have answered a few of the questions that I’ve received about why Owen will be using them.

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Back view, while being worn.

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Front view while being worn.

What is the purpose of AFOs?  AFO’s are used for people who have impaired ankle function.  In Owen’s case, the doctor is hoping that by giving him more ankle support he will better be able to control his body for walking.  To walk, you need to control your hips, knees and ankles at once.  She feels by cutting it down to only two of the three, Owen will start walking sooner.  Also, Owen is showing a tendency to come up on his toes, especially on his right side.  AFOs prevent walking on tip toes.

AFO with no shoes

AFO with no shoes

Does Owen have Cerebral Palsy (CP)?  Owen’s development team is reasonably confident that Owen will not have a CP diagnosis.  At this time, his muscle tone is “essentially normal” in all four extremities.  He has mild increased tone in both of his hamstrings and ankles.  Also, his feet are flat during standing, and as I mentioned above, he favors his tip toes at times.  His doctor feels that by getting his earliest walking in the correct position, through AFO use, there is a chance that his mild tone issues will improve, or at least, not get worse.  She keeps saying, “Owen is a moving target”, which means that she doesn’t feel his tone is fully determined yet.  She is confident that Owen could walk without AFO’s but we are choosing to be aggressive now, in hopes that he may not need AFO;s for life.  From a development and neurological standpoint standpoint, Owen has been diagnosed with PVL, Muscle Weakness, Global Developmental Delay and Impairment.

What is the Process for Getting AFO’s?  In our experience, molds were created through briefly casting the foot, ankle and shins.  As shown here.

Owen getting molded for his AFOs (two weeks ago)

Owen getting molded for his AFOs (two weeks ago)

I was able to pick a fun fish print from a book of many options.  I thought it would be good for summer (assuming it ever gets warm here).  Over the last two weeks, the molds were used to make custom fit, plastic braces for Owen.  Today we went back and the braces were tried on and the final cuts were made and the straps were added.  In all, the appointment was an hour and forty-five minutes because it took about one hour between trying on the braces and making the final adjustments.

Completed AFOs.  Do you love his fish print?

Completed AFOs. Do you love his fish print?

What are Owen’s first Impressions of his AFO’s?  Owen has been doing really well so far.  Within 5-6 steps of hand held walking he had adjusted to the braces and walked comfortably.  When we got home, he crawled and cruised with no complaints.  We will work him up to wearing the braces for longer periods of time, but for now, we are starting at 1-2 hours a day while he’s playing.  The goal is for him to wear the AFO’s during most of his periods when he’s standing, cruising or working on walking.  He will not wear them for sleeping or rest.  We do need to get to the store to buy some more socks that will go higher than the brace.  Amy, mom to the adorable Ailyn Rose has recommended Target store brand socks that are $1.50 each.  That’s a much better deal than the $15-20 AFO specific socks on the market.  Old Navy Triple Roll Socks are another favorite for Amy and Ailyn.

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Owen’s AFO’s are hinged, which means his ankles can flex up, but not side to side. His PT has said, non-hinged AFOs are similar to walking in ski boots, so I’m glad he has the hinges.

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The shin strap is for stabilizing the AFO so it doesn’t move around while he walks. The lower strap is the more functional strap in terms of supporting the ankle.

20130409-121745.jpgBeing only a few hours in, I’m far from an AFO expert, so, PT’s and other’s with AFO experience, please add any thoughts or wearing advice that you have.  As we prepared family for Owen’s braces, I struggled to find a page that talked about AFOs in lay terms or showed pictures from a lot of angles, so I wanted to make that available on ANRC, but I know there are readers with much more advice than I have, so please share!  AFO’s are relatively common in the preemie world and we preemie parents are vultures for information.

© Copyright Tatum, All rights Reserved. Written For: Ain't No Roller Coaster

20 thoughts on “First Day with Ankle Foot Orthotics (AFO’s)

  1. I love Owens design! Jackson also has AFOs. Thanks for the suggestion on the socks. We did have trouble finding shoes to go over the braces. I found the Nordstrom kids shoe dept. was fabulous as they have worked with AFOs in the past and were helpful with what shoes fit the best.

    • Sara, Locally, Kid’s Feet was really good about it too. I got Owen’s shoes the day before we found out he was getting braces, but mentioned there was a chance he’d be getting them and the shoe they recommended worked perfectly (thank goodness!). Which brands of shoes do you use for Jackson? Owen’s are http://www.tsukihoshi.com/

    • I’m glad it was helpful, Amy. I hope Molly adjusts to her braces well. Three days in and Owen still isn’t bothered by his. Fingers crossed for you too.

  2. Love the fish!!! I really hope he continues not to mind them. That is one huge struggle with us. I highly recommend Converse shoes! So easy to get on. And, you don’t have to buy super big. Welcome to the AFO world. Ailyn walks so much better in them…. When she wears them

  3. great photos and description of the process. I love the fish design on Owen’s AFOs!! My mom, who is a pediatric PT, was up visiting last week so when Virginia’s PT was here on Friday we were discussing putting her in SMOs. Even though I have seen and heard about AFOs through my mom, your post was super helpful.

    I second the Nordstrom recommendation too. In addition to being generally awesome, they will also sell you shoes in different sizes which is especially helpful for kids that only need one brace.

  4. Tatum, we have Geox shoes but the brand you mentioned looks great. I will have to check out that store. Jackson’s feet grow so fast!

  5. The fish are gorgeous! Great summertime print. We wear night-night shoes, but I like the Falls Creek brand bobby socks. They come in toddler sizes and are very light weight. Maybe my son just has sweaty feet, but these seem to work best for him. His type of AFO is only mid calf, so they may not be tall enough. Meijer stores and I think maybe Target carry this brand.

  6. Just found your blog and it is wonderful! My son Parker was born 2 days past his due date and I was induced because of low amniotic fluid. When he was born his muscle tone was extremely stiff and I automatically thought CP. Since then everything has loosened up except for his lower extremities. We still haven got a diagnosis of CP from his pediatrician or specialist. The specialist says its a sensory disorder. Parker will not get off his tip toes. We have been through a round of serial casting and he got his first pair of afo’s the first of Jan. this year. Parker is now 20 months old and still isn’t walking. We go the first of July to be molded for a different kind of afo called the noodle. The specialist said it will not be as restrictive and she’s hoping that this kind will get him walking which he is so close. Going into the first week with his afo I didn’t know what to expect and would have loved to have gotten tips and info from other mommy’s that had dealt with them. Just wanted to let you know this blog will be wonderful for anyone taking care of a child/toddler with afo’s. also I have found Striderite shoes to work the best with Parker’s afo’s.

    • Hello Bittney, Thank you for introducing yourself and you son, Parker. I’d love to see pics of the Noodle AFO. Let me know how it does. Thanks too for the Striderite tip, we’re going to be in the market for another pair of shoes soon.

  7. Headed to pedi orthopedic today for a toe walking eval. My little one is almost 5. Thanks for this I feel slightly better now that I at least have an introduction as to what is to come. Thanks!

    • Vikstik, I hope the appointment went well and am happy to hear you’re feeling a little more prepared. Thank you for leaving your comment!

  8. Can I ask who you saw at Gillette for the eval? Louie is set to see a Dr. Stiff (physical medicine) in a few weeks- I think it is a resident. It seems to take a long time to get an appt so I took the first one available. Lou isn’t walking yet so it will be interesting to see if he needs AFO’s as well.

    • Dr Ward is Owen’s PM&R dr at Gillette. Good luck w/ your appointment. From what I hear, they all are good there. You can also keep calling scheduling to see if there are any new appts available – in case of cancellations. I love Gillette – but their scheduling is not their strong point.

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  10. I have found that Childrens XW NewBalance are perfect for AFOs. Just remember to take the sole insert out so that it is deeper for the orthotic to fit in it. And order 1 size up

  11. Love this blog – Im in Cape Town , South Africa and my four year old CP daughter , who can only crawl will be getting her AFO’s next week . Very excited about it , cant wait for her to take her first step

  12. Thank you for this information. My daughter just turned three and we have an appt to get casted Friday for her AFOs because she is a toe walker. Hopefully this will help! Thank you!

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