Ankle-foot orthoses (AFOs) are among the most commonly prescribed lower limb orthoses. They are custom made for each individual to encompass the foot, ankle and leg, finishing just below the knee. Made from high temperature thermoplastic AFOs are supplied to combat a variety of factors, these may include muscle weakness, joint instability and high muscle tone.
 
Fitted with a variety of purposes in mind including controlling alignment, increasing mobility and independence, assisting rehabilitation and/or to reduce pain, AFOs are also provided with the intention of preventing deformity occurring. Depending on a child's needs they may be hinged (made to bend at the ankle) or solid (no movement at the ankle) and fitted on either one or both legs. This information sheet aims to inform parents and carers what AFOs are, what they do, what to expect in a casting, fitting and review appointments and how to care for both the child and the AFO.    

AFO Prescriptions

In order to receive an AFO a valid referral is required, both public and private referrals are accepted however private patients are subject to fees for both the orthoses and clinical time. Once a referral is gained an appointment will be made for casting of the AFO.

Casting Appointment

On the appointment day it is essential for the clinician to assess the lower leg; this means either wearing clothing that finishes at or above the knee or pants/skirts that can be rolled up above the knee. During this appointment the clinician may ask you to walk and also test ranges of motion of the leg and foot to ascertain your functioning capabilities and typical walking pattern.

A 'negative' cast will be taken of the leg/s as required by rolling plaster bandage around the leg, waiting until it sets (3-6 minutes), and taking it off again. From this cast your AFOs will be made. The production process takes 3-4 weeks until the AFOs are ready to fit. An appointment to collect your AFOs will be made on the day of casting.

Fitting Appointment

A few things are required at your fitting appointment, these include:

• The lower leg should be exposed or easily accessible, similar to your casting appointment.
• Bring along knee high socks that fit well and are relatively wrinkle free.
• Bring your current runners or school shoes.

At this appointment the AFO has been roughly trimmed to fit your leg and will require some adjustment and addition of straps before the final fitting and completion of your orthoses. This occurs on the same day. The total process should take from 40-90 minutes, with the clinician leaving the room for periods of time to do any modifications. You may wish to bring along a book, electronic game system, personal listening device or the like to pass the time.

AFOs At Home

Fitting an AFO

Here are a few points for fitting and wearing an AFO

• Your child should wear knee high cotton socks or tights under the AFO, this will reduce any rubbing. 
• If your child has an AFO for each foot, make sure that you are putting them on the correct feet. 
• When you put the AFO on your child, bend their knee to 90 degrees (a right-angle) or more and push the heel down and back into the heel of the AFO. It can help to gently lift your child's toes upwards to check that his or her heel is right down in the heel section of the AFO. 
• Firstly fasten the ankle strap firmly, then the calf strap. Make sure all the straps are fastened securely. 
• Once the AFO is on, your child's shoe can now be worn over the orthoses and your child's foot.
• Your child should always wear shoes or runners with the AFO unless he or she only wears them in bed. Runners are ideal as they are wider and deeper than normal shoes. You may need to remove the insole to give you extra room.
  
  

Removing the AFO

When you remove your child's AFO, always check his or her skin. Sometimes AFO's cause a slightly red line around the edge of the orthosis, but this should disappear within half an hour or so. If your child has any pain or skin marks that do not disappear within half an hour or develops blisters, you should contact your orthotist as soon as possible.

Looking after the AFO

The AFO should be regularly cleaned by wiping with a damp cloth and soapy water. After cleaning, it should be completely dry before being reapplied. Do not use a heat source, e.g. hair dryer or tumble drier to dry your AFOs.

It is not uncommon that straps or padding become worn or break. Contact the department as these are only minor repairs and can often be completed quickly.

Similarly if you think your child is outgrowing the AFO also contact the department to make an appointment. It takes two or three weeks to get an appointment and two or three weeks to make an AFO, so call in plenty of time.  

Don'ts with AFOs

• Don't cut, file, heat or damage your AFO(s)
• Don't wear socks with wrinkles or that have a 'lumpy' texture
• Try not to wet the straps when washing your AFO(s). If required towel dry straps only.
• Do not leave AFO(s) to soak or attempt to dry it with heat, e.g. hair drier, direct sunlight.

For more information

Please contact your orthotist if you have any queries or concerns regarding your child's treatment with AFOs

Royal Children's Hospital
Orthotic and Prosthetic Unit
Flemington Road
Parkville 3052

orthotic.prosthetic@rch.org.au

Tel: (03) 9345 9300

Produced by the Royal Children's Hospital (RCH) department of Orthotics.

Disclaimer: The information contained on the site is intended to support not replace discussion with your doctor or health care professionals. The authors accept no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.