Ankle and foot orthotics

What is an ‘Ankle Foot Orthosis’?

An Ankle Foot Orthosis, or an ‘AFO’, is an orthopaedic device worn around the lower leg, ankle and foot that offers support and correction to this region of the body - they are called Ankle Foot Orthoses because they control the movement of the ankle and foot. Sometimes referred to as ‘Splints’ or ‘Leg Braces’, AFO’s can be used to treat a wide range of conditions and presentations that affect these joints.

Ankle Foot Orthoses come in many shapes and sizes to suit your child's specific presentation - some AFO’s might have hinges at the ankle joint, specialist liners or straps or specially shaped or pitched footplates. Some are designed for increased stability, others to improve neurological feedback and some are even designed to give more energy return. Most AFO’s are made from thermoplastics, but they can also be made of many other materials such as carbon fibre, metal and/or leather.

Some children may need a pair of AFO’s, whereas others might need only one - every child’s orthotic needs are unique, and here at Children’s Orthotics we strive to offer your child the support they need, when they need it.

Why might my child benefit from the use of an AFO?

There are many reasons why your child might benefit from an AFO;

• Ankles instability leading to frequent trips and falls

If your child suffers from weakness or hypermobility at the ankle that causes them to often ‘roll’ or ‘go over’ on their ankle - they may benefit from the support an AFO provides. Due to their close fitting nature and rigid materials an AFO can offer much more support than any type of footwear - offering your child protection from the damage that can be caused by constant ankle strain and reducing their risk of frequent falls.

• Loss of range of motion at the ankle due to tiptoe walking

Children can begin tiptoe walking for a multitude of reasons - be it a sensory preference, or as a result of another condition they may have. Tiptoe walking can even occur without a direct cause, this is known as idiopathic tiptoe walking. Whatever the reason, tiptoe walking can cause a shortening (also known as contracture) in the calf muscles, making standing with their feet flat on the ground very uncomfortable - and in some cases - impossible. An AFO can help to preserve range of motion at the ankle joint, make walking a more comfortable experience for the user and can even contribute to the regaining of range of movement in some cases.

• Deformity

Whether your child was born with a limb difference, or they have developed one as a result of a preexisting condition, the use of AFO’s can help to hold your child in a more optimal position as they grow and develop. This will help them to walk more comfortably and reduce the risk and severity of further deformity.

• Pain when walking

AFO’s work to hold your child in a more biomechanically stable position. They also help to reduce the aches and pains associated with walking on a misaligned foot.

When might an ankle and foot orthosis be appropriate for my child?

There is not a standard age for the provision of an AFO, as children who need this type of bracing will benefit from wearing one at any age. Your orthotist may choose to advise the use of an AFO after first trialling less rigid devices, such as insoles and/or orthopaedic boots to see if these are sufficient for your child. This is a fairly common treatment pathway that is used to avoid ‘over-bracing’ - however if your orthotist feels that it is necessary, they may choose to bypass less supportive options and recommend an AFO straight away.

What conditions are ankle and foot orthotics often used for in Children?

This list of conditions is not exhaustive. If you are unsure if you would be suitable for ankle and foot orthotics please contact us to discuss.

What are the benefits of ankle and foot orthoses?

There are many benefits using AFO’s, which will differ depending on what your child needs their AFO for and on the type of AFO they have, but some common benefits are;

What types of Ankle Foot Orthoses are available?

There are two main pathways for AFO’s, these are ‘off the shelf’, or bespoke.

Off the shelf AFO’s are devices that are prefabricated. They are made out of specialist orthotic grade materials, they are not bespoke to your child - but they are specially designed to help with certain pathologies. This makes them a great and more economical option for those who fit within the indications for use of the device. Your child will still need to be assessed by one of our experienced orthotists to confirm suitability.

Bespoke AFO’s offer your child more personalised support, and achieve a closer fit. They’re made from casts of your child's feet and lower legs, capturing the shape of their specific anatomy. Bespoke AFO’s are advised when your child needs a bit more support, has more complex biomechanical needs/anatomy, or when they would benefit from a more highly personalised device.

There are several different styles of AFO that might suit your child, these include but are not limited to:

• Solid AFO

A solid AFO, also known as an ankle-blocking AFO, is a solid device that controls the ankle in all four of its available planes of movement (Medially/Laterally and Plantar/dorsiflexion - in plain english; side to side, and up and down).

• Hinged AFO

A hinged AFO might be given when your child needs support in the medial and lateral plane (to stop it rolling from side to side) and during plantarflexion (the action of moving the foot away from the body, for example going on to tip toes), but doesn’t need as much support during dorsiflexion (the act of bringing the foot up towards the shin).

• SMAFO

SMAFO’s, otherwise known as a Supra-Malliolar Ankle Foot Orthosis, offer less rigid support than either the solid or the hinged AFO - allowing those that are suitable for it more movement and a lower profile of device. A SMAFO extends just above the ankle bones (or the Malleoli), making it shorter than many other AFO devices.

• SAFO

SAFO’s, or Silicone Ankle Foot Orthoses are a soft, silicone device that work on principles of compression to achieve ‘dorsal pull’, lifting the foot in gait and offering gentle support. Due to the material, SAFO’s are easy to clean, safe for use in water, and are the only type of AFO that can be worn without a shoe on - making them a great option for active children who just need a little more lift.

• DAFO

A DAFO, or Dynamic Ankle Foot Orthosis, is a type of device designed most often for those with neurological conditions. DAFO’s are shorter than other styles of device, and often have a neurological footplate design.

• GRAFO

The GRAFO, or Ground Reaction Force Ankle Foot Orthosis is a type of AFO that is usually used to reduce instability at the knee joint, as well as at the foot and ankle, its design features support that wraps around the shin, rather than around the calf.

• PLS AFO

A PLS AFO, or Posterior Leaf Spring Ankle Foot Orthosis is a device that offers more energy return than other styles of AFO, they are not as highly supportive at the ankle but offer a fantastic solution for those children that would benefit from a little bit of extra propulsion.

• Night time AFO bracing

A night time brace can also be worn to bed inorder to stretch the muscles during sleep, offering a gentle stretch during the night. They tend to be more heavily lined than a daytime AFO, making them comfortable to sleep in.

How long will my child’s Ankle Foot Orthosis last them?

This is a very common question with a tricky answer - on average they tend to last from 6 months to a year, however so many variables affect the longevity of your child’s device that it really is impossible to tell. If your child is slightly older and their rate of growth has slowed down, there is a good chance that their devices will last them longer. That being said - if they are quite active and use their AFO’s for sport then there is a good chance that they will become worn out quicker.

The rate of your child’s growth, activity levels and how you, and your child look after these devices will all contribute to how long these will last your child.

What will happen at my child’s assessment appointment?

At your child’s assessment appointment our orthotist will accurately assess your child’s condition to establish the correct AFO for your child’s needs. This assessment will involve discussing your child’s symptoms, lifestyle and goals. Their walking will be observed and a full range of motion plus muscle power tests undertaken. The orthotist will then take this opportunity to take any casts or measurements they may need to order or manufacture your child’s devices.

What if my child is not suitable for an AFO?

At Children’s Orthotics we are always aiming to give your child the device that best suits their individual needs, your orthotist will use the assessment appointment as an opportunity to check whether an AFO is safe and suitable for your child. If they feel that it’s not the right device for them, your orthotist will make alternative suggestions of devices they think would be more in-keeping with your child’s needs and lifestyle. They will be able to explain their reasoning for this in the assessment appointment with you, and discuss any differences in pricings.

What will happen at my child’s fitting appointment?

Once their AFO’s are ready, your child will be booked in for a fitting appointment. At the fitting appointment our Orthotist will ensure the device fits your child properly, and is as comfortable as possible - if necessary they might make some small adjustments in the clinic. Once your orthotist is happy with the way the device fits, they will discuss how to wear-in their device properly. A few weeks after this fitting appointment, a review appointment will take place to check on your child’s progress with the device.

How do I arrange an assessment for an ankle foot orthoses?

To get in touch or arrange an appointment, you can call us at 0330 088 3949 or email office@orthotics.co.uk.