By Marilyn Johnson

As posted to the email support group (Marilyn is a pharmacist)

Many orthotists will ask what color you want, "white" or "flesh." I tried the flesh tones first–and was disappointed. Their flesh color did not match mine, and I could not find knee-highs that had the same color either. So the next time around I asked for white. When you wear white knee highs with the white or somewhat clear plastic brace, the braces don’t stand out. Now granted, this is more important to females wearing dresses, skirts, or shorts. Try to get both AFO’s made at the same time–different lots of the plastic used will be slightly different in color. It seems reasonable to ask for white straps if you opt for the white braces, but white does tend to get dirty–and show it–and the straps cannot be taken off and washed! The straps have Velcro fasteners. Unless you have them folded over so the sticky Velcro is not exposed when putting the AFO’s on and taking them off, you are apt to snag nylons and rayon/nylon type shirts/slacks.

Considerations other than "vanity" – Different types of AFO’s:

1. The complete, solid unit–no hinge at the ankle. It is harder to drive with these, but you can still do it if you slide your foot up and down the gas pedal instead of pressing against the pedal. The ankle does not move much in this type, and might be more prone to swelling due to the inactivity. A "normal" person walks heel first, kinda rolling forward onto the ball of the foot and toes. There is a "spring" at the end which tends to lift the toes off the ground. It is harder to make yourself walk heel to toe with the solid variety, but it can be done. One of my physio’s retrained me in walking with the old variety but said I needed the hinged model. I kept training with the old model until the new ones were made. She was surprised to see how well I did with the old model just before the new ones! But the new ones seemed less tiring to me.

2. The hinged at the ankle variety. These may come in two styles–I asked for a spring in the hinge after getting the one with the ankle stop (you can pull your ankle up, but your foot can’t drop below 90 degrees. Why you can drive easier since you still can’t really "push down" I haven’t figured out, but there seems to be a little give if you actually push!). My request for a spring to help lift my toes was denied because I had a lot of "recurvatum"–when your knees snap back as you walk. The spring would make that worse–injuring the knee cap and increasing the instability causing falls. The ankle stop in one set was adjustable but is fixed in my present set. The adjustable one kept getting out of place, so I am having better luck with my present one. But, if you have very tight or short Achilles tendons, making it impossible to hold you foot at a 90 degree angle to your leg, and you are now stretching them or have more relaxation and are seeing an improvement getting to that point, you might want the flexible stop. It is set at a given point, and can be adjusted as improvement occurs. But ng, making the toes drag a little.

Which brings up fitting:

1. Wear shorts when you go in for fitting: They wrap a plaster gauze around your legs, let it dry, and then "saw" it in such a way they can take it off! Kinda messy but not uncomfortable. But you can’t do it while wearing slacks unless the legs are wide enough that they can be pulled up far above the knees comfortably. Coulottes and shorts work. You will probably want to go home and shower to get the stuff all off–don’t plan on going straight to work!

2. To prevent foot drop, the AFO must be made so there is a 90 degree angle at the foot/leg part. If when you are sitting down (some do this with you on a table and your legs hanging down) your foot wants to drop, then the orthotist must hold the foot in place while he wraps your foot/ankle. He will want to hold the arch where it should be, and hold the foot so it points straight instead of out to the side or inward. The goal is to get the foot in the position it should be in. NOTE: If this is not the normal position your foot is in, it will not feel comfortable the first few days–it is important to wear the AFO’s only a few hours at a time at first to give your foot a chance to behave for awhile and then rest a bit. If you still cannot wear the AFO’s for more than 3 hrs at a time after a week or two, it is time to go back for an adjustment: For instance–my feet have high arches that collapse and ankles that roll in. My grandma ended up walking on the inside of her ankles! My ankles rubbed against the brace and caused too much irritation. Inserting padding and placing a strap just above the ankles worked. Extra padding in the arch area has also been helpful with a previous pair. Even though they are custom made, mine have never "fit right" the first time they are put on–adjustments were always necessary. 3) I have found that in my case the higher the brace goes up the calf, the less recurvatum (snapping knees) I had. Short AFO’s just would not work. But they can only go so high–shouldn’t go much higher than knee-hi knees scraped together–"kissing knees") that I needed long-leg braces, which I am currently wearing. Mine have a custom strap around the inner leg instead of a knee hinged on the inside of the leg (only one knee hinge on the outside–).

Oh–what to wear when wearing these silly things. You won’t be able to wear your old shoes. You need a larger size, and a wider width. You also do better with extra depth. It also helps if the shoe has a longer "last"–I don’t know if that is the correct word for what I mean: a longer tongue area so you can get the foot into the brace when it is in the shoe! Now, you can buy extra depth shoes that are wide enough and big enough and spend a fortune. If you are a female, you can buy men’s joggers (I am currently using McGregor’s from K-Mart) and take out the insole. I prefer shoes with Velcro straps instead of laced shoes as they are much easier to get on and off! The Birkenstock sandals with their straps work for one of us–I would be afraid to use it in my case because my ankles roll so. A regular oxford just doesn’t work in my case, but my brother uses them. (But with the newest AFO’s he can’t get his shoes on!!) I found that wearing two pairs of socks–knee his along with footlets or a thin anklet reduced irritation on my feet a lot. The fabrics would slip together and keep my foot from rubbing the AFO. I think you do need knee-his or calf-length hose for men when wearing these–provides more "breathing" and less friction against the plastic. Some orthotists place a special liner on the inside of the AFO for the whole thing. That provides a softer surface, but you still need the full length sock. Some find the porous stuff hard to clean when they have "accidents" but water and baking soda have worked fine for me.

Saturday, September 8th, 2012