Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 - Here's my feedback on using a hybrid AFO FAB based on our experience w/ an AFO prior to switching to Dr. Ponseti's care. We had two styles of AFO that we used, one was a " clam shell " type with two pieces; one fit the back and bottom of her foot and then the front/top half clamped on and was held together with velcro straps (like a two-piece ski boot I guess), the other was just a half shell that went from the back of her calf down under the foot and past her toes and again, was strapped on with velcro. The sweating in the AFO was atrocious for my daughter (the two piece being worse than the one piece unit). She wore it during cooler weather- I can't imagine how much worse it would have been during the dog days of summer! They did drill air holes in the plastic, but it did little to alleviate the sweating problem. As an aside- she wasn't what I'd consider a sweaty or " warm " baby either. We did deal with sweat issues in the leather Markell shoes also, but it was minor compared to the plastic AFO. I don't see how a custom molded AFO would be more economical than the Markell shoes or sandals. The plastic AFO would tend to be outgrown faster in my mind versus the shoes which conform to the foot, yet the material " gives " allowing for the foot to grow. You don't have this option with the plastic mold (and if it's made " large " to accomodate growth it might not fit the smaller foot properly, allowing slippage). We also had issues with detecting and correcting pressure points with the hard plastic since my daughter couldn't tell us where it touched or rubbed her foot so I had to have her wear it and then see if there were any spots irritating her- which meant lots of trips to the orthotist to work out the bugs on the newly molded braces. I would also be concerned about the affect that the AFO had on the calf muscle over time. About taking the standard Markell shoe brace on and off- I had no problems doing it by myself without an extra set of hands. I think using an AFO on the FAB is a great idea for children who have additional defects to their feet which make standard shoes or sandals more difficult to keep on the foot. For example, perhaps this concept would work better than the shoes for a child who is missing bones or toes. A narrower foot structure might benefit from the custom molded AFO. The other downside that I see to using an AFO is that when a child's foot is ready for the next size, you have to have the mold made (which in our case involved casting, then using the cast as a mold), then wait for the actual plastic piece(s) with the straps to be made by the orthotists. This is a time-consuming process that might not be bad for a " local " patient, but would be a pain for those who are traveling from out of town. At the time that was in the AFO, I lived an hour away from the orthotist and I was *constantly* driving there and back for fittings. I hated the orthotists by the time it was all over- though much of our problem was of course caused by the fact that her foot wasn't corrected either! I assume this custom molding/fitting process is also true for the sandals, but for the Markell shoes, they're a standard item on the shelf. That's my two cents! & (3-16-00) left clubfoot, switched to Ponseti method at 4 mo. old Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Thanks for your input! You bring up some valid points, esp. the economical one, our insurance is picking up 100% of the AFO's and brace so I guess that part is not affecting us, but I'm sure that wouldn't be the case for everyone. The orthotist said that the hard plastic shell part would probably last Sammy about a year or more, depending on how fast his feet grow. The softer plastic insert which is made with a mold will have to be re-made about as often as you would need shoes (and yes, you do have to allow about 2 weeks for it to be made). As far as pressure points we haven't had any, I think the softer inside " bootie " prevents the hard plastic shell from digging into their skin?? Thanks again for your comments, I'm working on compiling what everyone says to give to Dr. Dobbs as suggestions. > > - > Here's my feedback on using a hybrid AFO FAB based on our experience > w/ an AFO prior to switching to Dr. Ponseti's care. We had two > styles of AFO that we used, one was a " clam shell " type with two > pieces; one fit the back and bottom of her foot and then the > front/top half clamped on and was held together with velcro straps > (like a two-piece ski boot I guess), the other was just a half shell > that went from the back of her calf down under the foot and past her > toes and again, was strapped on with velcro. > > The sweating in the AFO was atrocious for my daughter (the two piece > being worse than the one piece unit). She wore it during cooler > weather- I can't imagine how much worse it would have been during > the dog days of summer! They did drill air holes in the plastic, > but it did little to alleviate the sweating problem. As an aside- > she wasn't what I'd consider a sweaty or " warm " baby either. We did > deal with sweat issues in the leather Markell shoes also, but it was > minor compared to the plastic AFO. > I don't see how a custom molded AFO would be more economical than > the Markell shoes or sandals. The plastic AFO would tend > to be outgrown faster in my mind versus the shoes which conform to > the foot, yet the material " gives " allowing for the foot to grow. > You don't have this option with the plastic mold (and if it's > made " large " to accomodate growth it might not fit the smaller foot > properly, allowing slippage). We also had issues with detecting and > correcting pressure points with the hard plastic since my daughter > couldn't tell us where it touched or rubbed her foot so I had to > have her wear it and then see if there were any spots irritating her- > which meant lots of trips to the orthotist to work out the bugs on > the newly molded braces. > I would also be concerned about the affect that the AFO had on the > calf muscle over time. > About taking the standard Markell shoe brace on and off- I had no > problems doing it by myself without an extra set of hands. > > I think using an AFO on the FAB is a great idea for children who > have additional defects to their feet which make standard shoes or > sandals more difficult to keep on the foot. For example, perhaps > this concept would work better than the shoes for a child who is > missing bones or toes. A narrower foot structure might benefit from > the custom molded AFO. > The other downside that I see to using an AFO is that when a child's > foot is ready for the next size, you have to have the mold made > (which in our case involved casting, then using the cast as a mold), > then wait for the actual plastic piece(s) with the straps to be made > by the orthotists. This is a time-consuming process that might not > be bad for a " local " patient, but would be a pain for those who are > traveling from out of town. At the time that was in the AFO, > I lived an hour away from the orthotist and I was *constantly* > driving there and back for fittings. I hated the orthotists by the > time it was all over- though much of our problem was of course > caused by the fact that her foot wasn't corrected either! I > assume this custom molding/fitting process is also true for the > sandals, but for the Markell shoes, they're a standard item > on the shelf. > That's my two cents! > > & (3-16-00) > left clubfoot, switched to Ponseti method at 4 mo. old Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2005 Report Share Posted January 28, 2005 Jenni, Thanks for your input! > > >- > >Here's my feedback on using a hybrid AFO FAB based on our experience > >w/ an AFO prior to switching to Dr. Ponseti's care. We had two > >styles of AFO that we used, one was a " clam shell " type with two > >pieces; one fit the back and bottom of her foot and then the > >front/top half clamped on and was held together with velcro straps > >(like a two-piece ski boot I guess), the other was just a half shell > >that went from the back of her calf down under the foot and past her > >toes and again, was strapped on with velcro. > > > >The sweating in the AFO was atrocious for my daughter (the two piece > >being worse than the one piece unit). She wore it during cooler > >weather- I can't imagine how much worse it would have been during > >the dog days of summer! They did drill air holes in the plastic, > >but it did little to alleviate the sweating problem. As an aside- > >she wasn't what I'd consider a sweaty or " warm " baby either. We did > >deal with sweat issues in the leather Markell shoes also, but it was > >minor compared to the plastic AFO. > >I don't see how a custom molded AFO would be more economical than > >the Markell shoes or sandals. The plastic AFO would tend > >to be outgrown faster in my mind versus the shoes which conform to > >the foot, yet the material " gives " allowing for the foot to grow. > >You don't have this option with the plastic mold (and if it's > >made " large " to accomodate growth it might not fit the smaller foot > >properly, allowing slippage). We also had issues with detecting and > >correcting pressure points with the hard plastic since my daughter > >couldn't tell us where it touched or rubbed her foot so I had to > >have her wear it and then see if there were any spots irritating her- > > which meant lots of trips to the orthotist to work out the bugs on > >the newly molded braces. > >I would also be concerned about the affect that the AFO had on the > >calf muscle over time. > >About taking the standard Markell shoe brace on and off- I had no > >problems doing it by myself without an extra set of hands. > > > >I think using an AFO on the FAB is a great idea for children who > >have additional defects to their feet which make standard shoes or > >sandals more difficult to keep on the foot. For example, perhaps > >this concept would work better than the shoes for a child who is > >missing bones or toes. A narrower foot structure might benefit from > >the custom molded AFO. > >The other downside that I see to using an AFO is that when a child's > >foot is ready for the next size, you have to have the mold made > >(which in our case involved casting, then using the cast as a mold), > >then wait for the actual plastic piece(s) with the straps to be made > >by the orthotists. This is a time-consuming process that might not > >be bad for a " local " patient, but would be a pain for those who are > >traveling from out of town. At the time that was in the AFO, > >I lived an hour away from the orthotist and I was *constantly* > >driving there and back for fittings. I hated the orthotists by the > >time it was all over- though much of our problem was of course > >caused by the fact that her foot wasn't corrected either! I > >assume this custom molding/fitting process is also true for the > > sandals, but for the Markell shoes, they're a standard item > >on the shelf. > >That's my two cents! > > > > & (3-16-00) > >left clubfoot, switched to Ponseti method at 4 mo. old > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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