Patient Care questions can be directed to:
Pediatric Orthotic Specialists strives to work
within the health care community in a team approach to achieve the best
outcomes for our patients. All patients requiring orthotic care should
be evaluated by a physician who is trained to determine appropriate
Question: A school nurse from Grand Rapids wrote:
Why are AFO (Ankle Foot Orthosis) straps sometimes made to fasten where children can't easily reach them?
Answer: The strapping system on AFO's are a critical element in the overall fit and function of the orthosis. When we design a strapping system for a particular patient, we have to consider the patient's tone, type of orthosis and specific pressures that will be exerted within the orthosis. The straps need to hold the patient's foot snugly down and in to the orthosis. If the straps do not hold snugly or exert too much pressure in a small area, a variety of problems could be occur.
The child's foot must be maintained all the way down and in to the orthosis for the following reasons.
1. Many AFO's are designed to maintain the ankle joint at a 90 degree angle. This allows the patient to have their foot flat on the floor while the leg is vertical. It also keeps the calf muscles stretched out to prevent a loss of Range Of Motion (ROM). If the child is able to plantar flex (pull their heel out) within the orthosis, Some children will have an increased risk of loosing ROM.
2. The orthoses that we make are designed to maintain the bony alignment and structure of the foot and ankle. If the patient is able to move their foot around within the orthosis, there is a likelihood that they may be coming out of alignment. A lack of being held in alignment is a possible culprit for pressure areas at various bony prominences, loss of ROM, loss of proper joint movement, discomfort, abnormal strains on more proximal joints, increased 'tone' and possible development of deformity over time.
3.Pistoning can also occur when the strapping system does not hold the patient's foot into place. Pistoning is a term that describes vertical movement of the foot within the orthosis. Pistoning can cause blisters and callous formation on the back of the heels It can also cause increased pressure where the straps are located across the top of the foot. The foot pistons into the strap with more force than would be needed to simply hold it down.
In Summary... Holding the heel down and in to the orthosis is the primary focus for any strapping system that we make. Along with that are other concerns such as simplicity of use, fitting into a shoe, and durability.
Many children are not able to adequately strap on their own AFO's due to tone, tightness, lack of dexterity, understanding the importance, etc.
However, In those instances where children are able to put on their own orthoses correctly, We will certainly try to design a system that they will be able to use.
We try to ask parents about this issue at the evaluation or casting appointment so that we can make the necessary accommodations. If you know of a patient of ours that you believe could don his/her own orthosis correctly, please have the parents call our office and we will be happy to adjust what we can to facilitate them.
Question: A Physical Therapist from Grand Rapids wrote:
Do you do upper extremity and spinal orthoses as well as lower extremity orthoses?
Answer: We do not do any upper extremity orthoses. We will do spinal orthoses, but only for patients for whom we are also treating the lower extremities.
We are very focused on lower extremities and we are proud of the design, craftsmanship and quality that we are able to devote to each lower extremity patient. It is because of our focus and specialization that we are able to achieve the results that our patients deserve.
Question: A Physician from Chicago asked- What is a Rooster Boot? A mutual patient mentioned one to me.
Answer: The Rooster boot design is a custom, dynamic night stretching orthosis for children that have a loss of range of motion in their calf muscles(heel cords). They have been developed and refined over the last 6 years by Pediatric Orthotic Specialists of Grand Rapids, MI.
The orthosis is fabricated to comfortably hold the patient into subtalar neutral or 'congruent' positioning of the foot and ankle in order to insure that the stretch being applied is focused onto the effected muscle groups and not placing a further strain on already compromised ligaments and intrinsic structure of the foot.
Patients undergo a thorough evaluation to determine the exact position for the “corrective casting” that is used to create the model from which the orthosis will be made. Along with their corrective casting, Pediatric Orthotic Specialists uses two types of dynamic ankle joints to provide an adjustable stretch into dorsiflexion. The amount of tension on the joints is able to be adjusted for maximum stretch while keeping the patient comfortable in the orthosis. The configuration of the ankle joints also allows for automatic adjustment as the patient gains or looses range of motion.
In addition, Pediatric Orthotic Specialists uses a unique process for fabrication which involves overlapping components and padding which provide total contact throughout the foot and ankle for maintaining correction in the bony alignment while greatly reducing pressure areas.
The use of Rooster boots have demonstrated success in increasing range of motion for a variety of diagnoses ranging from severe burns, muscular dystrophy, cerebral palsy, spina bifida and many others. The success of the Rooster Boots have postponed or eliminated the need for tendon lengthening surgery in many cases.
Some pictures are located on the 'orthotic designs' page of this site.