Afos are usually amyoplasia children’s first pair of shoes. They will begin to wear these immediately following club foot treatment. The tendency of the clubfoot is for the toes to curl back inward and the achilles tendon to tighten up causing the toes to point downward. It is very important that the AFO applied to your child fits properly and does not allow the heel to slip from firmly touching the bottom. This will allow the foot to plantar flex allowing the achilles tendon to tighten which could result in having to undergo another tendonotomy. Remove the AFO multiple times a day and stretch the foot into the dorsiflex position and hold once the foot stops. Consult with your doctor on how soon you can begin this stretch as the tendon will be weak following the last casting (done at the completion of the tendonotomy). This will keep the achilles stretched and lessen the chance of regression. It is also very important to keep the forefoot pushed outward by wearing the abduction brace (bar) while the child sleeps. If your child is walking allow them time out of the AFO and Bar to promote muscle strength. Being confined to the AFO for a prolonged period of time without excercise or circulation breaks can cause atrophy and muscle atrophy translates into a foot that is not strong enough to maintain correction. Massage the area as much as you can and E-Stim/Tens/Muscle Stimulation can also be used on the dorsiflex muscle group to counter the imbalance.
Applying the Ponseti Boot and Bar
Dobbs Bar “Dynamic Bar” (alternative to the static bar)