Written by Sarah Peavy, SPT from Elon University
Information:
Orthotics are commonly used for children to assist with mobility and range of motion. There are many different ways that orthotics can be used depending on the individual needs of the child wearing them. Two of the most common types are Ankle Foot Orthotics (AFOs) and Supramalleolar Orthotics (SMOs). AFOs affect joint kinematics at the ankle joint and have a limited effect on knee kinematics. This means they have an effect on all directions of ankle motion and some motion at the knee. SMOs may be good for controlling valgus or varus foot tendencies, but it will not control plantarflexion or dorsiflexion. This means that SMOs are good for controlling the side to side motion of the foot/ankle only.
Commonly used Orthotics:
AFO | SMO |
 |  |
Ankle Foot Orthotic | Supramalleolar Orthotic |
Ankle control in all directions and helps maintain the foot in a neutral position when standing. | Side to side foot control and helps maintain the foot in a neutral position when standing. |
Important Things to Know:
Fit:
Once orthotics are recommended for you child, typically by a physical therapist or a doctor, a licensed orthotist will come and measure your child's foot. They will then have an orthotic fabricated to the exact measurements and specifications for your child's needs. The orthotics will be delivered and assessed on your child and small adjustments are made to ensure the perfect fit. They will also, often times, make a line with marker on the strap of the orthotic to indicate the correct spot to pull the strap to for the optimum level of tightness across the top of the foot.
How to Put the Orthotics on:
Start with socks, usually any sock will work, but when you receive a pair of orthotics, they often will give you sweat wicking, seamless socks which are great for orthotic use. Next, choose the correct orthotic for the foot (i.e. left orthotic for the left foot). Many times they are labeled, this may seem intuitive, but can be tricky in the beginning. Now, open the side flaps (they are made of flexible plastic and should pull apart to fit your child's foot), and place their heel into the heel slot and ensure it is pushed all the way back. To check if the heel is in the proper place, place the foot in the orthotic on the floor then push down on the child’s bent knee. If you do not feel it moving around, it is seated properly. Loop through and tighten the middle strap that goes right under the bend in their ankle first, then bring that strap all the way to the marked line on the orthotic. Secure the other straps (toe strap and shin strap if present) and the orthotic is now on correctly.
Risks for Issues:
Problems can arise for a few reasons: the child's foot is not seated properly in the orthotic, the orthotic is on the wrong foot, or the orthotic is too small. In all instances friction can occur between the skin and the orthotic (even if they have a sock on). Friction can cause a blister which will result in the inability able to wear the orthotic until it heals. This often decreases the child's quality of movement and increases some children's risk for falls. If blisters are a recurring problem, the orthotic may be too small and your child may be due for new ones. If blisters or redness is happening consistently, contact the physical therapist that is seeing your child to assess and decide best course of action.
Skin Inspection:
Before putting on and after taking off orthotics, it is pertinent to check the skin for any redness or blisters. If you note redness that persists for longer than 30 minutes, do not put the orthotics back on. If there is a blister, do not use a band aid with the orthotic as it will most likely cause more friction making the blister worse, or causing an open wound. In either case, leave the orthotics off and repeatedly check the skin for healing. If you have any questions, reach out to the PT working with your child as they may have different tips and tricks to help you navigate life in orthotics!
Resources
Liu XC, Embrey D, Tassone C, et al. Foot and ankle joint movements inside orthoses for children with spastic CP. J Orthop Res. 2014;32(4):531-536. doi:10.1002/jor.22567
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