Question
My four year old daughter was recently fitted for her second set of AFO's.  She has tight heal cords.  Her foot is about ten degrees off from a nuetral position.  She wore the first set for about 4 monthts, started having issues with fit, quit wearing them and she is still walking on toes!  We recently got the new AFO's and they are so huge compared to her others.  Her first set fit like a glove - she wore them for 5 hors the first day and then wore them all the time after that.  This second set seems like they don't fit at all.  I am obviously going in for another fitting because she can't wear them, but I don't know if I have any confidence in this place.  Aren't AFO's supposed to be fitted like a glove?  Her new ones have all kinds of room around her ankles and the sides of her feet, her heals are lifting, I had to buy a shoe 2 sizes too big to fit them in.  Also, I am curious about your suggested treatment for toe walking?  We have also tried PT.

Answer
Hi Donna,

You are on the right track.  For toe-walking physical therapy is important but more vital is continued home exercising and stretching.  Your therapist should be able to assist with the exercises.  And yes, the AFO needs to be very exact and should be adjusted or remade if the fit is not perfect.  In some cases Achilles lengthening procedures are performed if the above measures have failed.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
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