Orthotics

Orthotics come in many different forms as described below. They can be both “off the shelf” or custom made and are usually externally worn devices that aim to treat, prevent or support the position of the foot or lower limb.

There are several different types of orthotics. These include:

• Custom insoles
• Ankle foot orthosis
• Knee, ankle foot orthosis
• GRAFOs
• Shoe raises
• Rocker soles
• Gaiters
• Night or resting splints
• Off-the-shelf orthosis

• Custom insoles ​
• AFOs ​
• KAFOs ​
• GRAFOs ​
• Shoe raises ​   
• Rocker soles  ​
• Gaiters ​
• Night / resting splints ​
• Off-the-shelf orthosis

Ankle Foot Orthosis 

An Ankle Foot Orthosis or AFO is a custom splint for your lower leg. It is designed to control the movement in the foot and ankle.  

AFOs can be prescribed for a number of reasons:  

• To make walking easier  
• Keep your foot or ankle in a better position  
• To support a weakened or affected muscles  
• To reduce the risk of falls  
• To reduce pain

Knee, Ankle Foot Orthosis

If your child requires more support, they might benefit from a KAFO (knee, ankle foot orthosis). As the name suggests, a KAFO comes up over the knee, providing more stability while still allowing movement of the knee joint.  

Dynamic Ankle Foot Orthosis 

A DAFO (dynamic ankle foot orthosis) is an orthotic that supports the foot and ankle only. They typically fit like an ankle boot, providing flexible and thin external support for the ankle.  

Insoles 

• Your child will only be seen in this clinic if open to the physiotherapy Service.
• Your child will be referred to this clinic by their physiotherapist.
• This clinic is run in conjunction with an external orthotics company. Your child will be seen in clinic by an orthotist and physiotherapist. This joint approach allows us to provide the best orthosis to fit the child or young person's functional needs.
• The clinic is run every two weeks on a Tuesday between 9am and 4pm. You will receive an appointment via appointment letter. Should you not be able to attend this appointment, please contact therapy admin on 0300 555 5965.
• Your child will have two appointments. The first is an initial assessment and taking casting or impressions. The second is a fitting appointment.

This clinic is for children or young people who are open to the Community Paediatric Physiotherapy team and have been referred by their physiotherapist.

Your child will be seen in clinic by an orthotist and physiotherapist. This joint approach allows us to provide the best orthoses to fit the child/young person's functional needs.

The clinic is run every two weeks on a Tuesday between 9am and 4pm. You will receive an appointment via letter.

Your child may require two appointments. The first is an initial assessment where casting or impressions are taken, and the second may be a fitting appointment. Your orthotics may also be fitted by your named therapist outside of this clinic. 

In their initial appointment your child will have an assessment that will consist of some or all of the following:

• Discussion with parent and child about current mobility skills and relevant equipment.
• Review of lower limb joint ranges.
• If your child is mobile, a review of their standing posture and gait pattern.
• If your child has previous orthotic provision, a review of this will be completed.

During the initial appointment your child may have an impression of their feet taken or casting (using plaster cast) completed. This will then be sent off to the factory for their orthosis to be made. Please see casting section below for further information on this.

Casting for AFO

• Your child will be sitting in their wheelchair or on a plinth. If your child is small enough, they can also sit on the lap of their parent or carer. You may need to distract your child during this process to keep them calm and still.
• A tubigrip sock will be placed on one or both legs, depending on which leg/s need orthotics. A flexible plastic strip is then passed down the front of the sock; this acts as a protective barrier so that the cast can be cut off later.
• The orthotist will place rolls of plaster in warm water. Once they have soaked for a short time, the orthotist will begin wrapping the plaster around your child’s leg. This will not be painful. The orthotist or physiotherapist may also need to hold your child’s leg in a certain position to ensure sure the casts are taken at the correct angle.
• Once the plaster is dry, the orthotist will use a scalpel or scissors to cut it off; this will run along the line of the plastic strip placed into the sock earlier in the process. The blade will not go near your child’s skin or hurt them, but they may need reassurance about this.   

What should my child wear for Orthotics clinic appointment?

• We recommend shorts or leggings. If they are wearing trousers, these should be easy to roll up to allow the physiotherapist and orthotist to review foot posture and position.
• We will ask your child to remove their shoes and socks during this assessment.

What to bring to my orthotics appointment?

• Any current orthosis
• Mobility aids if used
• Suitable clothing (shorts where possible) ​

How quickly will my child receive their orthotic provision?

For most orthotic provision, you should expect a two-week turnaround between the initial casting appointment and the fitting appointment.

Should your child’s orthotic provision be more complex, there may be an additional two weeks added to this to ensure that the factory has adequate time to produce this to a high standard.

Please note for KAFO provision, there will be two fitting appointments.

Will my child needs orthotics forever?

Every child is different. Your child’s need for orthotic provision is likely to change throughout their life. Some children only require orthotics for a short period of time and others need them into their adulthood.

Questions about your child specifically should be taken to your child’s therapist, however, as mentioned above the need for orthotics can change.  

My child has grown out of their splints/insoles, what do I do? 

If your child is under the care of a physiotherapist at the Child Development Centre, you should contact them as soon as possible to let them know. They will add your child to the waiting list to be seen in clinic for new splints. 

What happens if my child has orthotics and is discharged from physiotherapy?

Should your child be discharged from the physiotherapy service, your child’s orthotic provision will no longer be completed at the Child Development Centre. Upon discussion with your physiotherapist a referral will either be completed by them, or GP to the orthotic service at Peterborough City Hospital.

My child’s splints are really uncomfortable or causing red marks, what do I do? 

If your child has attempted to wear their new splints a few times and is finding them really uncomfortable and complaining of pain, let your child’s therapist know. The same can be said about splints leaving marks. After taking off the splints, some redness is normal. However, this should disappear within 5-10 minutes. If the redness continues or the splints cause blistering or skin breakdown, inform your child’s therapist as soon as possible.