Prefabed Footplates for Pediatric AFO's -Summary

Prefabed Footplates for Pediatric AFO's -Summary

John Izak, CPO

I doubt Beverely Cusick would use pre-fabed foot plates, but I have a full
set of the Cascade DAFO Medium foot plates and use them on kids throught
adults. When ever possible with them sitting elevated in front of me and a
rigid platform to rest them on as I have my cast in place. I cast shanks
first then concentrate on the footplate or ankle down component of the cast.
I have a full length mirror on the wall to the side of my patient so I can
see the dorsi or plantarflesion positioning and I can then control the
hindfoot - forefoot relationship. I do not incorporate the plate inside my
cast but lubricate them with vaseline, so they don't stick, and then hold it
under the thin casting material on the foot. I had bad results getting my
footplates back from the labs I was using when they were an integral part of
the cast.

You can set a stroke patients foot directly down on the board and do any
needed corrections or in the case of a plantarflexed CP kid you now have a
firm plantar platform to hold onto while you manipulate the foot into the
best available position.

I use the Cascade DAFO trimming trough on all my casts with the modified
carpet layers inside hook blades in a utility knife. My cast saw has only
been used on one cast in the last year or so.

Hope this answers your question.

Robert A. (Bob) Bangham, C.O.,L.O
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We make all footplates after plaster of paris castings with a special
rectyfi called dafo , if you are more intersted in the technic please mail
again .

BR

Lars Falkenman
CPO
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First Billie Cusick is teaching in Brazil for the next few weeks.
Second I personally don’t use footplates, and I also don’t us orthoamerica
or cascades systems. There only one girl that I have ever casted in supine,
the rest of the kids are sitting. I think that the main point is finding the
position that the foot relaxes in. that could mean having the little guy
watch barney or big bird, or sitting in mom’s lap. Positioning can be knee
flex, maximal external rotation at the hip. Don’t comprise rotation
deformity for dorsiflexion. Reduce the amount of supination, or pronation
over getting dorsiflexion.
Most of the kids that I do have preparatory AFO’s done first, usually done
by the PT. There has been non that have to had surgery. Most of the kids
have had at least one Dr. tell them surgery is what is needed.

John Russell
3161 Putnam Blvd.
Pleasant Hill, CA. 94523
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I have used both of the available casting foot plates. Preferably I like the
finished product from Orthomerica over Cascade. The footplates are easier to
modify if needed prior to casting as well as capturing a better impression.
I have done hundreds of these types and have had better success with
Orthomerica. I have had to have several afo's redone do to ill fit when
using the Cascade system. None with the TC2 system. I hope this helps.

Mitch Presley Jr., LPO, BOCO
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I've used some of the pre-fab footbeds from Cascade but find I do a better
job by handcasting. I don't cast in supine but generally the child is held
by the mother or other caregiver. I primarily try to control the hind and
forefoot and if possible correct for DF/PF. I don't get too excited about
the DF/PF as I can modify my mold before filling. I use fibertape. Molly
Pitcher CPO
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I use Orthomerica and they work great. The footplate system works great
and keeps the PT's happy with the way it works. At least you know YOU can
take a good cast and will get back exactly what you want, not some
preformed pre-fabricated component. They are extremely easy to use and are
cast in a sitting position.

Don
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In response to your question- Firsly I work primarily with children-

I used to use cascades footplates in the past but after about a year I stopped
for a nunber of reasons:
It was good as a starter but building up the footplate was always necessary to
get the arches to the individual requirement - this is very time consuming ans
taxing on the childrens patience

I found that often the footplate would move a bit on the foot while I was
casting causing a lack of congruity between the foot and the plate and hence a
lack og alignment between the footplate/foot/ leg complex. - not exactly what
was desired.

We discovered over time that we can with correct casting get an excellent
contour with all the arches and with good allignment in the cast and of
course in our final product. ( I was a pediatric PT before I became an
orthotist so that this issue is very important to us )

As for the position - I used to cast in prone with a 90 flexion of the knee
cause I thought it gave me better control with the spastic child.
For the past 5 years I have been casting with the child sitting either
independently or on his parent. I found that the children were more
cooperative when they could see what was going on and/or felt more at ease on
their parents. When they are very spastic or are fighting I ask the parent
to flex the hip maximum and then while casting I keep the knee flexed too.
As for the all round allignment - I thionk it is a question of how you are
used to casting and what things you pay attention to.

I would love to here other peoples responses. Hope Bev answers too.

Vivian Alexander
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Well, that's it for the first round of responses for prefabed footplates. The
method that I currently use and find highly successful is similar to
Vivian's. I am fascinated by the success of Cascade Orthotics in their
fabrication of DAFOs from casts sent in from all over the world. The fact
that other people are doing those casts is another discussion. It would be
neat to hear Bev's opinion on this discussion once she returns from Brazil.
By the way, the original DAFO is of flexible design and supramalleolar,
anything else is a variation of a plastic AFO. So there Bev and Nancy Hylton
I made that clear.

John Izak CPO
Lawall Prosthetics-Orthotics
Philadelphia Penna.