Excessive IR with AFO

Excessive IR with AFO

Gina Retallack

12/29/2011

I'm currently treating a 4 y/o boy with CP (hemi) who presents with left equino-varus (correctable) and IR (femoral anteversion). Before he came to me, he was using a custom PLS- AFO with dynamic trim at the foot (SMO-style). I would think this would be the best orthotic treatment for him also (PLS AFO or SMO with kiddie gait...along these lines), but the parents told me that this AFO made his gait worse because it exacerbated his IR (with increased circumventing during swing resulting in frequent tripping), so they stopped having him wear it after a couple of months. As a result, they want nothing to do with this orthosis. We tried having him wear just an SMO (DAFO #4) with a proximal wrap-around strap, which helped control the triplanar deformities in his ankle/foot, but obviously didn't help control the equinus (although it didn't trigger the excessive IR). Can someone shed some light on why his IR would worsen while wearing the AFO?

Thank you,
Gina