>Sorry, I missed out on posting this one with my list of replies yesterday
>
>Rod,
>This is indeed a common problem. We’ve been using custom molded AFOs cast
>and modified in some forefoot abduction, neutral or slightly valgust
>hindfoot, and some dorsiflexion. If you absolutely must, it’s not hard to
>attach the AFOs to the DB bar. There is also the Ponseti Brace, it’s new,
>but people seem to feel it gets the best instep purchase. If you’re
>interested I can forward you information about this.
>
>If you must stick to the shoes and bar, this has been published by
>Michelle Hall, CO to help people get better wear out of the system:
>
>
>Helpful Tips:“urn:schemas-microsoft-com:office:office” />
>
>1. Expect your child to fuss in the orthosis for the first 2
>days. This is not because the orthosis is painful, but because it is
>something new and different.
>
>2. Play with your child in the orthosis. This is a key to getting
>over the irritability quickly. The child is unable to move his/her legs
>independent of each other. You must teach your child that he/she can kick
>and swing the legs simultaneously with the orthosis on. You can do this
>by gently flexing and extending the knees by pushing and pulling on the
>bar of the orthosis.
>
>3. Make it a routine. Children do better if you make this treatment
>a routine in your life. During the 3-5 years of night/naptime wear, put
>the orthosis on any time your child goes to the “sleeping spot.” They
>will figure out that when it is that time of day they need to wear the
>brace. Your child is less likely to fuss if you make the use of this
>orthosis a part of the daily routine.
>
>4. Pad the bar. A bicycle handle bar pad works well for this. By
>padding the bar you will protect your child, yourself, and your furniture
>from being hit by the bar when the child is wearing it.
>
>5. Never use lotion on any red spots on the skin. Lotion will make
>the problem worse. Some redness is normal with use. Bright red spots or
>blisters, especially on the back of the heel, usually indicate that the
>shoe was not worn tightly enough. Make sure that the heel stays down in
>the shoe. If you notice any bright red spots or blistering contact your
>physician.
>
>6. If your child continues to escape from the orthosis try the
>following: (check after each step to see if the heel is down, if not
>proceed to the next step)
>
>a. Tighten the strap by one more hole
>
>b. Tighten the laces
>
>c. Remove the tongue of the shoe (Use of the orthosis, without the
>tongue, will not harm your child)
>
>d. Try lacing the shoes from top to bottom, so that the bow is by
>the toes.
>
>7. Periodically tighten the screws on the bar. Tools have been
>provided.
>
>
Rod Lawlor
Senior Prosthetist/Orthotist
Royal Children’s Hospital
Melbourne, Australia
Ph +61 3 93455870
Fax +61 3 93455106
