Club Feet & Orthotics
So this week I learned some very interesting information and I thought I would share.
On Monday, we went down to Shriners so I could get their feedback on Pooka’s feet, boots, bar & AFOs. And to my surprise, they recently added an orthotist to the Spokane team. Some of the other Shriners locations have full orthotics facilities in house. After meeting with the regulars, who thought Pooka’s feet looked good, we were sent to Peter, the new in-house orthotist. He spent 7 years as an orthotist at SLC Shriners before coming to Spokane.
He took one look at Pooka’s AFOs, shook his head and said something to the effect of, “Yeah, these aren’t going to work!” We spent the next hour or so getting new boots, a new bar and getting fitted for new AFOs. But the most interesting part was the education I got on the orthotics process.
So apparently the majority of orthotics are made by taking a cast, making a plaster mold and forming the AFO around the mold in an oven. And this works great for the majority of cases. Normally the patient just needs general support or minor one-directional correction (pronation, supination, dorsiflexion, plantarflexion, etc.)
But when a child has club feet, they are often out of alignment by small degrees in a zillion different directions.
He explained that most orthotists don’t have much experience with clubfeet. In fact, many of them have never dealt with clubfeet. Pooka was our previous orthotist’s first pediatric SB case. He had seen one adult case previously.
With club feet, he said it is important that the AFOs support the feet in small degrees in multiple directions. They need to be an exact fit to the feet. And Pooka’s first set of AFOs certainly don’t look anything like her feet inside.
Peter said that with club feet it is important to use a facility that can design the AFOs digitally and then either use a C&C or 3D Printer to manufacture them from the digital file. Interesting, right?
Right now, Peter sends the digital file to Portland Shriners where they use a C&C “Carver”. But he is trying to get a grant to purchase a 3D Printer for Spokane.
So he still took casts, but he wrapped them super tight. Then he drew all over them with a marker. He took measurements and usually he takes pictures, I think. Not sure why he didn’t take pictures of Pooka’s feet. Then he somehow transfers the cast and his drawings and measurements to a digital file where he can edit them until he is happy with them. I didn’t ask about the transfer process, but I wish I had.
Then he sends them off to Portland to have them made.
He says the inside will look like Pooka’s feet, but then they will build up the bottom to make it flat. That made so much sense to me. She is less than 90 by 3 degrees on one foot and 8 degrees on the other foot, so I was wondering how that would work. So they will match those degrees on the inside, but the bottom of the AFO will have a layer of something to make them flat. I’m anxious to see them, to be honest. I hope they live up to his descriptions!
I ordered them in the same cute “purple herringbone” pattern, which he found hilarious. The actual color pattern is called “carbon”. But he liked my description so much that he joked about sending over the order for “purple herringbone” and see what Portland said back!
I will post comparison pictures when I get them. But for now you will have to settle for some cute pics of Pooka herself!