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!


  • That’s not settling! The girl herself is a gazillion times cuter than AFOs, no matter how cool they are!!

    Very interesting. I can’t wait to see how it goes when you get them!!

  • She is so pretty and looking so grown up! That is just wonderful that you have a orthotist who knows what he is doing! I’m sure the new afos will be drastically better than the pair now. I’m really not sure what processes our orthotists have gone through to make Claire’s braces. Our orthotists have seen lots of kids with SB and the braces do seem to look like her feet inside with the build ups to make them flat but I have never heard anything about the 3D digital files–that sounds pretty advanced! Excited to see pics!

  • I’m glad you got someone from St. Louis Shriners. Everything I’ve heard is they’re awesome. We’re about equidistanct from St. Louis and Chicago, and we go to Chicago, but have friends who go to Shriners in SL.

    To hijack the topic, what I don’t understand is why people (doctors, therapists, orthotists) who don’t have SB experience can’t just say “this is out of my league, and you should really go to X” Sooooo frustrating.

  • Ok, first off, she is toooo cute. I love her curls and her expressions! What a doll!

    Really interesting about the AFOs. The 3D digital images/printer options sound amazing. Certainly sounds like it has so many advantages over the standard case and mold technique. Can’t wait to see the final product. This also made a lot of sense to me as to why Pooka had so much trouble with her first set of AFOs and Caroline has not had as much trouble – Caroline only seems to have dorsiflexion as her issue to correct and it sounds like only one “problem” = ok for standard AFOs. Hmmm….something I will keep in mind, though, if problems arise. Thanks for the info!

    Also, I know Pooka had issues with shoes staying on with her previous AFOs. A friend introduced me to Plae shoes. Have you seen them? Too big for Caroline (smallest size is 8, I think), but maybe a good option for the future? (please excuse if this is already part of the SBN equipment list…)

    klgs24, I completely agree with what you are saying – I think some doctors/therapists are afraid to admit when they do not know something. Maybe pride, maybe a product of our litigious society. *sigh*, I think the only thing to do is keep asking questions, never settle for something that does not sound right to your mommy gut, keep reading, keep up with these helpful boards of knowledgable families. And the fight goes on and on….

  • Wow! just saw all the shoes in the “equipment” section. Yay. My dd was just measured for AFOs today. This will be our first pair, as she just had pretty significant surgery to both feet.
    When her casts come off, I guess I will have to have some shoes to bring, but I have NO idea what size her feet will be. Wow. Lot’s to think about for me here.

  • So we got our new AFOs and they are so much better than the first. But I would say the majority of the improvement is in the padding inside and on the sole. I wonder if the same thing could have been accomplished with the original? The major difference in shape of the AFO itself is on the back of the leg and heel, which you can see in the 3rd picture.

    They fit her nice and snug, but none of her shoes fit over them and we only have Payless & WalMart in our small town. So I ordered two pairs of Stride-Rite shoes, one in 4W and the other in 4XW. They arrive in the morning. I’m really hoping they work as I am anxious to give her a stable surface to pull up on. If not I will probably have to spend a whole day in the city trying to find something that will fit.

  • Well, those certainly look like they would fit much better! So glad you won’t have to worry about her slipping out of them anymore! Wal Mart and Payless both make very wide shoes. In the past if the braces required more than 2 shoes sizes up from her normal shoe size, I have had them remade b/c its just too hard to crawl in shoes that big. Skidders are a good option to just add some traction without adding bulk. They won’t work for crawling outside but they would work inside while you are looking for other shoes.

  • Wide shoes in infant sizes? Like 1-4? I’ve never seen W options in baby shoes at Payless or WalMart. Are you saying they just tend to be wide or are actually sized W vs. M?

    She’s currently a size 2 without AFOs, but I had a size 4 on hand that was WAY TOO NARROW. We debated on what size to order. . . 3? 3.5? 4? We finally decided on a 4. I hope we made the right choice. I will know in the morning. I ordered these:

    The Nikki comes in XW, which is what I ordered, but I actually have more hope for the Bristol as I can remove the elastic bands and replace them with laces. I can also add more velcro to the strap if necessary. We will see.

    My main goal was to find something listed as WIDE that could be here by Monday.

    I will update when we get them.

  • It seems to me that Wal Mart reg. shoes just tend to run wider than the stride rite wide shoes. Stride Rite shoes used to work for C but when she got bulkier braces, Wal Marts worked much better. I’m sure a lot of what works is just specific to the braces and hopefully the ones you ordered will work great. Thats a really good idea to take off the velcro and put in laces–I would have never thought of that.

  • The new shoes and the AFOs stayed on and perfectly positioned ALL DAY LONG!

    I didn’t have to make a single adjustment.

    Three cheers for Shriner’s & Stride-Rite!

  • Hooray for shoes that work!!! Just food for thought down the line, we were able, actually the orthotist did it, to add a strip of velcro to the existing strap on our little Mary Jane’s from Tsukihoshi ( and they fit perfectly after that. The low scoop and the extra give on the strap were very helpful. Not pushing the brand, just the features that worked for us.

    Also, if she starts standing much expect her little feet to grrrrooooowwwww! We were in infant 2’s when this all started and now she properly fits her 4s.

  • I saw that cool strap in the pics you posted awhile back. What a great idea. I will definitely keep that in mind for the future.

    Our strap does not reach, but stride rite has a piece of velcro on the tongue that keeps the strap down. Luckily the strap isn’t necessary to keep these shoes on.

    We have 3 days under our belt now. We put them on in the morning and we take them off at night with no adjustments necessary in between. And no pressure points of any kind!

    To be honest, I’m in shock about how well they work.

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