Custom AFO Casting and Specification

Buchanan Orthotics manufactures a range of custom made devices, created to the clinical prescription. We have a long history of providing high-quality custom plastic devices to the NHS.

To minimise the risk of a misunderstanding it is recommended that when ordering custom AFOs that our order form is used

Shape capture is a vital part of the assessment for Custom Ankle Foot Orthoses (AFO). A poor cast will result in an increase in rectification time and the possibility of a poorly fitting device that requires alteration at fitting. We do understand that it is impossible to take the perfect cast and this is increasingly difficult in patients with spasticity or certain disorders. 

Casting

• Try to take the cast at the angle you require for the completed AFO. Changing the angle of the cast before filling may affect the areas of build-ups, especially at the ankle, leading to modifications being needed at fitting.
• It can be helpful to take the cast with the foot on the ground as this prevents you having to hold the leg and allows for assessment of the angles.
• When determining the angle at which the AFO needs to be, be sure to consider the pitch of the shoe. This will affect the tibial ankle and lead to abnormal alignment of the knee and hip at fitting.
• Ensure your cast is smooth and free of tension marks from plaster bandages. This will lead to the volume of the AFO being more accurate. 
• If the patient has bony prominences, be sure to ask for the amount of plaster to add to create relief for them. 
• When taking casts for both right and left ensure the height requested can be accommodated by both casts.  
• If you are requesting a neurological footplate to mark the positions of the met domes and other anatomical landmarks.
• Before sending the cast, please seal it in the correct alignment and if a courier is used, package safely, so the cast isn’t damaged in transit. 

 

Specification

• If you want the AFO at a specific angle, please mark it down to be checked before rectification in case it needs to be adjusted.
• If you need a specific 3-point force system implemented into the AFO be sure to mark on the patient where you need plaster removed in order to achieve it.
• When giving specific instructions, try to keep it simple. Overcomplicating the information provided will lead to confusion and may jeopardise the final result.
• If you want a specific shape of AFO for bony reliefs, ensure the timelines are drawn onto the chart. Likewise, if you require the same trim lines as a current AFO, draw it on the cast stockinette before plaster application. 
• Record the shoe size of the patient. This will help at the fitting, so excess material doesn’t need to be taken off the footplate. If it is possible, try to send the shoe in with the cast or a draft of the foot. This will lead to an optimal fit being achieved. 
• If you are asking for pads then specify what material and thickness you would like them.
• Always markdown on the specification chart how high you would like your AFO. If it is marked on the cast, this sometimes doesn’t transfer to the plaster when filled and could lead to it being manufactured to high/low.

Manufacture

• Know your materials. Homopolymer is much stiffer than co-polypropylene but is more brittle and notch sensitive which can lead to failure. If choosing coloured plastic, the plastic can have different properties than white plastic with a transfer due to the colour addition. 
• If the patient has a plantarflexion contracture, please ask for the angle that you would like the AFO to be pitched to. It will not be done automatically. 
• Wedging on AFO’s is usually done in EVA; however, if you would like a different material i.e. high density plastazote or cork then please specify this. 
• Likewise, if a specific amount of posting is required, i.e. heel only, or taper to met heads, please specify this. 

 

General Advice

• Be sure to state what type of AFO you are wanting on the 5 part order form, i.e. “Solid AFO or PLS AFO” 
• Request stiffeners (carbon fibre and ribbed reinforcements available) to increase the rigidity at the ankle if you want to keep the plastic thinner and more profile. 
• If the patient has a lot of calf tissue, consider the wingback design that allows the tissue to be accommodated instead of being nipped by the proximal trim when the knee is flexed.
• The casts that are sent in and rectified are kept for 3 months unless it is specified on order to “KEEP CAST”. 
• For DAFO’s please be accurate with the trimlines you are wanting and draw them on the chart. Likewise, include extra specifications in the additional info section, i.e. Northvane DAFO inserts or neurological features. It will not be added if not requested.