Arizona AFO Casting

Don Pierson, CO, C.Ped

Ok, you need to order a custom AFO for a patient and this requires that you provide a casting of the patient’s lower leg. It seems logical that you would desire the following:

1. the AFO will fit and function perfectly for the patient
2. the patient would not have to return to be re-cast due to the fabrication facility stating that it is an inferior cast
3. the AFO would not need to be returned because it wasn’t fabricated exactly how you wanted it

Well, then there are some important guidelines which you must follow to assure a good result. These guidelines may seem they are a “given”, but many doctors do not follow them. A custom AFO is expensive and your time is valuable. You also do not want to discourage the patient by not getting things right the first time.

If you follow these five easy steps you will have much better results:

1. Cast as high up the leg as you want the AFO to be, and even an inch or two higher if possible. Otherwise you are leaving a lot of guess work as to the size and shape of the patient’s leg.
2. Position the leg, ankle, and foot in the most neutral position in which the patient is comfortable. So often a cast is taken with the foot in 20 degrees of plantar flexion and then the lab is instructed to correct it to neutral. Here again, there is guess work involved when contouring the plaster mold in the Achilles area. It is so much simpler to take the cast in the desired position than to adjust it. The same goes with the forefoot and hind foot. If they are correctable, correct them! Don’t rely on a technician in some distant lab to be able to know your patient’s anatomy. When you are done with the cast, visually compare it to your patient’s leg and see if it closely resembles it. If it doesn’t, take another cast. Don’t ship it off hoping a miracle happens along the way.
3. Take the time to delineate all boney landmarks and potential problem areas. These markings can be done to the exterior of the cast with a marker or indelible ink pencil, or to stockinette that is first applied to the patient prior to the casting material such as plaster bandage or fiberglass.
4. Write the patient’s name and your company name on the cast. Remember some labs get in 60 or 70 casts a day that tend to look similar. By writing the info on the cast there is much less of a chance of a mix up.
5. Wait for the cast to dry before shipping it. A fresh plaster cast holds a lot of water in it. If you place it in a box before it has dried it can end up completely flat by the time it arrives at the destination. An STS sock can get severely distorted if it is not dry prior to taking it off of the patient.

You want a good return on your investment. Take the time to assure that you are providing the best cast possible. You will be pleased with the results.

PATIENT ASSESSMENT, FOOT POSITIONING & CASTING

The following video shows how to assess the patient's gait pattern, establish a correct position of the patients lower limb, then cast them for an Arizona AFO.   This instructional video demonstrates the casting by utilizing an STS casting sock as well as a fiberglass roll.

The following video is a case study and casting of a CVA/Drop Foot Patient for an Arizona Extended AFO.