AFOs

As soon as Elena started bearing any weight on her feet, it was obvious something wasn’t right. Besides her legs being incredibly stiff, her feet pronated badly. Her right foot was particularly bad—she stood nearly on the inside of the ankle and not the bottom of her foot. She got her first pair of AFOs before she really started any sort of independent standing, mainly to try to develop an arch in her feet, as she had none. The instep of her AFOs were gradually built up. At first, she wore her braces without shoes. Since she was so quiet, there really was no fighting with her braces. By the time she was communicating, wearing braces had become normal, and she’d use the sign for “hurt” if her braces or shoes had any problems.
Our first problem with AFOs came up when Elena needed shoes (about 13? months old). The shoes fit the AFO, not the foot, so normally they are at least a size too big. This is a lot of weight, not to mention an awkward size, for a child who has issues lifting her feet off the ground. AFOs also don’t breathe, and sandals typically get caught in the hinges of the brace, so Elena’s feet get very hot and sweaty. Elena’s feet are always trying to point, and her legs are always trying to straighten, so keeping her in her braces was a real struggle, she’d always be popping out, and then getting her little heels pinched in the back hinge. In order to get her back in the brace, we’d literally strongarm her foot into a flexed position and stuff it in the brace. Over time, this became easier, but never “easy”. Still, the payoff is fantastic. She can now stand with flat feet, and her feet are not as pronated—the right is still worse than the left, but not by much. The wearing of AFOs is greatly facilitated by Botox treatment, which we have had for a year and a half at this posting.