SN FAQ: Orthotics (braces, splints & lifts)

Assembly_Reqd

Welcome to the Special Needs Frequently Asked Question thread! Please feel free to also create your own post in a new thread if you need more information or support. If you do post your own thread, we want as many parents as possible in your similar situation to 'see' your question. Please be specific and include the potential diagnosis or procedure in your post title.

We have been told our child needs orthotics. (SMO's, AFO's, etc)

What lead you to go and get your child's feet looked at?

Who do you see for your child's issues?

What was the fitting process like? Any tips?

What kind of orthotics did you get and did insurance cover it? Did you have pay anything OOP?

What kind of shoes did you end up getting?

How do you keep the orthotics clean?

Any other tips? (Socks, etc)

MaxandRuby

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These responses are in regards to DS2 who is currently 2.5yr old diagnosed with CP (diagnosed at 9mos, 3wk).

We have been told our child needs orthotics. (SMO's, AFO's, etc)

What lead you to go and get your child's feet looked at?  Overall, I did not like the way his feet looked. He pronates BADLY. So I started asking questions and went from there.

Who do you see for your child's issues? For feet issues he sees a PT, his pedi (if you want to include that), and an orthopedic doctor. He did see a podiatrist recently because of ingrown toe nails (both big toes) which I attribute to how he stands and grips the floor with toes.  The PT is who has actually gotten his orthotics.

What was the fitting process like? Any tips? We took a prescription from the PT to the brace shop on base. I brought along things to keep DS2 occupied (like Angry Birds on my phone and his brother's Leap Pad) - especially because he is not a fan of people messing with his feet. He sat on my lap on an exam type of table. They put a "sock" type thing on his foot. They wrapped wet stuff around it (like what you do for a cast) to make a mold. They did that for each foot. They took those molds and sent them to Cascade where custom SMOs were made. They were delivered back to the base brace shop. The brace shop called to let me know they were in. We went to base and to the brace shop to pick them up/have him try them on. They fit and that weekend we went and bought shoes so he could start wearing them.  For the DAFO he wore (this was the first orthotic), the EI PT measured his foot and then ordered the DAFO (this was a pre-fabricated orthotic vs a custom one).

What kind of orthotics did you get and did insurance cover it? Did you have pay anything OOP? DS2's first orthotic was a Cascade Jumpstart Bunny DAFO. It was purchased through Kansas EI and was lent to us at no cost.  DS2 currently wears a Cascade custom SMO. Insurance covered the whole thing.

What kind of shoes did you end up getting? We got a regular width New Balance shoe and took out the insole. I loved these shoes. DS2 currently wears an XW New Balance shoe and an XW Stride Rite shoe with his SMOs. Both of these shoes have the insoles removed.

How do you keep the orthotics clean?  To clean them, I go to the Cascade website to look up the instructions.  :-)  I think it is mainly soap and water on the plastic part but I'd have to look it up again to be sure.

Any other tips? (Socks, etc)

realisticdreams

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Welcome to the Special Needs Frequently Asked Question thread! Please feel free to also create your own post in a new thread if you need more information or support. If you do post your own thread, we want as many parents as possible in your similar situation to 'see' your question. Please be specific and include the potential diagnosis or procedure in your post title.

We have been told our child needs orthotics. (SMO's, AFO's, etc)

Our PT originally brought up for Peyton the need for AFO's possibly just on her right foot.  We have also had SMO's on both feet and currently have orthotics (I don't remember the particular brand offhand)  

What lead you to go and get your child's feet looked at? 

We were already in PT and it was brought up by them originally.  We just had to get the script from the pedi.  The orthotic inserts script was given to us by the physical medicine dr at the spina bifida clinic because we told him she seemed to be falling more in the SMO's 

Who do you see for your child's issues? 

Our PT and physical medicine dr handle P's foot/ankle issues. 

What was the fitting process like? Any tips?

I know sometimes kids are actually casted to get a mold, but we have always just had a pretty simple type fitting (at 3 different places) where they take measurements, etc.  We get our items through an orthotic & prosthetic clinic, but our PT was able to actually do measurements for our last item and we just picked it up there.

What kind of orthotics did you get and did insurance cover it? Did you have pay anything OOP?

Our old insurance did cover the first AFO's I'm not 100% sure if they covered the SMO's and inserts but I know her secondary picked it up. 

What kind of shoes did you end up getting?

We used new balance wide most of the time.  The shoe really doesn't matter except for getting one with a good fit because the orthotic is generally doing most of the work so you don't need a super expensive shoe. 

How do you keep the orthotics clean?

We were able to whipe down afo/smo we haven't cleaned the inserts yet..(good question!) 

Any other tips? (Socks, etc)

becareful with smo/afo's without socks because they are plastic and slippery, also pay attention to if your child seems worse in them or has red spots or pain.   

MaxandRuby

realisticdreams:

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Any other tips? (Socks, etc)

becareful with smo/afo's without socks because they are plastic and slippery, also pay attention to if your child seems worse in them or has red spots or pain.   

FYI: If you have Cascade brand orthotics, it says on the site that you need to wear socks with them.

realisticdreams

MaxandRuby:

realisticdreams:

Assembly_Reqd:

Any other tips? (Socks, etc)

becareful with smo/afo's without socks because they are plastic and slippery, also pay attention to if your child seems worse in them or has red spots or pain.   

FYI: If you have Cascade brand orthotics, it says on the site that you need to wear socks with them.

I know ours wasn't that brand but curious you mean socks over or under?  We always did socks under but then if she took her shoes off she would go slippy sliding.   

MaxandRuby

realisticdreams:

MaxandRuby:

realisticdreams:

Assembly_Reqd:

Any other tips? (Socks, etc)

becareful with smo/afo's without socks because they are plastic and slippery, also pay attention to if your child seems worse in them or has red spots or pain.   

FYI: If you have Cascade brand orthotics, it says on the site that you need to wear socks with them.

I know ours wasn't that brand but curious you mean socks over or under?  We always did socks under but then if she took her shoes off she would go slippy sliding.   

We have been told by various PT therapist and the orthopedic doctor to wear socks and then put on the orthotic. For what M wears, he is not supposed to wear his SMO (or DFAO when he had those) unless he was wearing shoes as they aren't meant to be used without shoes.

ToastieSimons

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Welcome to the Special Needs Frequently Asked Question thread! Please feel free to also create your own post in a new thread if you need more information or support. If you do post your own thread, we want as many parents as possible in your similar situation to 'see' your question. Please be specific and include the potential diagnosis or procedure in your post title.

We have been told our child needs orthotics. (SMO's, AFO's, etc) 

What lead you to go and get your child's feet looked at?  DS has severe hypertonia.  He keeps his feet pointed and it can lead to a shortened heel cord.  We use them to keep his heel cord stretched and to help give him support for learning to stand.

Who do you see for your child's issues?  We see a physiatrist and a physical therapist.  Our PT recommended AFO's and our Physiatrist wrote the prescription.  We then went to a professional orthotics company.

What was the fitting process like? Any tips?  Ours are custom AFO's.  DS was basically casted.  They put socks on his legs and wrapped him in cast material (gauze coated in plaster).  They inserted a rubber hose along his leg before wrapping.  While the material was hardening they held his foot in position (bent at a 90 to his ankle).  After about 5 minutes they used scissors and cut along the tubing and removed it.  The whole process took about 15-20 minutes.  Because of his tone, holding his feet bent at a 90 is painful for him so the procedure was a a little bit hard on him towards the end.  It took 2 weeks for the AFO's to be molded then we went back and got them fitted. Oh and we got to pick out a cool pattern.

What kind of orthotics did you get and did insurance cover it? Did you have pay anything OOP?  We have custom AFO's.  (With race cars on them).  Our insurance covered them under their DME clause.  We had to pay OOP. The cost to insurance was 1740 and we had to pay $293.  Obviously everyone's insurance is going to be different.

What kind of shoes did you end up getting?  Our AFO's have foam support built in so stride rite didn't fit.  We ended up with payless shoes but they were too heavy.  So then we bought the Keepin Pace Shoes made for orthotics.  They were very expensive and hard to get on.  We then decided to buy a pair of Skidders (they're socks with a rubber sole on them) from Target (don't buy the imitations from Walmart) for $12.99.  They work great.

here is a picture of my son's AFO's
https://lh3.ggpht.com/-rNGhk75mg9Y/TmomoOAQcTI/AAAAAAAAAHc/4QwBW9G2Ros/s1600-h/DSCN0789-2%25255B2%25255D.jpg  

https://lh5.ggpht.com/-3CKaGE4DiyI/TmommMIaUSI/AAAAAAAAAHU/W2DivQXQfzE/s1600-h/DSCN0787-2%25255B2%25255D.jpg 

How do you keep the orthotics clean?  A toothbrush and warm water with a little bit of dishsoap.  And not wearing them uncovered outside.

Any other tips? (Socks, etc)  Always wear socks with them!  We use Children's Place and Old Navy cuffed socks but they leave imprints on his feet of the grippies.  I have found at Target some Oshkosh brand socks that are high and have no grippies.

MaxandRuby

I want to add more to this now!

DS2 is now on his 3rd type of Cascade orthotic.  It is another custom one (like the 2nd pair) but is a little higher (has a strap that goes across the front of the ankle that is to help keep him from being on his tippy toes). Insurance covered these 100% too.

Shoes: We are using a pair of Wal-Mart shoes that the orthotic guy gave us. It was nice because we were able to walk out of the brace shop wearing the new orthotics and shoes!  These are a regular width shoe with the insole removed. I plan on buying a 2nd pair of shoes in a couple of months though.

Socks: The same guy also gave us a pair of SmartKnit socks. I really really like them. DS2's feet sweat really bad in his orthotics and I don't feel like his feet are as sweaty. They are seamless also. I like them enough that I bought a pair from the orthotic place also and would be willing to buy more.  In general for socks though you need a sock that is higher then the orthotic.