Orthotic Services

Custom ground reaction ankle foot orthotics (GRAFOs) are commonly prescribed for daytime use for treatment of moderate to severe musculoskeletal weaknesses or deformities of the foot and ankle. GRAFOs are designed to control congenital or acquired skeletal malalignment and can be dynamically aligned using heel/forefoot posting and wedging to optimize the patient’s standing alignment and dynamic gait while addressing the underlying condition such as: drop foot, knee hyperextension and buckling, excessive in-toeing/out-toeing, ankle instability, low muscle tone, spasticity, arch collapse, and supination. AFOs can also provide additional benefits such as a reduction in fatigue, increase in walking speeds and efficiency, and improvement of overall safety. GRAFOs can be fabricated out of either plastic or carbon fiber. Material choice is determined based on the patient’s weight and degree of correction required to normalize gait patterns. Carbon fiber GRAFOs differ from plastic GRAFOs because they are fabricated using a combination of carbon fiber, fiberglass and resin which are fabricated in a particular pattern to achieve specific mechanical properties such as increased stiffness for exceptional control or to create a strut along the back of the calf or along the side of the ankle that will act as a spring to propel the patient forward while walking. The carbon fiber strut will provide a dynamic response at push-off on the patient’s braced side and accommodate for weakened ankle musculature, and in doing so will increase gait efficiency and reduce fatigue. Carbon fiber GRAFOs can be aligned and tuned in order to correct the patient’s mal-alignment and achieve additional functional goals such as prevention of drop foot, knee hyperextension, buckling or falls and increase walking speeds. GRAFOs often have flexible inner boots to aid in donning, allow for skin inspection, and better control the forefoot and heel while walking. GRAFOs are taller than standard AFOs and typically encompass the entire foot and terminate right below the knee. In order to provide knee stability and additional rotational control GRAFOs also have an additional panel of plastic just below the knee instead of the usual strap. 

Custom plastic knee ankle foot orthotics (KAFOs) are commonly prescribed for daytime for treatment of severe musculoskeletal weaknesses or deformities of the knee, ankle, and foot. KAFOs are designed to control congenital or acquired skeletal malalignment and can be dynamically aligned using heel/forefoot posting and wedging to optimize the patient’s standing alignment and dynamic gait while addressing the underlying condition such as: drop foot, severe knee hyperextension and buckling, knee valgus and varus, low muscle tone, spasticity, excessive in-toeing/out-toeing, ankle instability, arch collapse, and supination. KAFOs can also provide additional benefits such as a reduction in fatigue, increase in walking speeds and efficiency, and improvement of overall safety. Plastic KAFOs can be designed with a solid ankle or metal or plastic joint depending on functional goals and can have locking or free knee joints. KAFOs often have flexible inner boots to aid in donning, allow for skin inspection, and better control the forefoot and heel while walking. KAFO trim lines typically encompass the entire foot and calf to create a lower AFO section and join to an upper thigh section with a knee joint. The top of the KAFO typically terminates just below the groin. 

Custom plastic ankle foot orthotics (AFOs) and knee ankle foot orthotics (KAFOs) are commonly prescribed for nighttime use for positional correction of an ankle and foot deformity or knee ankle foot deformity and/or to stretch tight musculature, reduce or prevent joint contractures, or provide post-surgical support. Nighttime AFOs are typically lined with aliplast foam to reduce the risk of skin breakdown and can be designed with a solid ankle or a metal/plastic knee or ankle joint depending on functional goals. Additionally, flexible inner boots are frequently added to aid in donning, allow for skin inspection, and better control forefoot and heel during non-weight bearing and stretching.  AFO trimlines typically encompass the entire foot and terminate a few inches below the knee. KAFO trimlines typically encompass the entire foot and calf to create a lower AFO section and join to an upper thigh section with a knee joint. The top of the KAFO typically terminates just below the groin.

Custom plastic hip knee ankle foot orthotics (HKAFOs) are commonly prescribed for daytime for treatment of severe musculoskeletal weaknesses or deformities of the hip, knee, ankle, and foot. HKAFOs are designed to control congenital or acquired skeletal malalignment and can be dynamically aligned using heel/forefoot posting and wedging to optimize the patient’s standing alignment and dynamic gait while addressing the underlying condition such as: drop foot, severe knee hyperextension and buckling, knee valgus and varus, low muscle tone, excessive anterior trunk lean, hip instability, spasticity, excessive in-toeing/out-toeing, ankle instability, arch collapse, and supination. KAFOs can also provide additional benefits such as a reduction in fatigue, increase in walking speeds and efficiency, and improvement of overall safety. Plastic HKAFOs can be designed with a solid ankle metal or plastic  ankle joint, free or locking knee and hip joints, and plastic lumbar section or pelvic band. Design characteristics  are determined by functional goals. HKAFOs often have flexible inner boots to aid in donning, allow for skin inspection, and better control the forefoot and heel while walking. KAFO trim lines typically encompass the entire foot and calf to create a lower AFO section and join to an upper thigh section with a knee joint. The top of the KAFO typically terminates just below the groin. 

Hip orthoses are commonly prescribed to control moderate to severe musculoskeletal weaknesses or deformities of the hip joint caused by congenital deformities or acquired injury. Hip orthoses include waist and thigh sections and can be made in a fixed position or have an adjustable hip joint to control flexion, extension, and internal/external rotation. Common pathologies treated with hip orthoses include: hip dysplasia, cerebral palsy, orthopedic injuries of the proximal femur and hip joint.

Upper extremity orthoses are commonly prescribed to control or correct moderate to severe musculo-skeletal weaknesses, deformities, or contractures of the fingers, hand, wrist, and elbow.  Upper extremity devices are typically made from plastic or neoprene with rigid metal or plastic stays or posts to control alignment.

Spinal orthoses are commonly prescribed to control or correct moderate to severe musculo-skeletal weakness, deformity, or instability of the spine. Spinal orthoses can be used to aid in healing after a traumatic injury or corrective surgery. Spinal orthoses are typically made from flexible plastic with padding and adjustable strapping. Common pathologies treated with spinal orthoses include: cerebral palsy, low muscular tone, disc herniation, vertebral fracture, spondylolisthesis, spondylosis, spinal surgery.