Pediatric Services

Custom plastic supramalleolar orthotics (SMOs) are commonly prescribed for daytime use for the treatment of mild to moderate musculoskeletal weaknesses or skeletal deformities of the foot and ankle. SMOs 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: correction of arch collapse, correction of in-toeing and ankle instability. SMOs can also increase walking speed, efficiency and safety. SMO trim lines encompass the entire foot and terminate just above the ankle bones.

Custom plastic ankle foot orthotics (AFOs) are commonly prescribed for daytime use for treatment of moderate to severe musculoskeletal weaknesses or deformities of the foot and ankle. AFOs 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, 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. Plastic AFOs can be designed with a solid ankle or metal or plastic joint depending on functional goals and often have flexible inner boots to aid in donning, allow for skin inspection, and better control the forefoot and heel while walking. AFO trim lines typically encompass the entire foot and terminate a few inches below the knee. 

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 trim lines typically encompass the entire foot and terminate a few inches below the knee. 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 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 musculoskeletal 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 musculoskeletal 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. 

Partial foot prostheses are prescribed to manage partial amputations of the foot. The partial foot prosthesis supports the longitudinal and metatarsal arches, restores foot length for proper shoe fit and restores the anterior lever arm of the forefoot. Partial foot prostheses can be fabricated as a shoe insert style or they can extend over the ankle bones or to the knee for additional control and additional mechanical advantage. Benefits of using a properly fitting partial foot prosthesis include: reduced adverse pressures on the end of the remaining foot, increased stability and balance, improved safety and efficiency when walking, and reduction in fatigue.

Below knee prostheses are prescribed to manage amputations of the leg below the knee. A below knee prosthesis is comprised of a carbon laminated total surface bearing or patellar tendon bearing socket that supports the residual limb and provides a surface for weight-bearing and alignment control; flexible inner socket that increases comfort; lightweight endoskeletal componentry or hard exoskeletal frame; a SACH, flexible keel or carbon fiber dynamic response foot; gel or pelite liners for interface between the limb and socket; suction, pin, cuff or anatomical suspension systems. Benefits of using a properly fitting below knee prosthesis include: reduced adverse pressures on the end of the residual limb, increased stability and balance, improved safety and efficiency when walking, and reduction in weight through the contralateral limb, and overall decrease in fatigue.

Extension prostheses are prescribed to manage significant leg length discrepancies caused by deformity or absence of a part of the lower leg. An extension prosthesis is comprised of a carbon laminated socket that supports the foot provides a surface for weight-bearing and alignment control; flexible inner socket for increased comfort; lightweight endoskeletal componentry or hard exoskeletal frame; a SACH, flexible keel or carbon fiber dynamic response foot; socks and pelite liner for interface between the limb and socket and anatomical suspension. Benefits of using a properly fitting extension prosthesis include: establishing equal leg length between both limbs, reduced adverse pressures on the end of the residual limb, increased stability and balance, improved safety and efficiency when walking, and reduction in weight through the contralateral limb, and decrease in fatigue. 

Above knee prostheses are prescribed to manage amputations of the leg above the knee. Knee disarticulation prostheses manage amputations at the level of the knee and are typically weight-bearing on the distal end. An above knee/knee disarticulation prosthesis is comprised of a carbon laminated ischial containment, quad brim, or subischial socket that supports the residual limb and provides a surface for weight-bearing and alignment control; flexible inner socket for increased comfort; lightweight endoskeletal componentry; a constant friction, hydraulic/pneumatic, or microprocessor-controlled knee; SACH, flexible keel or carbon fiber dynamic response foot; socks, gel or pelite liners for interface between the limb and socket; suction, pin, lanyard or waist belt systems. Benefits of using a properly fitting above knee or knee disarticulation prosthesis include: reduced adverse pressures on the end of the residual limb, increased stability and balance, improved safety and efficiency when walking, and reduction in weight through the contralateral limb, and decrease in fatigue. 

Hip disarticulation prostheses are prescribed to manage amputations at the level of the hip joint and are defined as a complete absence of the lower extremity. A hip disarticulation prosthesis is comprised of a carbon laminated standard Canadian or low profile “Bikini” socket that supports the hip joint and pelvis and provides a surface for weight-bearing and alignment control; flexible inner socket for increased comfort; lightweight endoskeletal componentry; constant friction or hydraulic hip joint; a constant friction, hydraulic/pneumatic, or microprocessor-controlled knee; SACH, flexible keel or carbon fiber dynamic response foot; suction and waist belt suspension systems. Benefits of using a properly fitting hip disarticulation prosthesis include: reduced adverse pressures on the pelvis, increased stability and balance, improved safety and efficiency when walking, and reduction in weight through the contralateral limb, and decrease in fatigue.

Upper extremity prostheses are prescribed to manage amputations of the wrist, hand, elbow, and shoulder. An upper extremity prosthesis is comprised of a carbon laminated socket that supports the residual limb and provides a surface for weight-bearing and alignment control; flexible inner socket for increased comfort; lightweight endoskeletal componentry; a mechanical friction or myoelectric controlled wrist, hand elbow and shoulder; harnessing for manual componentry control, socks, gel or pelite liners for interface between the limb and socket; suction, pin, systems. Benefits of using a properly fitting above upper extremity prosthesis include: reducing adverse pressures on the end of the residual limb, increased stability, ability to accomplish bimanual tasks, improvements in performing independent activities of daily living. 

Visit Ottobobock's youtube channel below for more detailed descriptions of upper extremity prosthetics and additional resources.

https://www.youtube.com/playlist?list=PLHyzPKz93e7g_F-xsE_L2eYiQn9rVP4Dg