© 2014 All Rights Reserved Nationwide Children’s Hospital. Do not copy without written permission
Idiopathic Toe Walking Orthoses Chart
Orthotic Type
Shoe Inserts
with Carbon
fiber plates
Off the Shelf
AFO
Custom Hinged
AFO
-
Advantages
Limits toe walking by limiting toe extension
-
Disadvantages
Child can still plantarflex ankle and thus may be able to continue to toe walk (Geil 2012 and Herrin
2012)
Allows for continued strength training of ankle
plantarflexors/dorsiflexors (less joint restriction)
-
Some insurance companies will not pay for an orthotic that is cut below the malleoli and therefore
may not cover the cost of a hotdog with carbon fiber plates.
-
Can’t be visually seen by others which might increase compliance
because the child does not look different from peers
-
Provide consistent sensory input into entire foot
-
Lower cost option than Kangaroo or custom AFO
-
Can be ordered directly by the physical therapist
-
May be more effective in maintaining heel contact with gait once
no longer using the orthoses (Geil 2012)
-
Limits toe walking by limiting ankle plantarflexion and active
dorsiflexion
-
The plastic under the toes is thin. Thus, the child may be able to extend toes and continue to toe
walk within the kangaroo
-
No anterior strap allows for PROM into DF with functional activities
-
May have to increase shoe size to fit braces into shoe which can cause tripping
-
May be covered by more insurance companies because it is cut
above the malleoli.
-
Brace can be seen by others and thus compliance may be reduces because they look different from
peers
-
Locks ankle in neutral so child is not working on active ankle plantarflexion/dorsiflexion. Could
cause further weakness in already weak muscles
-
Costs more than hotdog shoe insert with carbon fiber plates.
Limits toe walking by limiting toe extension, ankle plantarflexion
and active dorsiflexion and thus may be most effective in reducing
toe walking (Geil 2012 and Herrin 2012)
-
Most expensive option
-
May have to increase shoe size to fit braces into shoe which can cause tripping
-
Higher parent satisfaction with results after treatment as compared
to hot dog with carbon fiber plate. (Herrin 2012)
-
Brace can be seen by others and thus compliance may be reduces because they look different from
peers
-
Hinge allows for passive ankle dorsiflexion with functional activities
-
Locks ankle in neutral so child is not working on active ankle plantarflexion/dorsiflexion. Could
cause further weakness in already weak muscles (more joint restriction).
-
Night Splint Options
Splint Type
Bivalve Night Cast
Advantages
Disadvantages
-
Maybe a good option if child is already going through serial casting
-
Unable to change the angle of stretch with changes in ROM
-
Some children find it more comfortable than an AFO
-
Some children are able to remove them or they come off with plantaflexion
-
If the child has any significant foot deformity, this can be
-
May not be cost effective to use this in addition to a custom daytime AFO
accommodated for within the cast
-
If child has difficulty tolerating loud noise or vibration, the cast saw may be difficult for them to
tolerate
Hinged AFO with
stretching straps
-
If child will need a custom AFO to address toe walking during the
-
day, you can add stretching straps and they can wear it as a night
If child is not going to be using a custom AFO during the day then a DAFO #9 might be a better
option because can stretch at angles < 0 degrees and has a non-skid surface on bottom
without paying for 2 different braces
-
Will not be effective if child is unable to achieve at least a neutral ankle dorsiflexion position
-
Able to adjust angle of stretch past 0 degrees dorsiflexion
-
Expensive
-
Maybe able to hold foot in a better alignment as compared to non-
Can provide a stretch even if the child is unable to achieve 0
-
Expensive
degrees dorsiflexion
-
If the child needs a custom day AFO, then this might not be covered because you are asking for 2
custom braces
Night Splint AFO
-
Has a non-skid surface on the bottom of the brace for safety if they
orthoses for the child. Consider a DAFO #2 with stretching straps in this situation.
have to get up at night
-
Maybe able to hold foot in a better alignment as compared to noncustom braces
Dynasplint
-
Child can actively plantarflex to take a break from the stretch at
-
Expensive and may have difficulty with insurance coverage
night which may improve tolerance
-
More bulky then other night splints and thus can be difficult to wear them on both feet at one time
Able to adjust the tension on the brace to provide a different
-
Unable to walk in them if the child has to get up at night
intensity of stretching
-
If child has foot deformity (i.e.: supination or pronation), this brace may not control this motion well
-
Only holds child’s ankle in 90 degrees. Unable to adjust the angle or intensity of the stretch.
-
If child has a foot deformity (i.e.: supination or pronation), this brace may not control this motion
Able to provide a stretch to a child who is not able to achieve 0
degrees of dorsiflexion
Off the shelf ankle
dorsiflexion night
splints
-
Cheaper option
well
Off the Shelf Plantar
fasciitis Braces
-
Cheaper option
-
Only holds child’s ankle in 90 degrees. Unable to adjust the angle or intensity of the stretch.
-
If child has a foot deformity (i.e.: supination or pronation), this brace may not control this motion
well
© 2014 All Rights Reserved Nationwide Children’s Hospital. Do not copy without written permission