Ankle-Foot Orthosis (AFO) and Toddler Supramalleor Orthotics (SMO)

My two year old has tuberous sclerosis complex .Sometimes with TSC comes developmental delay it is a genetic disorders with a very wide spectrum.  My son has low muscle tone and has not yet learned to walk. He has started standing and also standing without support for up to a minute so far. His right ankle turns in when he stands so much so it almost looks broken ( he's also double jointed isn't that cool!) We are on our second set of Braces. The first were SMO's and now since he has mastered crawling he is in AFOs with ankle hinges which allow him to "squat" down ,but unable to stand on tippy toes.
Here are some helpful tidbits from our experiences.

Here are his SMOs He wore at 18 months till 26 months so roughly 8 month of wear(cute right) WE love Camo!

 Here are is Afos GOTTA CATCH EM ALL! POKEMON!

1. HAVE FUN PICKING OUT STRAP COLOR AND COOL PATTERNS!

2. SURE STEP SHOES ARE GREAT AND SAVE YOU THE TROUBLE OF HAVING TO SHOE SHOP FOR SHOES BOTH WIDE AND LONG ENOUGH FOR THE BRACES. GENERALLY THEY MAKE THEM TWO SIZES BIGGER AND THE BRACES ARE SUPPOSE TO LAST AT LEAST 6 MONTHS. our office sold them there at the office. ***Side not don't leave with out putting everything on first. sometimes the braces wont go into the shoes just right and need a bit of shaving around the toes.

3.A FRIEND OF MINE ALSO SUGGESTED GETTING SOME SLIPPERS WITH TRACTION FOR AROUND THE HOUSE WEAR. THE SURE STEP SHOES ARE BIGGER THAN WHAT YOUR CHILD SHOE SIZE IS AND THEY ARE HEAVY AND CLUNKY. GREAT SHOES THOUGH. 

4. I HAD AN EPIPHANY THE OTHER DAY! GETTING A 2 YEAR OLD TO KEEP SHOES AND SLIPPERS ON CAN BE DREADFUL! TO JUST WEAR THE BRACES BY THEMSELVES OFF OF THE CARPET IS A TERRIBLE ACCIDENT WAITING TO HAPPEN. THEY ARE SO SLIPPERY. NO TRACTION.. WE'VE HAD TWO SLIPS ALREADY. I WAS TAKEN BACK TO TAP DANCE CLASS (WHICH I DREADED) I WAS VERY CLUMSY AND SLIPPED LIKE CRAZY UNTIL MY MOMMY GOT ME THESE TO PUT ON THE HEEL OF MY SLIPPERY TAP SHOES. NO MORE SLIPPING!

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  NON-SLIP GRIP PADS

  
  

  
  

   

   5. BE EVER DILIGENT IN PUTTING THEM ON YOUR CHILD. SOME DAYS I HAVE A LOVE/HATE RELATIONSHIP WITH THEM. WHEN I CHANGE His diapers I HAVE TO DODGE HIS HEAVY BRACED IN LEGS AND FEET LIKE HAMMERS OR LIGHTSABERS.. >.< MY POOR SHINS, FACE, AND CROTCH (tMI). first time around we were really bad at putting them back on after nap time. Now even though it may not be the most comfortable he has his nap in them. after bath time at around 7 they are off for the night till first thing in the a.m. If your toddler enjoys taking the velcro off grab some of daddy's socks and fold them over the braces. They will look like leg warmers "She's a maniac maniac"
  As you know watch for redness and irritation. What an exciting time for you and your little one. these braces are such a great tool. Good luck on this adventure      ...AND RUN FOREST RUN!

  

  only real men wear floral diaper covers

From Wikipedia

Ankle-foot orthosis (AFO)

An AFO worn on the left foot with ankle hinge

Schematic ankle-foot orthosis

An ankle-foot orthosis (AFO) is an orthosis or brace that encumbers the ankle and foot. AFOs are externally applied and intended to control position and motion of the ankle, compensate for weakness, or correct deformities. AFOs can be used to support weak limbs, or to position a limb with contracted muscles into a more normal position. They are also used to immobilize the ankle and lower leg in the presence of arthritis or fracture, and to correct foot drop; an AFO is also known as a foot-drop brace. Ankle-foot orthoses are the most commonly used orthoses, making up about 26% of all orthoses provided in the United States.^[9] According to a review of Medicare payment data from 2001 to 2006, the base cost of an AFO was about $500 to $700.^[10] An AFO is generally constructed of lightweight polypropylene-based plastic in the shape of an "L", with the upright portion behind the calf and the lower portion running under the foot. They are attached to the calf with a strap, and are made to fit inside accommodative shoes. The unbroken "L" shape of some designs provides rigidity, while other designs (with a jointed ankle) provide different types of control.
Obtaining a good fit with an AFO involves one of two approaches:

1. provision of an off-the-shelf or prefabricated AFO matched in size to the end user
2. custom manufacture of an individualized AFO from a positive model, obtained from a negative cast or the use of computer-aided imaging, design, and milling. The plastic used to create a durable AFO must be heated to 400°F., making direct molding of the material on the end user impossible.

The International Red Cross recognizes four major types of AFOs:

Flexible AFOs	Anti-Talus AFOs	Rigid AFOs	Tamarack Flexure Joint
may provide dorsiflexion assistance, but give poor stabilization of the subtalar joint.	block ankle motion, especially dorsiflexion; do not provide good stabilization for the subtalar joint.	block ankle movements and stabilize the subtalar joint; may also help control adduction and abduction of the forefoot.	provide subtalar stabilization while allowing free ankle dorsiflexion and free or restricted plantar flexion. Depending upon the design; may provide dorsiflexion assistance to correct foot drop.[11]

The International Committee of the Red Cross published its manufacturing guidelines for ankle-foot orthoses in 2006.^[11] Its intent is to provide standardized procedures for the manufacture of high-quality modern, durable and economical devices to people with disabilities throughout the world.