[tri-med] Re: AFO's

----- Original Message ----- 
From: "Jocelyn Knowd"
> Karen, what should you put to prevent chafing.

I should explain. These are two different situations but a similar
principle.

AFO's are made of a hard thermoplastic. They are moulded to fit closely to
the form of the foot / ankle and leg. It is close but when they are moulded
there is a small area allowed between the plastic and the skin. (usually
just enough for a thin sock or tubigrip)

When you get blisters or pressure areas from them its because the plastic is
to close to the skin. Usually this is just an area in the AFO's that is too
close to the skin. If you put foam in there you are actually decreasing the
space and making it rub even more. Foam in particular is a no no because it
actually increases shearing forces not decreases it. (because it "grabs")
What you need to do is to increase the distance between the plastic and the
skin - not decrease it.

You increase the distance by flaring the AFO - that is heating it up and
pushing it out and away from the skin at the particular point that is too
close. You can't flare to far though or you will get shearing (rubbing)
because of movement.

The rule of thumb with any splint is not to put anything in them thicker
than moleskin. Moleskin is like a very thin, soft felt - about the thickness
of tubigrip. Two thicknesses eg socks bunching will cause pressure areas.
That gap is very small and it should be.

Another cause for red areas and blisters is shearing from movement. In
simple terms the AFO's should have minimal movement once they are strapped
on. If they are not strapped on tightly enough or there is too much space
between the skin and the AFO (that is they don't fit properly) then it will
rub and cause shearing of the skin. In this case they need to go back and be
adjusted or folk need to learn to put them on properly.

The ankle strap is the "working" strap on AFO's. It has to be very tight.
The foot and ankle should not be moving within the AFO. The top strap around
the calf just needs to be firm - its not the "working" strap. If the ankle
strap isn't tight enough then you will get movement of the foot in the AFO -
that causes shearing and blisters.

Any redness or blisters in AFO's is a definite no no. Within a very short
period of time a red area can go to an ulcer.

A lot of therapists seem to forget their basic rules of physics and even
they will pad out AFO's - but they shouldn't. They should either flare them
if its an area to close to the skin or get them remade if there is shearing
from too much movement.

Corns are a different problem, but a similar situation. Corns occur because
one toe rubs against the other over a long period of time - Jocelyn you can
probably blame all those years of wearing pointy toed shoes :-))

Putting foam in there will stop the corns from rubbing immediately but its
not really a long term solution. You need shoes that give your toes room to
spread out, AND I would recommend toe separators.

Most podiatarists will make these for you. They are like an insert that goes
into your shoes and it keeps the toes straight and separated. They are
usually made of solid foam or moulded and covered with moleskin (the
moleskin absorbs perspiration - foam makes you sweat). The fit between the
toes at the base. Think toe separators that you use when you paint your
toenails :-))

Given your diabetes and age (sorry Jocelyn!!) I would be seeing a
podiatarist about your corns anyway. You can probably access a free service
through your local community health centre.

I have not lost my mind - it's backed up on disk somewhere.
-- Unknown

Keep Looking For Rainbows!!
   _--_|\
 /Karen \
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          v Karen, Mum to Alex (9 years, T-18 Mosaic)
http://members.optushome.com.au/karens

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