By Martye Baylock MS, PT

Early in my career I served rural patients. Many patients had issues with walking, muscle tightness, muscle tone, and being able to move independently. Many of my patients were in need of bracing and orthotics, but the nearest place for them to be cast for these could be up to an hour or more away. I decided as a young, new graduate to find a way to educate myself in a way that I could become the resource these parents, patients, and families needed.

Cascade DAFO (Dynamic Ankle Foot Orthotics) has dynamic properties, multiple options of styles, fit, and ease of communication. That is what I love about this company. Fortunately, they were offering a class on casting, fitting, and brace selection only a couple of hours from where I was living. I signed up immediately!!!

What I Learned:

• How to properly cast for custom orthotics. This involves making a cast of the patient’s feet and ankles that Cascade DAFO can then use to create an orthotic that is custom molded to the patient’s body. This allows the brace to work in an optimum way providing individualized results for a patients.
• How to select the appropriate style of brace for a patient. Many factors go into selection of an orthotic for a patient. It is very important to analyze gait, movement patterns, and transitions. A brace should be the least restrictive it can be and still provide the patient with the stability and dynamic properties they need to function toward independence.
• How to fit the brace upon receiving and adjusting as needed to maintain a brace that is comfortable and functional for the patient.

Training a patient through gait training and functional gross motor skills training when they receive an orthotic is very important. A brace or orthotic is typically needed because of an issue with muscular control, be that strength, range of motion, muscle tone, or motor planning. It is very important to remember that a brace or orthotic is not the therapy the child needs. The brace may be helping the child with proper foot positioning, muscle facilitation, tone inhibition, or other issues, but physical therapy is what is needed to then strengthen, stretch, re-educate musculature, and gait train. The goal is for a child to develop these muscular skills themselves to decrease the bracing needed over time.

Throughout my 17 year career as a physical therapist, I have been analyzing, selecting bracing, casting, fitting bracing, and training with orthotics. I still get excited every time a patient receives a brace or orthotic that changes the way they function and interact with their environment. I get even more excited as they transition to bracing with less support and learn to control their own muscles and bodies for improved independence in their world!!