AFO Tips from Complex Child

AFOs, or Ankle Foot Orthoses, are very common types of braces worn by children with a wide variety of conditions. When used properly, AFOs can greatly enhance a child’s function, by helping her stand or walk, and may also help prevent foot and ankle deformities.

Dynamic ankle-foot orthosis, DAFO. Cascade DAFO

Susan Agrawal, Complex Child October 22, 2013

AFOs are typically pretty simple devices—they look like a hard plastic “boot” that is worn on the ankle and foot. Despite their simplicity, there are a few tips that can make them easier to wear and fun.


There are hundreds of different types of AFOs, but they can be grouped into a few common categories. These include the following:

  •  Low AFO  – these braces just cover the ankle and slip into the shoe
  •  Static AFO  – a rigid brace that keeps the foot and ankle solidly braced
  •  Dynamic AFO  – a mostly rigid brace that allows some dynamic movement
  •  Hinged AFO  – a two part brace with hinges at the ankle to allow freer ankle movement

For just a smattering of the styles available, check out all the types made by the most common AFO manufacturer in the United States, Cascade DAFO.


While it is possible to buy AFOs off-the-shelf, in most cases children receive custom braces. The fitting process involves making casts of the child’s feet and ankles. Typically, a thin material is placed over the child’s foot and ankle like a sock to protect the child’s skin. A long piece of foam may be placed vertically to facilitate cast removal. Then the ankle and foot are wrapped in standard fiberglass casting material. Once the cast is dry, it is removed using a standard casting saw, using the foam piece to protect the child’s skin. While some children may not like the loud noise of the saw, most find its vibrations comforting and not frightening. The casting process typically takes only about 15 minutes per foot.

Once casting has occurred, the AFO is customized to the child’s foot/ankle and his or her specific bracing needs. Many orthotists make their own AFOs, while some send the casts out to other companies who specialize in custom AFOs.

An orthotist at Shriners Hospital for Children—Twin Cities works on a custom device. Photo courtesy of Shriners Hospital for Children, Twin Cities


There is no doubt that AFOs are a fashion statement. AFOs can now be made using patterned or colored plastic, and the inside padding and Velcro straps that usually come with them may also come in patterns and colors. For example, Cascade has choices in plastic patterns, strap patterns, strap colors, and padding colors/patterns.

If you are limited by your orthotist in patterns or colors, AFOs can always be customized using stickers or stick-on jewels. Straps can sometimes be replaced with colored hook and loop from a crafting store or online merchant. Some types of paint can even be applied to AFOs, as long as they are safe for children, waterproof, and don’t chip.


While some children may be able to wear any type of socks underneath their AFOs, others may find short socks or socks with ribs and seams to be uncomfortable. The seams may rub and cause irritation, while short socks may allow plastic and strapping to rub against bare skin.

It is best to choose socks that are at least as tall as the AFOs with few or no seams. Thinner socks usually work the best, since thicker ones may not fit easily within the brace. Girls’ knee socks work well for both boys and girls. In the summertime, knee-high hose may work for either gender. Boys’ or girls’ soccer or athletic socks also may work, though some have seams or are too thick. Girls’ tights work fine during all seasons.

Some companies make seamless socks, either for children with AFOs or for children with sensory issues. These tend to be somewhat expensive, but do serve their purpose well. Common brands include:

Many times you can find seamless socks or tights at major retailers as well.

Try to pick socks that are long enough so that a few inches of material continues above the AFO. You can fold the top of the sock over the AFO to prevent it from shifting or riding down.


It can be a challenge to find shoes that fit over an AFO. The best thing to do is take the AFO to the shoe store and try placing it in shoes to see what fits.

There are special shoes for AFOs available, but they tend to be expensive. Keeping Pace and Hatchbacks are the two most commonly found brands. They may be purchased from your orthotist or directly online.

Regular shoes may work as well. When attempting to find shoes, keep the following in mind:

  •  Go big  – pick shoes 1-2 sizes larger than your child’s actual size
  •  Go wide  – wide shoes simply fit better
  •  Go long  – shoes with a long tongue that extends almost the length of the shoe are easier to get on
  •  Go strappy and zippy  – shoes and sandals with straps that can be adjusted or zippers may be easier to get on
  •  Go bare  – remove any insole inside the shoe for extra space

Some styles that parents recommend include Converse shoes, Stride Rite wide shoes, Crocs, DCs or skate shoes, and Skecher’s Twinkle Toes or S Lights.

Complex Child is a monthly online magazine written by parents of children with special healthcare needs and disabilities. It is intended to provide medical information, along with personal experiences, in simple language that other parents can understand. Articles are on a wide variety of topics ranging from basic information on medical conditions and treatments to advice on how to beat insurance company denials.
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Susan Agrawal, the editor of Complex Child, is the parent of Karuna, a child with complex medical needs who passed away 9/19/2014. Karuna was diagnosed with cerebral palsy secondary to hypoxic ischemic encephalopathy, and a progressive disorder that was likely autoimmune causing multisystem organ failure. Karuna was vent-dependent, had a GJ tube, a central line, was 100% TPN (IV nutrition) dependent, was on oxygen, and used a Foley catheter.
Susan holds a humanities PhD and used to serve on the faculty of a top research university in the Chicago area. She is actively involved with Feeding Tube Awareness Foundation as a content specialist and board member. In addition to her work on Complex Child, she also maintains Kids’ Waivers, a website devoted to information on Medicaid waivers for children, and helps run MFTD Waiver Families, an advocacy and support group for families in Illinois who receive home nursing.
She currently cares for her typically developing children Sameer and Neena.

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