Wednesday, January 6, 2010


To the uninitiated, that stands for...uh, what does that stand for again? Ah yes, Dynamic Ankle Foot Orthotic. That's it. And that's what one looks like. And this is the piece of plastic and Velcro that had me on the floor, nearly in tears just before the holidays.See, for a long time now, we've been concerned that Smunch walks on his toes...a LOT. It's not just once in a while. It's not just when he wants to see something above his line of sight. It's not just when he needs to pee...although it makes him look like he always needs to pee. Considering that I've never tried to take a photo of him on his toes, these were exceedingly easy shots to find in my vast photo library.Now, you may wonder, as my mother often wonders, aloud, "Why does it matter if he walks on his toes?" It's a reasonable question and I hope that Smunch's physical therapist would have discouraged this course of action if it didn't matter at all.

This is what I know. Smunch's "heel cords" are very tight. We started our physical therapy with stretching exercises. With the cords stretched out, at least it would be more comfortable for him to walk with his heels down. If he keeps walking on his toes, it's possible he'll no longer have the flexibility to stop.

The stretching was very successful when we were doing it faithfully. He gained a lot of motion, but it didn't stop him from toe-walking. And stretching twice a day is a hard and draining routine to keep up in addition to school, homework, sports and speech therapy, so once we slacked off, the flexibility went away too.

Then we went to shoe inserts to see if that might help. Our PT wasn't optimistic, but the inserts are relatively cheap and easy to use. They made zero difference, but one thing was obvious. This kid walks on his toes A LOT. The toes of the inserts are already worn away in spots. The heels? Not at all.

So, we were left with DAFOs as our only option. Smunch went to be casted for them before the holidays and we picked them up just before Christmas. In the office, the PT put them on and then put Smunch's shoes back over them, saying that they barely fit.

I have to admit that I felt a huge sense of relief when Smunch tried these on for the first time in office. It was the first time in a long time that I've seen him look comfortable walking flat-footed. It felt so normal.

The next day, when it was my turn to put them on, I loosened the shoes and stretched and wiggled Smunch's feet around until he complained. I just couldn't get his regular shoes over those things. They're slippery plastic on the bottom, so you have to wear them with shoes.

And I had more psychological issues with the whole thing than I'd anticipated. Not only was I crazy frustrated with trying to get them on and hurting my child in the process, but these things? They make him look like he has a real disability. Children with cerebral palsy have these things to help support their ankles. Smunch doesn't need them that badly and I felt ridiculous cramming his little legs in there because he walks on his toes. I gave up.

The next day, I went out and bought some cheap shoes a size bigger for the express purpose of wearing them over the DAFOs. I couldn't get those on either, but Daddy came up with a shoe horn and over time, they've stretched out a little bit. It's no longer such a process. He wears them 2-5 hours a day and only after school. He complains about having them put on, but once they're on, he's pretty happy.

The only thing he can't do is ride his new bike in them. The bike is too big and since he can't point his toes with the orthotics on, he can't reach the ground at all. Bummer. But there's plenty of time for bike riding.

Smunch is certainly happy to take his DAFOs off in the evening. And then?

He tippy toes off to bed.


. . . Lisa and Robb . . . said...

For whatever it's worth, I apparently walked on my toes throughout my childhood. I think that my parents nagged me about it, until the pediatrician told my mother to stop, because my mom walked on her toes, and I was just following her example.

I'm pretty certain that I walk on my whole foot, now. In fact, I'm crazily flexible, and can bend over and lay my hands flat on the floor, without bending my knees.

Still, orthotics are great things, and can work quite quickly!

Mona said...

Glad that it looks like the DAFOs are going to do the job. Ria's shoes are, i think, 2 sizes too big to fit her DAFO's, but she's also got a chunk of stuff pushing up her arch area, and that makes it impossible for shoes a mere 1 size to big.

DAFO's aren't much to pay for a healthy preemie, I guess. (just read your more recent post).