The Best Alternative to AFOs – Recommendations from a Shoe Fitter

Has your child been complaining about their AFOs? Are you constantly buying shoes that are too big in order to fit your child’s AFOs? There are alternatives to AFOS, such as insertable foot orthotics, that may be just what your child needs to feel sufficiently supported and comfortable inside their shoes. In this article, I will discuss the #1 insertable foot orthotic for children as the best alternative to AFOs.

Please note that I am not a medical professional, but I have been fitting children’s shoes and orthotics for the last 10 years. The best orthotic for your child might not be one that is perfectly suited for your child, it might be the one that actually gets worn! I have seen several cases of children who refuse to wear their AFOs due to the following reasons:

• Self-conscious about looking different than their peers
• Pain and discomfort
• A limited selection of shoes
• Difficulties putting AFOs on and off

The goal of this resource is to inform families of children who wear AFOs that they might have an alternative to the AFOs. With that said, if your medical professional believes that AFOs are still the best way to treat your child’s foot issues, then you should follow your medical professional’s advice.

What Are AFOs?

“AFOs” or ankle-foot orthoses are commonly used braces to support the foot and ankle. AFOs have a wide range of shapes and sizes, however, they often encapsulate a patient’s entire foot and lower leg to completely stabilize them. Typically, AFOs are made with sturdy plastic that is both supportive and comfortable, and some sort of closure method to firmly secure the AFOs to the patient’s legs. Some AFOs are rigid and allow for no movement of the feet/ankle. Others are more dynamic and can allow for isolated ankle movement while keeping the foot stable or even movement in all parts of the foot/ankle.

AFOs can be used to treat a variety of foot issues however, they are often used to treat neurological and musculoskeletal disorders. Some common conditions AFOs help treat in children include:

• Cerebral palsy
• Foot drop
• Low muscle tone (Hypotonia)
• High muscle tone (Hypertonia) 
• Joint hypermobility
• Multiple sclerosis
• Foot or leg injury

*Be sure to talk with your child’s doctor if you think they might need an AFO and to determine which AFO is best for them.

Difficulties Fitting Shoes with AFOs

While AFOs can be great devices for treating and supporting different foot problems, they can also provide issues of their own. Most notably, some parents end up buying shoes that are too big for their child’s feet in order to compensate for the large size of many AFOs.

It is crucial that while AFOs do provide foot support of their own, they should never be fitted at the expense of a child’s shoe size. In other words, a child’s orthotics and shoes work together in treating their foot ailments, and therefore both must be fitted correctly and accordingly. Furthermore, if AFOs are placed inside shoes that are too large for a child, many of the stabilizing benefits of the AFOs will be lost. Here is an article where I recommend some of the best shoes for AFOs.

Other Difficulties with AFOs

Aside from shoe-fitting struggles, AFOs can sometimes cause other issues. Potential problems children and families face with AFOs include:

• Skin irritations (blisters, redness, sores) 
• Improper fit
• Bulky/uncomfortable feeling
• Difficulties putting AFOs on and off
• Expensive AFO prices

*All this being said, please consult with your child’s doctor before stopping your child’s AFO use or trying out an AFO alternative. AFOs can be and often are the best way to treat certain foot/leg issues.

What Makes the Orthotics I Recommend Effective?

1️⃣ Deep Heel: The orthotics I recommend provide deep heel cups that ensure your child’s weight is being equally and properly dispersed throughout their heels. These heel cups also help control the alignment of their heel and lower leg. Even without a full AFO, these deep heel cups will make sure your child’s feet are adequately and actively stabilized.

2️⃣ Deep Medial and Lateral Flanges: Along with the deep heel cups, these orthotics provide significant medial and lateral flanges to adequately stabilize all parts of your child’s feet, specifically cradling the sides of your child’s feet (medial plantar and lateral plantar).

3️⃣ Medial Rearfoot Posting: The rearfoot postings of these orthotics provide a slight elevation to the heel to help properly align your child’s feet. This posting also helps to secure the orthotics inside your child’s shoes, reducing potential side-to-side movement of the orthotics.

Before and After

Take a look at the following before and after comparison of a flat-footed child with rolled ankles using the insertable orthotics I recommend.

Before

The child’s feet are collapsing inwards and their rolled ankles are further impeding their proper foot alignment.

After

The child’s feet are much straighter. The orthoticʼs deep heel cups, medial and lateral flanges, and rearfoot posting help align the child’s feet comfortably to the proper position.

The Best Alternative to AFOs

littleSTEPS® insertable orthotics are my #1 recommended orthotics as AFO alternatives. I recommend this orthotic for children with flat feet, rolled ankles, overpronation, low muscle tone, hypermobility, toe walking, and knocked knees. Remember that less bracing usually leads to fewer restrictions and fewer restrictions usually lead to more natural movements.

You won’t have to order your children’s shoes bigger than a half size or a full size of your child’s longest foot size.

Are You Unsure of What Orthotic Size to Order?

It is important to get the right orthotic size for your child to get the full benefits that they have to offer and to ensure they fit properly inside your child’s shoes:

*For these orthotics you do not need to remove the original insoles of your child’s shoes first. Just put the orthotics directly into their shoes!

If you are still unsure, feel free to email me with any specific questions about what orthotic size would work best for your child and I will be happy to assist you: [email protected]

What Shoes Work Best with Orthotics?

Remember that your child’s shoes work in tandem with their orthotics to treat and support their feet. To see my favorite children’s shoes for orthotics and what shoe features are important to search for when buying orthotic-accommodating shoes.

Whether your child wears AFOs, full-length, or quarter-length orthotics you must fit them in the correct pair of shoes so they can pave the road towards strength, balance, comfort and independence.

Have you tried these orthotics before? Is there another AFO alternative you tried that has worked well for your child? Let us know in the comments below so other families can benefit from your experiences.

References:

https://nolaro24.com/ls.html

What Are AFOs and How to Use Them? | Align Clinic – Align Clinic (align-clinic.com) Professional Guide for Everyone wearing an Ankle-Foot Orthosis (AFO) (alcammedical.com)

Ankle-Foot Orthosis (AFO) Types (verywellhealth.com)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC644959