The video above will answer the following questions :
1.) How do you modify an AFO cast?
2.) How do you strip an AFO cast?
3.) How do you correct imperfections in an AFO cast?
4.) How do you protect boney land marks with the AFO modification stage?
If for some reason, you are unable to hear this video for any reason, or part of it, we are going to be including the transcription of it below to help you:
This is the AFO cast that is just about ready to be stripped, you can see that ankle is 90 degrees. We have corrected that in this cast and you can see a conduit pipe here that is extending out. What happens is we actually put this in like a horizontal stand and that is how we suspend the whole thing. So we can take off our plastic, we can take off our fiberglass, mold, and come down to the shape of the leg. This is our cast and we are just about to strip this down to the positive mold.
Here we have a positive mold, and we are now going to begin the process to actually strip the mold. So we have it suspended here more horizontally in our stand. We will tighten this down because we do not want to just move in any of which way while we are trying to do our work. So I tighten it down, and we start the process of just taking off our plastic wrap. Everything we did before, we got to undo now. Our plastic bandage here needs to come off and in order for us to get down to the bottom mold. We have now removed our plastic bandage here, see, our staples got to come out. I typically use a screwdriver and take that out here really quickly. This is where we stay away from the bony landmarks. You know, the technicians in our field are very experienced, and their huge part of the process and orthotist where prosthetist can also work on a mold, but there are many technicians in our field and they are the ones that they really make these braces and they detail that a person does not think about it, they are knocking it out. So people can wear their brace many as effectively as possible. So I am taking this off now and just a very gradual process. We have taken off the leg section, you can see this is where our cutting cube was, so that has made an impression there, inside this. We are going to now do the same with the foot.
I know that if I do not cut a line from here to here and from here to here, I could pop that whole heel off. so that is what we are going to do. I am going to try to do this, but we might need to use a cast saw. Okay so we are now kind of bringing the leg out of this, so now we have the person’s leg in a sense, we can subject it to heat, we can modify the mold safely, the person is not going to be harmed obviously. So I need to do certain things like this is an imperfection that needs to get taken care of cannot have that imperfection and stuff like that. Even the best orthotist will have imperfections in the cast, it just is what it is. So I am going to work on that now, and you are going to see the process quickly. Not every orthotist or technician does this but I am just going to use this powder. A) Because I like it. B) It helps kind of show what we are trying to do. So, not every AFO is made in the same way, so we have to think about things differently every time.
So we cannot have imperfections in the brace, they look terrible, and plus it might hurt the patient. So I am just going over this with this plaster at this point. Just trying to fill in imperfections like this. These are air bubbles. If you remember from before, I was trying to diminish the amount of the air bubbles that could possibly come into play because it creates little holes inside our cast. Right now, I am just generally adding and getting rid of these imperfections. As I am doing this, I am thinking about what the final shape is going to look like, and that is a lot of what I am doing right now. Another thing I can do is think about, not just about the final shape, but what are measurements like how much space I will need to add at the angle for example. We do not want plastic necessarily right on the ankle, so I do what I call to build up right here, for example. This is just a very generalized build up. So when we pull the plastic on top of this, there is actually going to be a small void there, where we could either put a pad or just leave a space. Back here this is where we corrected our cast, so I got to just do a transition that is smooth. It does not ruin anything for the patient and we are just doing a general transition like this. That is most of our work in terms of the application of plaster. I am going to do a little bit more here. We are going to create like the lateral for foot trim wall for the AFO. So we want it to be hugged right against the skin. We want it to just be away from that a little bit. We will show you what we mean in the final product but this is kind of how we do this. We are going to do the same thing on the other side. I think you can start seeing what we are trying to do with this. If you, for example, looking at this AFO, we are still making it but that trim wall on the side is more like up and down. If I did not add any plaster like I am doing here, it would be like the angled way in like this. So we have it kind of more up and down. The joint here for example, on this particular one- that is unfinished would be right on that ankle joint and causing pain or etc. So that’s why these build-ups at the ankle are so important. Because it helps to bring out that space a little bit. So this is one that we are working on and that is the whole point. This shape right here the forefoot is what we are going to turn this into. So this is step one in the modifying process. You do the same with TLS or back brace or knee brace for example. What I am going to do now is just quickly get a sanding shear here and kind of smooth this all down. The reason I am using this different color is it really helps me to know what I added on. Certain spots of the cast I can even take away even a little bit of the white, but you cannot do that everywhere. What you will see is it is already happening here in the leg. I tried to modify this mold and you can see that wants to stay, that particular piece right here. That is happening because that is us correcting the imperfections in the cast. So, if that makes sense, this is a little bit wet, which makes it easier to modify in a way but also some of it is coming off. The next step I will show you very quickly is I am going to smooth this up. This is a very generalized example of how an orthotist or technician would actually work on an AFO cast and we will show you how I am going to smooth this up and then I a going to show you the final product. Now what the orthotist does is they smooth up the cast. You want it to be smooth like that, you do not want imperfections like this was kind of more rugged I guess, the first word that comes to my mind. So we are trying to make that smooth. You can also see how it is filling in. That is really important if I guess with the modification phase what I am trying to point out. It is because there is a little valley right there that I am trying to take out. This is in the smoothing phase, you do this for an AFO, you can do it for a knee brace, you can do it anything else.