A series of case studies on the effect of a midfoot control ankle foot orthosis in the prevention of unresolved pressure areas in children with cerebral palsy.

This paper reports on a series of case studies where improvements were sought in muscle tone and gait in children with cerebral palsy. A Midfoot Control Ankle Foot Orthosis (AFO) was developed to control foot position in a cohort of patients with cerebral palsy (CP). The concept of controlling midfoot and hindfoot with an encapsulated internal Supra-Malleolar AFO that fitted into an external AFO was shown to be effective in ambulant children with CP. Some initial problems of compliance were noted and postulated to be due to difficulties associated with previous orthotic devices. Evidence from the case studies suggest that the developed Supra-Malleolar AFO orthoses enables children with CP to maintain mobility without skin tissue damage, delays the need for surgery and at the same time maintains the length of the Triceps Surae (Gastrocnemius and Soleus) complex. Plans for further research are discussed which will contribute to the evidence base for this particular orthotic device.