• AFO Order Form v5.3

    AFO Order Form v5.3

    Standard Fabrication 5 Business Days
    • Account Information 

    • Priority :             Morning Courier            Standard Courier        FedEx Ground          

    • Please do not submit any PHI, we do not need any PHI information to fabricate the device.

      Please be sure to submit your order when you have completed your order. There is no need to print for your records. Upon submission you will have the option to download a PDF of your submission.

      We will not have a record or you order if you do not click the SUBMIT button.

      Questions or concerns please contact us at 708-237-4084.

    • Order Information 
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    • 1. Device 



    • Malleoli 3mm Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 3 mm (1/8") build-ups to the medial and lateral malleoli. This will increase the overall ML by 6 mm (1/4")
      • Adding 3 mm build-ups to the navicular and calcaneal tuberosity
      • Arches at the plantar surface are NOT modified
      • If the order calls for a medial/lateral tibial extension to control varus/valgus, a build-up is made to emphasis the extension side but still maintain a 6 mm build-up
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Malleoli 5mm Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 5 mm (3/16") build-ups to the malleoli. This will increase the overall ML by 10 mm (3/8") 
      • Adding 3 mm (1/8") build-ups to the navicular and calcaneal tuberosity
      • Modifying the plantar surface of the cast to a depth of 6 mm (1/4")
      • If the order calls for a medial/lateral tibial extension to control varus/valgus, a build-up is made to emphasis the extension side but still maintain a 10 mm (3/8") build-up
      • Raised forefoot trimlines,  will have 3 mm added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Tone Reduction Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 5 mm (3/16") build-ups to the medial and lateral malleoli. This will increase the overall ML by 10 mm
      • Adding 3 mm (1/8") build-ups to the navicular and calcaneal tuberosity
      • Modifying the plantar surface of the cast to a depth of 3 mm
      • If the order calls for a medial/lateral tibial extension to control varus/valgus, a build-up is made to emphasis the extension side but still maintain a 6 mm (1/4") build-up
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Clubfoot Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 2 mm  (1/16") build-up to the medial malleolus and 8 mm (5/16") to the lateral malleolus. 
      • Add 3 mm build-ups to the calcaneal tuberosity
      • The medial side of the 1st MTP joint will be moved laterally, to align it with a mid-calcaneal line. The amount of material removed from the medial forefoot to bring the forefoot into proper alignment will be added to the lateral forefoot to restore the proper ML
      • A lateral fibular extension is created to control varus and load a pressure tolerant area of the fibula
      • Raised forefoot trimlines, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups to any marked bony areas





    • 2. Design 

    • Image-126

    • Ankle and Midfoot Modification Transitions

      • Anatomical
        • No blending or build up as we transition anterior to malleoli, or along the sides of the midfoot
      • Easy On Easy Off
        • Blending or addition of material to allow the patient easier donning and doffing at the ankle and midfoot.
      • Full Trough
        • Material added to "trough" the device so the trimlines are inline with the apex of the buildups. (Commonly used for Positioning or Night time Stretching AFOs).




    • Image-94

    • Image-95
















    • 3. Thermoforming 



    • 4. Finishing 



    • 5. Additional Instructions 
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    • 6. Anatomical Measurements 
    • HFN Chicago Billing 
    • Should be Empty: