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  • 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 be sure to submit your order when you have completed your order. There is no need to print for your records. Upon submission a PDF confirmation file will be emailed to you.

      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 
    •  - -Pick a Date
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    •  - -Pick a Date :
    • 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: