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The latest newsletter from ProLab: Preventing Malleolar Irritation with AFOs
For patients with peripheral edema from venous insufficiency, CHD, or renal failure, the circumference of their ankle can increase significantly as the day progresses. If these patients require a functional or gauntlet-type AFO, the time of day that you cast for and fit an AFO can affect the comfort of the device and your clinical outcomes.
If you both cast an AFO patient and dispense the device in the morning, the AFO usually fits well. However, the patient may return with complaints of malleolar irritation late in the day after wearing the brace. If you cast your patient in the morning and dispense the device in the afternoon, it will likely irritate the skin near the malleoli immediately.
To avoid this problem, cast your patient in the afternoon, when the leg and ankle are larger. This should help ensure a more comfortable fit regardless of the time of day that you dispense the AFO. Also, recommend that your patients, regardless of gender, purchase gradient knee-high compression hose (15 -21 mm Hg) or TED hose from a medical supply store to wear with their AFOs. This should help control edema in the lower extremity as the day progresses. Patient comfort, compliance, and clinical outcomes will be enhanced with additional musculoskeletal control of the AFO plus venous stasis control from the compression hose.