Bespoke AFOs help Flora walk

Flora, baby with spina bifida, getting ready for ankle foot orthosis fitting
#orthotics #oskar

Bespoke AFOs help Flora learn to walk

BY Daisy

25 January 2023

Flora was diagnosed with Spina Bifida when her mother had a scan at 38 weeks. Georgina recalls: “The consultant said initially that the baby could have 65% brain damage and suggested termination.”

Spina Bifida is a neural tube defect. The neural tube develops to form the spine and nervous system. If it doesn’t form correctly in the first few weeks of pregnancy damage to the spinal cord can occur, causing neurological dysfunctions, such as lower-limb paralysis, sensory impairment and hydrocephalus (build-up of fluid in the brain).

Following Flora’s birth, it was clear that she did indeed have limited lower limb movement and sensation. Georgina searched the internet for possible ways of improving the prognosis for Flora and found Gerti Motavalli, an American physical therapist who has pioneered Spinal Electrical Stimulation therapy for children with Spina Bifida. The therapy can be used by parents on their child safely at home and Georgina has become a vigorous advocate for it as she witnessed significant improvements to Flora’s circulation, sensation and function in her legs.

Flora was prescribed AFOs by the NHS to support Flora’s legs though it is fair to say that Georgina and SB specialist Gerti were not impressed by the fit of the AFOs provided: “Flora didn’t have enough support, her feet were sliding around in them.” As ever, Georgina searched for an alternative and found a recommendation for LOC from a fellow mum on Instagram.

Flora was first assessed by Connor Mumford, one of LOC’s clinicians on 16th June. As Georgina remarked: “The contrast in service is quite marked, LOC has a Gait Laboratory, unlike NHS provision, and they don’t need to bother with casting as all measurements are scanned by their own App on an Iphone. The first assessment was incredibly thorough.” Although Georgina and Gerti had initially wanted Flora to be prescribed a KAFO, Connor suggested that a better-fitting pair of AFOs would be more appropriate. In addition, Connor prescribed adapted footwear. This is almost a point of principle for LOC as incorrect footwear can nullify the effectiveness of the orthosis prescribed.

Spina bifida baby with ankle foot orthoses

Flora wearing her AFOs during a physiotherapy session

At the fitting appointment, Georgina immediately noticed the difference in the design of the AFOs: “They were much higher up the leg, giving much more support and they were moulded further around her lower legs and feet. And most importantly for me was Flora’s reaction, there was an immediate improvement, she gained so much confidence in her ability to walk. Connor and the team have been outstanding and given Flora so much more independence. The service provided is excellent with the critical differences being the gait analysis that leads to a very specific, bespoke AFO design and the frequent trouble shooting reviews provided.”

You can follow Flora and Georgina’s journey on Instagram @spinabifidanaturally.


An AFO is an Ankle Foot Orthosis which as the name would suggest encompasses the ankle and foot. The objective is to control the position and movement of the ankle. AFOs are used to support weak limbs; they can also be used to immobilise the ankle and lower leg to correct foot drop. When set up correctly they can also have a great influence on the knee and hip joints. They are the most commonly used Orthoses.

The length of time that one needs to wear an AFO very much depends on the condition being treated. If it is a long-term condition like cerebral palsy or post-polio syndrome it is likely to be years as the condition cannot be cured. Your orthotist will advise you.

A patient’s comfort in their AFO is vital for compliance with the prescribed wearing regime.

So there are a number of steps the orthotist should take to ensure a comfortable fit: the patient’s heel should fit fully into the heel cup without excess space, the contours of the plantar surface of the AFO should match the patient’s foot, for children there needs to be up to half an inch growth room in the toe shelf length. At LOC we use our Gait Laboratories at our Kingston and Manchester clinics to fine-tune our bespoke orthotics.

A GRAFO is used to control instabilities in the lower limb by maintaining proper alignment of limbs and controlling their motion. It reaches around to the front of the knee extending down to the ankle. It works by altering a patient’s limb presentation to displace load and impact as well as offering further control to the knee.

The most flexible type of AFO is a Dynamic Ankle Foot Orthosis (DAFO).  It is thin and provides flexible support to the foot and ankle.

We have the following facilities and amenities at our Kingston Upon Thames location:

  • Free parking
  • Wheelchair ramp
  • Disabled toilet
  • Baby changing facilities

We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.

If your child has a neurological condition like Spina Bifida or Cerebral Palsy and you would like to know more about what LOC could do for your child, please contact LOC directly.