The orthotic management of arthrogryphosis

The arthrogryphotic child poses many problems for the orthotist who will need to be consulted for corrective splinting as early as a few weeks after birth. These children are frequently born with gross flexion deformities and severe equinovarus club feet. The physiotherapist will give stretching exercises and strapping is applied to gain as much correction as possible. Simple Denis Browne derotat ion splints can be applied first with strapping and, when the feet are large enough, open-toe bootees can be used. As the child grows it may be necessary to use the Denis Browne calcaneal splint. Lowerlimb orthoses may be required for walking as early in life as one year as most of these children have a vast amount of energy and the will to progress. It is usual to provide the severely handicapped child with bilateral hip-knee-ankle-foot orthoses which may require a single pelvic band or bo th pelvic and thoracic bands with locking mech anisms at the hips. Corrective and accommo dating footwear will also be necessary.