Hagen Orthotics and Prosthetics, Inc

Hagen Orthotics and Prosthetics, Inc

Solutions for your orthotics and prosthetics needs

Lower Body


Your orthosis was designed in accordance with the highest standards of modem medical technology by a Certified Orthotist, an expert trained to fabricate, fit and maintain your custom-made device. You should arrange a follow-up visit to ensure that everything is functioning properly.

Hagen Orthotics and Prosthetics, Inc

General Wear

Your orthotist will have shown you how to put on and remove the orthosis at the time of your final fitting. A plastic ankle/foot orthosis (AFO) or knee/ankle/foot orthosis (KAFO) must always be worn with a shoe since it is extremely slippery, unstable and ineffective without one.

Either fasten the orthosis first and then put on the shoe, or slide the orthosis into the shoe and use a shoehorn to slip your foot into both. The break-in period should be a gradual introduction towards full-time wear. Start with an hour a day and continue to add an hour every day. If irritation occurs, remove the brace and evaluate the skin in the pressure area. The irritation could be from having a new orthosis, but if the area continues to stay red for more than an hour after removing the brace an adjustment may be necessary. Call us with any questions about the fit of the brace, if needed.

Wear Supportive Shoes

It is important to maintain the same shoe-heel height for which your orthosis was designed. Excessive height strains your knees and back, creating instability. Heels that are too low may also cause knee and back pain. As we have explained, shoes worn with an orthosis should prove sufficient support; slippers, sandals and loafers are inappropriate.

Patients with metal, carbon or plastic AFO’s or KAFO’s should check regularly for signs of pressure and irregular shoe wear, reporting abnormalities to your orthotist at Hagen O&P.


Your orthosis was made to fit you properly and provide the greatest possible degree of comfort. Like breaking in a new pair of shoes, it may take a brief period before the sensation of wearing an orthosis feels natural. Follow your orthotist’ s instructions regarding the length of time to wear the device as you build up your tolerance.

A properly fit orthosis exerts a firm, steady pressure, similar to an open-palm hand pushing against the body. It should not cause any sharp or stabbing pain or create bruises, calluses or blisters. Should this occur, call us immediately and arrange an appointment for an adjustment.

Occasionally, extended periods of standing during hot, humid weather will result in some swelling. Remove the orthosis and elevate your leg until the swelling subsides. If it persists or becomes painful, notify your orthotist at once.

Maintain Your Weight

It is important to maintain a relatively consistent weight. Your orthosis was custom designed for your weight and dimensions, so extreme gain or loss may cause improper fit and require a new orthosis. Growing youngsters need to be checked at regular intervals to maintain proper fit or their orthotics.

Daily examination of skin in contact with the orthosis should become a habit. A new orthosis may cause some redness which should disappear within 15 minutes after removing the device. If redness does not disappear, make an appointment to have this inspected.

Diabetics and people with lessened sensation are especially vulnerable to skin irritation, particularly in bony areas such as the shin or on the bottoms of the feet. Extra care should be taken, and even minor skin irritations should be treated promptly.


Any part of the body covered by the orthosis should be washed daily with warm water and mild soap. Generous rinsing ensures removal of all lather since dried soap irritates the skin. Thoroughly clean the bottom of your feet and between the toes to avoid bacteria and dirt collection. The body should be completely dry before wearing the orthosis. Shaving your legs may cause an itchy rash or irritation.

AFO’s should be cleaned regularly with alcohol or mild soap and water. Do not soak the orthosis in water or attempt to hasten drying by using a hair dryer or placing the appliance in front of a heater. Your orthosis may be towel-dried or left to dry at room temperature. Talcum powder will help prevent odors.

If any part of your orthosis becomes cracked or broken, make an appointment and bring it in for repair or replacement. Worn fabric portions should also be replaced. Make an appointment to have this inspected.


Use the device in the recumbent position ONLY. This is not an ambulating AFO. Wear schedule is determined by physician’s order or therapy evaluation.

Prior to application, inspect the device and the ankle/foot. Do not apply the device if there is significant redness on the skin that would come in contact with the device.

Upon device removal, closely inspect for skin integrity. Discontinue device use until any skin integrity issues are resolved, and the orthosis is adjusted or the wearing schedule is modified to eliminate skin integrity problems.

Treatment Rationale

Orthotic therapy for mild to severe joint stiffness, contracture, or abnormal tone and spasticity of the ankle and foot. The device treats plantar flexion, inversion/eversion, and rotation of the foot and hip. A recumbent orthosis, the DynaproTM AFO can facilitate the muscle inhibition and provide a low load prolonged stretch to the affected joint(s).


Increase available range of motion, active and/or passive, at the ankle joint to:

  • Improve/maintain functional alignment of the ankle/foot
  • Increase range of motion and mobility and decrease risk of skin breakdown
  • Reduce/eliminate contracture related pain and discomfort
  • Prevent permanent deformity

Orthotic Treatment

  • 1 Prepare the AFO for application by opening the closures so that the device is ready after passively stretching the ankle/foot.
  • 2 Lower extremity tone may require the use of NeurostretcTM or passive range of motion to reduce tone and facilitate muscle inhibition. Begin stretching, if necessary, at the hip before passively stretching the knee, then the ankle/foot. Passive stretch must address the plantar flexion, inversion/eversion, and rotation of the foot. Slowly and gently, use sub-maximal passive stretching to the point of noticeable resistance only (no discomfort!). Hold for a minute to allow the extension release of the affected joint(s).
  • 3 If necessary, heat-mold the semi-rigid insert to fit, if the plantar flexion or inversion/eversion is greater than 15° from neutral. Mold to apply 5° to 15° of additional stretch from the point of resistance to stretch for plantar flexion and inversion/eversion.
  • 4 Place the ankle/foot into the AFO, carefully aligning the apex of the heel with the right angle bend in the boot. While maintaining proper alignment of the heel in the boot, secure the forefoot strap. Next secure the shin strap, crossing over the middle in an X pattern. The secured straps should be snug, but a finger should easily be able to be inserted under the straps at the top and bottom to ensure it is not too tight.
  • 5 Bring the instep strap over the top of the foot, inserting the strap through the buckle. Tighten the strap to hold the ankle in the proper position in the AFO to ensure it will not slip out of proper alignment while the AFO is worn. Check the strap to ensure it is not too tight and will not apply unnecessary pressure on the foot.
  • 6 Adjust the dorsi-flexion resistance pull straps by securing the center of the pull strap on the bottom of the AFO at the ball of the foot. Bring each side of the pull strap through the slot on the top of the AFO pull strap. Using the resistance straps, correct any inversion/eversion by applying a low load stretch to the lateral side of the boot for inversion and the medial side of the boot for eversion. The remaining strap should be loose with no pressure applied to the strap.
  • 7 When the ankle/foot is in the neutral coronal position (no inversion/eversion or rotation) use both resistance straps to treat the plantar flexion contracture. The elastic strap support will flex, initiating muscle inhibition of the affected tendon(s). Predisposing the join to long effects stretch.
  • 8 Move the hip control bar if needed to the left or right side to control or prevent internal or external rotation of the hip while lying in bed.
  • 9 Adjust the strap tension as necessary to maintain the therapeutic action of the device.

Check device setting for continued application, at least once a month or whenever the patient is not experiencing a gentle stretch sensation. Re-adjust the orthosis to maintain a 5° to 15° of Dorsi-flexion beyond the point of resistance. No therapeutic value can be obtained, if the orthotic is not treating the affected joint with “neuroflex” therapy.

Always follow protocols if the patient is transferred to acute care or other healthcare facilities. Send orthotic care plan and orthotic device(s) and accessories with the patient. A wearing time adjustment is necessary each time there is significant disruption in wearing schedule. Device tolerance must be reintroduced gradually and noted in the care plan.


  • 1 Remove soft cover from frame
  • 2 Close all hook and loop attachments on soft cover and place in a laundry bag
  • 3 Hand or machine wash on gentle cycle with mild detergent. Do NOT use commercial washers or hot water, bleach or fabric softener
  • 4 Air dry

This product requires a physician’s order and must be properly applied by a trained professional. This product is a single patient use only. Any substitution or removal of the product parts voids the manufacture warranty. OCSI/Neuroflex, Inc. will assume no liability if the above instructions are not followed.