What is the appropriate modification for a child with CP who has -5 degrees of dorsiflexion during casting for custom AFOs?

The appropriate modification for a child with cerebral palsy (CP) who has -5 degrees of dorsiflexion during casting for custom ankle-foot orthoses (AFOs) is to cast in -5 degrees of dorsiflexion and plan to add an external heel wedge. This approach takes into account the child's existing limitation in dorsiflexion.

By casting in -5 degrees of dorsiflexion, the practitioner is accommodating the child's current range of motion. This ensures that the AFO is properly fitted to the child's foot position, promoting optimal alignment and function. The addition of an external heel wedge can provide the necessary correction to improve dorsiflexion during movement without causing discomfort or compromising stability.

This modification helps to create a dynamic interaction between the AFO and the child's foot, allowing for increased mobility while supporting the biomechanics required for ambulation. It addresses the specific needs of the child, facilitating better performance in activities that require ankle function.