2 months after foot surgery and new bracing

My last update on Kevin's foot was about a month ago after the green cast was removed and he was wearing the air cast. We've been going to physical therapy once a week for a month and each week he has been getting stronger. First standing for seconds and increasing over time. He was able to take steps with the air cast but needed to support himself with his hand. On March 9 he was fitted with the new AFO brace and he immediately began independently walking with no support. In fact, the next day we were visiting my parents and he immediately began going down and up the basement steps. He is now independently walking throughout the house and up and down the stairs easily with his AFO brace...which means he's up to all is old shenanigans in the house.

We had an appointment with the orthopedic doctor on March 17 (a week after receiving the AFO brace) and he said everything looked good with his foot...but he doesn't like the way Kevin's foot is positioned in the new AFO brace. 

I was confused when we received Kevin's new AFO brace because it still had a heel wedge. The AFO brace he wore before the foot surgery had a heel wedge but I thought it was because of the abnormality of his foot that he needed the foot wedge. The orthotist that makes the brace and our physical therapist explained:

"The current AFO is set in 0 degrees of dorsiflexion, or neutral ankle angle. This is in contrast to his previous AFO set in 15 degrees of plantarflexion, or -15 degrees of dorsiflexion. This change is secondary to no longer having a contracture in his ankle with his gastro/calf muscle. The angle of inclination has remained the same at 12 degrees (which is the reason for the heel wedge). This increases stability for standing and ambulation by placing the ankle in the proper position for activating muscles in the hip and stabilizes the ankle. The expected position of the ankle (angle of inclination) during midstance when walking is 12 degrees. In other words, the most stable moment during the gait cycle occurs when the angle of inclination reaches 12 degrees when standing on one leg during walking. This is the position we have put Kevin in to maintain his improved ROM and also increase his functional mobility and safety."

So this current brace with the wedge is why Kevin was able to walk independently immediately after getting fitted in it because it supports his balance and stability while protecting his foot and ankle. He cannot take steps without the brace on...yet. 

The orthopedic doctor spoke with our physical therapist and he is recommending a hinged AFO brace instead of the wedged AFO brace - to use the gained mobility in the ankle since the surgery and to maintain the increased range of motion from the heel lengthening.

It is my understanding, after talking to the orthopedic doctor and to some mom's at Kevin's dance class - that there is some risk of spasticity recurring in his foot if it is set in the wedged AFO brace position. It sounds like the hinged AFO brace will allow him more mobility to use the function he has gained through the surgery...which we of course want to maintain.

He can only walk with the wedged brace on at this time. It is my guess that once we receive the new hinged AFO brace - Kevin will not be able to walk as independently as he currently is with the wedged AFO brace. I am assuming that eventually he will gain this ability and trust that this will ultimately be better for Kevin's foot in the long run - to maintain the flexibly and mobility Kevin was given from the surgery. It sounds like we will end up having both braces and will alternate the wedged and hinged brace during the day until Kevin is able to walk independently with the hinged AFO brace. 

We scheduled Kevin's next surgery on his left hip for June 22.