Making Custom Ankle Foot Orthotics at Chedoke

Finding shoes for Cassie to fit over her leg braces is always a challenge. Cassie has two totally different braces on each foot making shoe fitting tricky. I feel as a mother that Cassie's footwear is an integral part of her orthotic management. It goes along with all that her orthotist does and needs to work for Cassie or else she struggles at school, gym and play.
Cassie is a typical 7 year old girl who wants to look fashionable and dress just like her girlfriends. Finding running shoes has been challenging. I have had luck with New Balance running shoes. New Balance have a removable insole and seem to be more adjustable with more velcro options.
Chedoke Prothetics and Orthotics department sells a pediatric running shoe called "hatchbacks". They cost around $67.00. Cassie has tried these shoes. The running shoes are wider and have a deeper inner heel box and toe box with cool velcro adjustable straps. The adjustable velcro allows the orthotist to internally adjust the shoe to varying thicknesses and offers good medial and lateral stability over the brace.
Personally, I was not satisfied with the Hatchback as I found the velcro started loosening off and Cassie had a loose shoe continually. Her EA complained many times that the shoe hindered her in gym class or at school. We had multiple adjustments of the Hatchbacks by Sharon her Orthotist and I was never completely satisfied.
In comparison, the new balance velcro stayed tighter longer. Interestly the New Balance even worked when Sharon cut them and adapted them to fit over her serial casts.
Finding a nice children's dress shoe for Cassie has been next to impossible at this point in time. I found a cool zip up boot that worked over the one set of braces and Cassie wore them with her dress and felt fashionable . Unfortunately I have not seen them in bigger sizes. We look at Childrens shoes often and find very little that is suitable but once we find a shoe that works Cassie just sticks with it.
Display of shoes on the wall at Chedoke. At least Hatchbacks are available in Cassie 's favourite colour pink!!
Cassie playing in the waiting room with the toys. She is waiting for Sharon Carr her Orthotist.

Making the new custom ankle foot orthotic. Cassie likes holding on to parts and participating in the process. Sharon is incredible with Children and knows Cassie well after seven years. It always goes smoothly with Sharon. Sharon's skilled hands, expertise and knowledge is unmeasurable to anyone else I've seen.
Next Monday it will be back to Orthotics for another serial casting and Sharon will continue making Cassie's new braces. Mom and Dad will plan for payment of our 25 percent of the braces and new shoes. Assisted Devices pays for 75 percent of Sharon's outstanding work, time and the braces themselves. Various funding options exist to pay the 25 percent but lots exclude you if you are middle class. I am battling Chris's Extended health benefits that have way to low a cap on orthotics and only pay every 3 years. I always ask for special consideration and send the benefits notes from specialists but the rules are set by the employer and the group benefit packages.

What is Serial Casting?

Serial casting is a process of applying and removing a series of light weight fiberglass casts to Cassie's leg. Every 1 to 2 weeks, the angle of the cast is changed to slightly stretch the muscles and move the joint a little closer to the correct position. Over time serial casting will make Cassie's muscles grow longer and improve the movement of her joint. The stretch is slow and gradual so Cassie has no pain wearing her cast. She is supposed to walk and run on her cast as usual. Sharon Carr her very talented orthotist is removing the cast with a special saw that is noisy but makes the removal quick and painless.


The old cast, signed by all her classmates and her teachers. Notice her specially made shoe that allows the orthotist to get the right angle for the cast.

The new Red and Green Christmas cast. Cassie walking the halls at Chedoke's Prothetics and Orthotics department with Cindy Gamberetto her Physiotherapist. Cassie loves the colours on her new Christmas Cast!!

Our little Miracle Girl Cassandra Fruck

C assandra Fruck was born a little over 7 years ago. Cassie as she is fondly known, has cerebral palsy as a result of an intraventricular hemorrage which she suffered in utero. The hemorrhage resulted in left sided hemiplegia and a condition called hydrocephalus. Since her birth she has undergone numerous hospital stays and operations including a shunt operation, a shunt infection and a second shunt insertion.
Cassie Fruck age 7 left sided hemiplegia CP, hydrocephulus an VP Shunt











The doctors new very early on because of her brain injury that Cassie had cerebral palsy. Even as a baby Cassie did not move her left hand normally, she could not hold her head up very well, she did not sit up at 7 months and she never crawled. Cassie has a team of people that have gotten her to the high functioning beautiful child she is today. She has physiotherapists, occupational therapists, pediatric neurosurgeon, orthopedic specialist, pediatirc orthotist as well as an entire extended family that has stood by her and supported her through every step of her development.

Despite her rocky start into this world, our precious little miracle attends grade 2 at Fessenden Public School. She is such a bright spot in our lives as well as all other lives she touches. She has a contagious smile: great personality and is just a well-rounded loveable , fun 7 year old. She has some limitations but she doesnt let this hinder her attempts at playing with kids her own age; trying to nurture those younger than her and being the best little sister she can be to her sister Julia, whom she adores.

Cassandra with her big sister Julia. Julia is such an inspiration to Cassie. Julia actively participates in physiotherapy after school program to motivate and encourage Cassie. It makes the program lots more fun and the girls get time together bonding!





Through out the years as Cassie has grown and developed into a typical 7 year old the muscles on her affected side have become prone to being shorter than those on Cassies stronger sideof her body secondary to decreased use. With the result of growth ( And Cassie is going to be tall!) Cassie's left foot has a shortened heel cord and tends to invert (turn in), such that she is walking on the outside border of her foot. Cassie's left hand is contracted and tight and her left thumb is stiffening inward.

Cassie needs to have an orthopedic surgery on her left foot. The medica named for her surgery is a medial column lengthening;lateral column shortening and a tibialis anterior transfer. Dr. Sarah Burrow's is Cassie's orthopedic specialist. Before this surgery can be performed Cassie's foot needs to be improved through Botox injections and Serial Casting.
Botox is a medication that relaxes spastic muscles. In Canada, it is approved for the treatment of equinovarus foot deformity arising from gastrocnemius spaticity in cerebral palsy. It is also very effective in treating spasticity in other muscle groups of various etiologies. A good medical article to read if you are interested is "The use of boulinum toxin in paediatric hypertonia". This article outlines the major use of Botox in children like Cassie.

Cassie's goals for the use of Botox as a treatment are to improve the range of motion in her left ankle and foot. To improve her walking abilities and to improve her left arm and hand function. The pharmacological effect of this medication only lasts for approximately three months. Therefore Cassie needs repeated injections to maintain the clinical improvements. Cassie also needs other treatments such as vigorous physiotherapy and serial casting.

Serial casing is a process of applying light weight fiberglass casts on Cassie's leg. Every week the angle of the cast is changed to slightly stretch the muscles and move the joint a little closer to the correct position. The serial casting sessions are an integral part of her orthotic management. The goal of serial casting is to restore the soft tissue extensibility of her muscles using normal physiologic adaptation mechanisms without compromising strength and power. Maintaining the muscle in a stretched position for 5-7 days results in new muscle cell growth which makes the muscle longer and the foot and leg more functional. . After the serial casting sessions a new custom ankle foot orthotic will be made. Cassie' new brace will improve her ability to function during every day activities.

Cassie at Chedoke's After School Physiotherapy Clinic with her physiotherapist Lindsay.



Stay tuned for a blog about Botox injections and Serial Casting. As well a special thank you to the Ancaster Community, St Johns Evangelical Lutheran Church and Fessenden Public school for Financial assistance to assist Cassie in receiving treatment!!