Determining Stirrup Placement

1. Determining Stirrup Placement For an AFO With Tibial Torsion

2. LATERAL MEDIAL Left AFO Determining Stirrup Placement with Tibial Torsion • For this demonstration a Left AFO is being fabricated • Draw a line across the width of the paper 1” from the bottom (baseline) • Locate the midpoint of the baseline and draw a line perpendicular to it about 4” high(centerline)

3. LATERAL MEDIAL Left AFO Determining Stirrup Placement with Tibial Torsion • Find the ankle M-L measurement on the orthometry form • Divide this measurement in half and mark the result on either side of the center line • Draw perpendicular lines 4” high on these marks (left and right side lines)

4. LATERAL MEDIAL Left AFO Determining Stirrup Placement with Tibial Torsion • Find the medial and lateral malleolar measurements on the orthometry form • Mark the medial measurement on the left side line if for a (R) AFO or on the right side line for a (L) AFO • Mark the lateral measurement on the opposite side line

5. Toe-Out Toe-In LATERAL MEDIAL Left AFO Determining Stirrup Placement with Tibial Torsion • Connect these two marks with a line (tibial torsion line) • Place a mark on the center line ¼” from the baseline • Using a protractor establish the toe-in/toe-out line on the baseline 1/2”-3/4” from the medial side line • Note: Toe-out line will lean laterally; toe-in line will lean medially

6. Toe-Out Toe-In LATERAL MEDIAL Left AFO Determining Stirrup Placement with Tibial Torsion • Place the shoe with the heel removed on the diagram so that: • the medial border of the shoe is parallel to the toe-in/out line • the back of the heel is on the 1/4” line • The heel section is centered within the medial and lateral side lines

7. Toe-Out Toe-In LATERAL MEDIAL Mark Mark Left AFO Determining Stirrup Placement with Tibial Torsion • Mark the edges of the sole where the torsion line crosses

8. MEDIAL LATERAL Left AFO Determining Stirrup Placement with Tibial Torsion • Remove the shoe from the diagram and turn it over so that the sole faces you • Transfer the marks on the sides of the sole to the bottom of the sole • Connect the marks with a straight line (stirrup positioning line)

9. MEDIAL LATERAL Left AFO Determining Stirrup Placement with Tibial Torsion • Place the stirrup on the shoe so that the posterior edge of the stirrup is on the positioning line • Trace the outline of the stirrup on the sole • Determine where the holes in the tongue are to be drilled, mark and center punch them

10. 1/8”-3/16” Determining Stirrup Placement with Tibial Torsion • Bend the tongue of the stirrup to conform to the curve of the sole leaving a clearance of 3/16" to 1/8" at the anterior most point

11. 1/8”-3/16” Determining Stirrup Placement with Tibial Torsion • Bend the tongue of the stirrup to conform to the curve of the sole leaving a clearance of 3/16" to 1/8" at the anterior most point • Drill all holes in the stirrup using an appropriately-sized drill for a #8 rivet

12. Determining Stirrup Placement with Tibial Torsion • Bend the tongue of the stirrup to conform to the curve of the sole leaving a clearance of 3/16" to 1/8" at the anterior most point • Drill all holes in the stirrup using an appropriately-sized drill for a #8 rivet • Countersink all holes on bottom of the stirrup

13. Determining Stirrup Placement with Tibial Torsion • Place the stirrup back on the shoe and mark the locations of the holes on the sole • Drill one 3/16” hole in the sole and place a rivet through this hole from the inside out to position the stirrup • Drill the remaining holes using the stirrup as a guide placing a rivet through each hole after drilling

14. Determining Stirrup Placement with Tibial Torsion • You are now ready to rivet the stirrup to the shoe