AFO Pistoning Problem non Toe Walker

The patient was seen today for adjustments to her left SAFO and her right UCB. She was still getting pressure at the back of the heel on the right side. I believe she is pistoning inside the brace. I fared the proximal trimline in the heel section. I encouraged mom to tighten the shoelaces tighter. Mom is concerned because the patient is externally rotating her foot on the left as she walks. I noted that the strap that is on the posterior section of the SAFO was very tight. I loosened this to allow her more plantarflexion. The patient is not a toe walker therefore the strap is loose for her. She was also getting pressure on the navicular. This was heat relieved and I added a pad along the 5^{1 metatarsal to adduct her foot more in the brace. The patient ambulated for approximately 50 feet. Her gait looked improved. I told mom to monitor the areas to ensure that they do not get worse. Because they have turned into calluses, they would take time to dissipate. I advised her to put lotion on the patient's feet at night. This would help soften the calluses. Everything else appears appropriate. The patient will be seen as needed.