PLASTIC AFO w/COMPOSITE STRUT  Logo
  • Access Legacy PDF work order. Legacy form will be accepted until Nov 1st. 

  • Please do not print the Review page.

    Scroll to the bottom, hit Complete and then download the work order. 

  • PLASTIC AFO w/COMPOSITE STRUT

    Intake Information
  • Please enter a correct Fab PCC#

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  • Daily HFN Capacity

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  • PLASTIC AFO w/COMPOSITE STRUT

    Patient Information
  • The Scan Upload is available at the end of the Form. 

    • Please complete this form. Next, after acquiring the scan via the Hanger3D app, go to Order Forms > Jotform Order and fill out the required information and submit the scan. 

      

  • The Cast Measurement fields are available at the end of the Form. 

  • Due to the scan being modified, the Alignment and Modification options will not be displayed.

    Any Alignment or Modification changes can be called out in the Notes section. 

  • PLASTIC AFO w/COMPOSITE STRUT

    Configurator
  • GUIDANCE

    • Any brace with a flat toe plate will require shoe work to function
    • Any brace without a contoured foot plate/toe ramp is prone to fail

    • Measurements: 
    • Patient Measurements
    • Patient Measurements
    • Patient Measurements
    • Alignment: 
    • i

      NEUTRAL is the Tibia perpendicular to the floor based on Heel Height. 

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

    • Final Forefoot Position:

    • Set the Forefoot in   *   ° of      *        

    • Set the Forefoot in   *   ° of      * Rotation.

    • Final Hindfoot Position:

    • Set the Hindfoot in   *   ° of      *        

    • Modifications/Trimlines: 
    • Standard Mods include:

      • 1/8" (3 mm) buildup at the Malleoli, Navicular and Base of the 5th. 
      • 1/8" (3 mm) reduction at the Medial Longitudinal Arch Apex. 
    • Image-1047
    • Image-1048
    • Intrinsic Heel Skive requires external posting/wedging.

    • Image-1106
    • Image-1049
    • Image-1064
    • Image-1050
    • Materials/Design: 
    • Image-1241
    • Image-1242
    • Posting/Wedging:

    • Posting:

    • Image-1118
    • Posting options will not be available if a Heel Wedge is selected.

    • {intrinsicHeel990} Intrinsic Heel Skive was selected.

    • Image-1119
    • Image-1120
    • Image-1121
    • Image-1122
    • Image-1123
    • Image-1138
    • Plastic

    • i

      Finished Plastic Thickness will be within 10% of the requested thickness. 

    • Special Order Transfer Papers can increase device turnaround time.

    • PLEASE SELECT DIFFERENT OPTIONS FOR TRANSFER PAPERS.

    • Image-1082
    • Padding: 
    • Additional Padding

    • Finishing: 
    • Image-1065
    • Image-1069
    • Image-1142
  • PLASTIC AFO w/COMPOSITE STRUT

    Notes
  • Your order will be sent to CDC after submission along with the Scan. No futher action is needed.

    (No Entry required at the LEO portal)

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