1. Determining Stirrup Placement
For an AFO With Tibial Torsion

2. 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)
Left AFO
LATERAL
MEDIAL

3. 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)
Left AFO
LATERAL
MEDIAL

4. 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
Left AFO
LATERAL
MEDIAL

5. 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
Toe-Out
Toe-In
Left AFO
LATERAL
MEDIAL

6. 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
Toe-Out
Toe-In
Left AFO
LATERAL
MEDIAL

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

8. 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)
Left AFO
MEDIAL
LATERAL

9. 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
Left AFO
MEDIAL
LATERAL

10. 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
1/8”-3/16”

11. 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
1/8”-3/16”

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