Manufacturing Guidelines

Ankle-Foot Orthosis
200
0868/002 09/2006 Physical Rehabilitation Programme
 MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of conflict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.

Acknowledgements:
Jean François Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
International Committee of the Red Cross Jacques Lepetit
19 Avenue de la Paix Bernard Matagne
1202 Geneva, Switzerland Joel Nininger
Guy Nury
T + 41 22 734 60 01 F + 41 22 733 20 57
Peter Poestma
E-mail: [email protected] Hmayak Tarakhchyan
www.icrc.org
© ICRC, September 2006 and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
All photographs: ICRC/PRP
Table of contents

Foreword 2
Introduction 4
Choosing between different designs 4
Casting and rectification 5
1. Flexible AFO 6
1.1 Moulding of EVA 6
1.2 Orthosis trim line 6
1.3 Vacuum moulding of the polypropylene 6
1.4 Preparation of the polypropylene shell 7
1.5 Preparation of the straps 8
1.6 Initial fitting and finishing 8
2. Rigid AFO 8
2.1 Moulding of EVA 8
2.2 Orthosis trim line 9
2.3 Plastic reinforcement 12
2.4 Vacuum moulding of the polypropylene 13
2.5 Preparation of the polypropylene shell 14
2.6 Proximal strap 14
2.7 Distal strap 15
2.8 Instep strap 16
2.9 Initial fitting and finishing 18
3. AFO with Tamarack Flexure JointTM 18
3.1 Moulding of EVA 18
3.2 Orthosis trim line 18
3.3 Plastic reinforcement 18
3.4 Installation of Tamarack Flexure JointTM 19
3.5 Vacuum moulding of the polypropylene 19
3.6 Preparation of the polypropylene shell 20
3.7 Preparation of the straps 22
3.8 Initial fitting and finishing 22
4. AFO anti-talus (anterior shell) 22
4.1 Moulding of EVA 22
4.2 Orthosis trim line 23
4.3 Plastic reinforcement 24
4.4 Vacuum moulding of the polypropylene 24
4.5 Preparation of the polypropylene shell 25
4.6 Preparation of the straps 26
4.7 Initial fitting 26
4.8 Finishing 26
List of manufacturing materials 27

Manufacturing Guidelines Ankle-Foot Orthosis 

 Foreword

The ICRC polypropylene technology

Since its inception in 1979, the ICRC’s Physical Rehabilitation Programme has promoted the use
of technology that is appropriate to the specific contexts in which the organization operates,
i.e., countries affected by war and low-income or developing countries.

The technology must also be tailored to meet the needs of the physically disabled in the countries
concerned.

The technology adopted must therefore be:

• durable, comfortable, easy for patients to use and maintain;

• easy for technicians to learn, use and repair;
• standardized but compatible with the climate in different regions of the world;
• low-cost but modern and consistent with internationally accepted standards;
• easily available.

The choice of technology is of great importance for promoting sustainable physical rehabilitation
services.

For all these reasons, the ICRC preferred to develop its own technique instead of buying ready-made
orthopaedic components, which are generally too expensive and unsuited to the contexts in which
the organization works. The cost of the materials used in ICRC prosthetic and orthotic devices
is lower than that of the materials used in appliances assembled from commercial ready-made
components.

When the ICRC launched its physical rehabilitation programmes back in 1979, locally available
materials such as wood, leather and metal were used, and orthopaedic components were
manufactured locally. In the early 1990s the ICRC started the process of standardizing the
techniques used in its various projects around the world, for the sake of harmonization between the
projects, but more importantly to improve the quality of services to patients.

Polypropylene (PP) was introduced into ICRC projects in 1988 for the manufacture of prosthetic
sockets. The first polypropylene knee-joint was produced in Cambodia in 1991; other components
such as various alignment systems were first developed in Colombia and gradually improved. In
parallel, a durable foot, made initially of polypropylene and EthylVinylAcetate (EVA), and now of
polypropylene and polyurethane, replaced the traditional wooden/rubber foot.

In 1998, after careful consideration, it was decided to scale down local component production in
order to focus on patient care and training of personnel at country level.

 ICRC Physical Rehabilitation Programme

Objective of the manuals

The ICRC’s “Manufacturing Guidelines” are designed to provide the information necessary for
production of high-quality assistive devices.

The main aims of these informative manuals are as follows:

• To promote and enhance standardization of ICRC polypropylene technology;

• To provide support for training in the use of this technology;
• To promote good practice.

This is another step forward in the effort to ensure that patients have access to high-quality services.

ICRC
Assistance Division/Health Unit
Physical Rehabilitation Programme

Manufacturing Guidelines Ankle-Foot Orthosis 

 Introduction

The aim of this document is to describe several methods for manufacturing ankle-foot orthoses
(AFO), working with the polypropylene technology used at the ICRC’s physical rehabilitation
centres.

Choosing between different designs

Without going into details, some features of different types of AFO are set out below to assist in the
choice of design.

Flexible AFO
• Dorsiflexion assistance
• Poor medio-lateral stabilization of the subtalar joint

Rigid AFO
• Blocks ankle movements
• Mediolateral stabilization of the subtalar joint
• Possibility of controlling forefoot adduction/abduction

AFO with Tamarack Flexure Joint TM

• Mediolateral stabilization of the subtalar joint
• Free ankle dorsiflexion
• Free or restricted ankle plantar flexion

AFO anti-talus
• Blocks ankle movements. Particularly efficient for preventing ankle dorsiflexion
• Poor mediolateral stabilization of the subtalar joint

 ICRC Physical Rehabilitation Programme

Casting and rectification

Patient assessment, casting and rectification of positive cast impressions are performed in
accordance with prosthetic and orthotic (P&O) standards.

For flexible AFO, the cast can be taken with 5 degrees of dorsiflexion so as to provide a preload and
ensure some spring action.

Manufacturing Guidelines Ankle-Foot Orthosis 

 1 Flexible AFO

1.1 Moulding of EVA

A flexible AFO does not usually require any EVA. However, in cases where it is necessary the
procedure described in section 2.1 (page 8) should be followed.

1.2 Orthosis trim line

To achieve the goal of allowing dorsiflexion of the ankle while preventing passive plantar flexion,
there are a number of design options.

4Mark the trim line as follows:

A The top is horizontal, 2 cm below the

fibula head.

B At the ankle, pass 2 cm behind the tip

of the malleoli to allow flexion of the
polypropylene.

C At the forefoot, leave the sides of the

toes and the head of the metatarsus
completely clear and pass the trim
line below them. This will allow the
polypropylene to follow the movement of
the metatarso-phalangeal joints.

Pull a stocking over the plaster model.

1.3 Vacuum moulding of the polypropylene

Dust the stocking with talcum powder.

Measurement of the polypropylene sheet:

1 Calf circumference + 10 cm.

2 Instep circumference + 10 cm.
3 Leg and foot length + 10 cm. (See next picture.)

Thickness 3 mm, 4 mm or 5 mm, depending on the patient’s weight.

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 1

Heat the polypropylene at 180° for 20 to 25 minutes, depending on the thickness of the
polypropylene and the efficiency of the oven.

Drape the polypropylene over the plaster model and stick it together along the anterior side.

Tighten the polypropylene around the suction cone by means of a rope or something similar.

Open the vacuum valve.

4Cut off the excess PP with a pair of

scissors while it is still hot.

Keep the vacuum on until the polypropylene cools down.

1.4 Preparation of the polypropylene shell

Draw the trim line on the polypropylene as described in section 1.2 (page 6).

Following the outline, cut the orthosis with an oscillating saw.

Remove the plastic shell from the plaster model.

Remove the stocking from inside the AFO.

Grind the orthosis trim line and smooth it.

Manufacturing Guidelines Ankle-Foot Orthosis 

 If an EVA has been moulded, transfer the trim line to the EVA and cut off the excess with a pair of
scissors.

1.5 Preparation of the straps

For the proximal strap, follow the procedure described in section 2.6 (page 14).

A distal strap might be needed, depending on the capacity of the patient’s shoe to hold the foot
inside the orthosis. If this is needed, follow the procedure described in section 2.7 (page 15).

1.6 Initial fitting and finishing

If EVA is used, glue it partially inside the orthosis.

The initial fitting is performed according to P&O standards.

Carry out the required modification on the polypropylene and smooth the trim line.

Glue the EVA completely inside the polypropylene, cut off the surplus and smooth the trim line.

2 Rigid AFO

2.1 Moulding of EVA

EVA (6 mm) may be moulded prior to the draping of the polypropylene, for the following reasons:
• to improve comfort;
• to prevent skin breakage in patients with sensation loss;
• for orthoses used at night.

Follow the procedure described below or, if the case does not require EVA, go on to the next section.

 ICRC Physical Rehabilitation Programme

4Position the plaster model with the
forefoot pointing downwards.

Measurement of the EVA sheet:

• width, instep circumference;
• length, that of the plaster model
(leg + foot);
• thickness, 6 mm.

Heat the EVA at 120° for 3 to 5 minutes,

depending on the efficiency of the oven.

Drape the EVA manually over the plaster

model and hold it in place until it has
cooled completely.

4Cut off the excess with a cutter or a pair of

scissors.

Staple the EVA onto the front of the plaster

model.

2.2 Orthosis trim line

2.2.1 “Standard” trim line

4Mark the trim line as follows:

A The top must be horizontal, 2 cm below

the fibula head.

B At the ankle, pass the line 1 cm anterior

to the tip of the malleoli.

C At the forefoot, leave the sides of the

toes and the head of the metatarsus
completely clear and pass the trim
line below them. This will allow the
polypropylene to follow the movement of
the metatarso-phalangeal joints.

Manufacturing Guidelines Ankle-Foot Orthosis 

 2.2.2 Trim line to correct forefoot adduction

Forefoot adduction is common in cases of clubfoot.

4Mark the trim line as follows:

A The top must be horizontal, 2 cm below

the fibula head.

B Increase coverage of the lateral mid-

foot, passing in front of the cuboid,
to enlarge the area of pressure.

C At the forefoot, the line must be

proximal to the 5th metatarsal head.

D Decrease coverage of the medial

mid-foot at the navicular/malleoli,
to facilitate donning.

E At the forefoot, cover the medial side of

the metatarsal head and toe, to correct
forefoot adduction.

10 ICRC Physical Rehabilitation Programme

2.2.3 Trim line to correct forefoot abduction

Forefoot abduction is often seen in cases of cerebral palsy.

4Mark the trim line as follows:

A The top must be horizontal, 2 cm below

the fibula head.

B Decrease coverage at the level of the

lateral malleoli, to ease donning.

C At the forefoot, the line must be distal

to the 5th metatarsal head, to avoid
metatarsus abductus.

D Increase coverage of the medial

mid-foot at the level of the navicular,
to increase mid-foot support.

E At the forefoot, the line must be

proximal to the 1st metatarsal head.

Manufacturing Guidelines Ankle-Foot Orthosis 11

 2.3 Plastic reinforcement

The AFO may need reinforcement, especially at ankle level. If necessary, use one of the following
methods; otherwise go on to the next section.

2.3.1 Double layer of polypropylene

4A second layer of polypropylene

covering the ankle and the foot is
moulded at the same time as the main
layer.

Cut a piece of polypropylene:

• thickness, 3 mm;
• width, instep circumference;
• length, foot length + 10 cm

Grind the last 3 cm at the proximal

end to gradually reduce the thickness
of the polypropylene.

4The two layers are heated at the same

time.

The reinforcement is placed on the

plaster model, then the second layer
is vacuum-moulded immediately to
obtain a perfect seal between the two.

A double layer of polypropylene has the disadvantage of reducing flexibility of the forefoot in relation to
the metatarso-phalangeal joint.

12 ICRC Physical Rehabilitation Programme

2.3.2 Channels in the polypropylene

The presence of channels in the plastic significantly improves its strength. There are several ways of
making these channels.

4Cut two strips of EVA:

• thickness, 6 mm;
• width, 7 mm;
• length, 15 cm.

Grind both distal and proximal ends to

gradually reduce the thickness of the
EVA.

Pull a stocking over the plaster model.

Glue the strip lightly onto the stocking.

The more anterior the position of the channel, the more the AFO will resist dorsiflexion of the ankle.

Reinforcements prolonged along the side of the mid-foot increase the volume of the orthosis so that it
may no longer fit into the patient’s shoe.

2.4 Vacuum moulding of the polypropylene

If this has not yet been done, pull a stocking over the plaster model. For maximum efficiency, the EVA
used to make channels in the polypropylene must not be covered with a stocking.

Follow the procedure described in section 1.3 (page 6), taking into account the presence or absence
of a double layer of polypropylene (section 2.3.1, page 12).

Manufacturing Guidelines Ankle-Foot Orthosis 13

 2.5 Preparation of the polypropylene shell

Draw the trim line on the polypropylene as described in section 2.2 (page 9).

Cut the orthosis with an oscillating saw, following the outline.

Remove the plastic shell from the plaster model.

Remove the stocking from inside the AFO.

Grind the orthosis trim line and smooth it.

If EVA has been moulded beforehand, transfer the trim line to the EVA and cut off the excess with a
pair of scissors.

2.6 Proximal strap

Use a ready-made Velcro strap 40 mm wide, or make a strap with Perlon webbing or some other
strong material.

4With a large tubular rivet, fix the belt

holding the loop on the medial side, 1.5 cm
below the proximal trim line.

The loop should be placed on the

polypropylene and not be in contact with the
patient’s leg.

14 ICRC Physical Rehabilitation Programme

4Insert the belt through the loop to measure
the required length.

Fix the strap with a large tubular rivet on the

lateral side. Make sure the strap is perfectly
horizontal before fixing it.

Cover the surface of the strap in contact with

the patient’s leg with 3 mm EVA.

2.7 Distal strap

You must choose between a distal strap and an instep strap. The latter has the advantage of holding
the calcaneum firmly inside the orthosis (equinus correction).

Use a Velcro strap 25 mm wide.

4With a large tubular rivet, fix the belt

holding the loop on the medial side, 4 cm
above the malleoli.

The loop should be placed over the

polypropylene and not be in contact with the
patient’s leg.

4Fix the strap with a large tubular rivet on the

lateral side. Make sure the strap is perfectly
horizontal before fixing it.

Cover the surface of the strap in contact with

the patient’s leg with 3 mm EVA.

Manufacturing Guidelines Ankle-Foot Orthosis 15

 2.8 Instep strap

Use a Velcro strap 25 mm wide.

Two techniques are presented, depending on whether the back of the foot is in a neutral position or
needs a valgus/varus correction.

2.8.1 Neutral position

4With a large tubular rivet, fix the belt

holding the loop on the medial side, at an
angle of 45° passing through the posterior
distal tip of the calcaneum.

The loop should be placed over the

polypropylene and not be in contact with
the patient’s leg.

4Insert the belt through the loop to

measure the required length.

Fix the strap with a large tubular rivet on

the lateral side, at the same angle of 45°.

Cover the surface of the strap in contact

with the patient’s leg with 3 mm EVA.

2.8.2 Varus/valgus correction

The strap will pass through a slot cut in the polypropylene.

4The slot is cut on the lateral side for varus

correction and on the medial side for
valgus correction.

Mark the position of the slot 40 mm from

the back of the foot and perpendicular
to a line drawn at an angle of 45° passing
through the posterior distal tip of the
calcaneum.

The slot should be 30 mm long.

16 ICRC Physical Rehabilitation Programme

4Make holes along the slot axis with a drill
fitted with a 4 mm bit.

4With a cutter, connect the holes with each

other.

Finally, smooth the trim line with a file.

4The loop is placed on the medial side for

varus correction and on the lateral side
for valgus correction.

Fix the belt holding the loop with a large

tubular rivet, at an angle of 45° passing
through the posterior distal tip of the
calcaneum.

The loop should be placed over the

polypropylene and not be in contact with
the patient’s leg.

4Insert the belt through the slot on one

side and through the loop on the other
side to measure the required length.

Fix the strap with a large tubular rivet just

outside the slot.

Cover the surface of the strap in contact

with the patient’s leg with 3 mm EVA.

Manufacturing Guidelines Ankle-Foot Orthosis 17

 2.9 Initial fitting and finishing

If EVA foam is used, glue it temporarily inside the orthosis.

The initial fitting is performed in accordance with P&O standards.

Carry out the required modifications on the polypropylene and smooth the trim line.

Glue the EVA completely inside the polypropylene, cut off the surplus and smooth the trim line.

3 AFO with Tamarack Flexure Joint TM

3.1 Moulding of EVA

Follow the procedure described in section 2.1 (page 8), or go on to the next section if EVA is not
required.

3.2 Orthosis trim line

Follow the procedure described in section 2.2.1 (page 9).

3.3 Plastic reinforcement

Posterior reinforcement for greater plantar flexion control is required when the orthosis is intended
to prevent plantar flexion (not fully described below).

Follow the procedure described below, or go on to the next section if plantar flexion is left free.

A second layer of polypropylene for positioning at the level of the Achilles tendon is moulded at the
same time as the main layer.

4Cut a piece of polypropylene:

• thickness, 5 mm;
• width, 2 cm;
• length, 7 cm.

18 ICRC Physical Rehabilitation Programme

4First the reinforcement (heated at
the same time as the polypropylene)
is placed on the plaster model, then
the second layer is vacuum-moulded
immediately to obtain a perfect seal
between the two layers.

3.4 Installation of Tamarack Flexure JointTM

On the plaster model, mark the position of the joint axis:

• laterally, at the apex of the malleoli;
• medially, slightly posterior to the distal tip of the malleoli.

Make sure that the joints are at the same level on both sides.

4Use the moulding dummies to form a

snugly fitting cavity for the Tamarack
Flexure JointTM.

Nail them vertically onto the plaster

model so that the midpoint is located
on the ankle axis.

Pull a stocking (cotton stockinet is too thick) over the plaster model.

3.5 Vacuum moulding of the polypropylene

Follow the procedure described in section 1.3 (page 6), taking into account the presence or absence
of a posterior reinforcement (section 3.3, page 18).

Manufacturing Guidelines Ankle-Foot Orthosis 19

 3.6 Preparation of the polypropylene shell

Draw the trim line on the polypropylene as explained in section 3.2 (page 18).

Cut only the contour of the orthosis with an oscillating saw. Do not cut along the separation between
foot section and calf section.

Remove the plastic shell from the plaster model.

Extract the moulding dummies and the stocking from inside the AFO.

4Draw the separation line between the foot Correct Incorrect

section and the calf section:
• Mark the middle of the cavities created
by the dummies.
• Draw a “V” anterior to the midline of
each cavity. Ensure that the “V” does not
extend backwards past the centre of the
cavity.

4For AFO with plantar flexion control,

draw a horizontal line posterior to the
marks joining the two sides.

4For AFO with free plantar flexion, draw

a “V” posterior to the midline of each
cavity. Ensure that the “V” does not
extend forward past the centre of the
cavity.

20 ICRC Physical Rehabilitation Programme

4Drill holes at the dimples left by the holes
in the moulding dummies:
• 5 mm for large size;
• 4.5 mm for small size.

4Use a thin-bladed saw (1/16’’ blade kerf or

less) to separate the foot section from the
calf section.

Do not use an oscillating saw because too

much material is lost along a ragged, wide
cut line.

Smooth the trim line edge with a hand deburring tool or a piece of glass. Do not grind the trim line
because this will reduce flexure coverage and reduce the ability of the cavity to anchor and control the
flexure effectively.

4Insert the Tamarack Flexure JointTM and

secure with metal fasteners and anchoring
screws.

Depending on the thickness of the

polypropylene, it may be necessary to
adjust the length of the screws if the ends
protrude inside the AFO.

Manufacturing Guidelines Ankle-Foot Orthosis 21

 3.7 Preparation of the straps

For the proximal strap, follow the procedure described in section 2.6 (page 14).

In some cases the patient might need a distal strap. If so, follow the procedure described in section
2.7 (page 15).

3.8 Initial fitting and finishing

If EVA foam is used, glue it temporarily inside the orthosis.

The initial fitting is performed in accordance with P&O standards.

Carry out the required modifications on the polypropylene and smooth the trim line.

Glue the EVA completely inside the polypropylene, cut off the excess and smooth the trim line.

Glue the flexure anchoring screws with a removable thread-locking compound (Loctite).

4 AFO anti-talus (anterior shell)

4.1 Moulding of EVA

EVA (6 mm) may be moulded prior to draping of the polypropylene:

• to improve comfort;
• to prevent skin breakage for patients with sensation loss.

Do not cover the foot, to avoid an increase of volume which may prevent the patient from wearing
normal shoes.

Follow the procedure described below, or go on to the next section if the case does not require EVA.

Position the plaster model with the forefoot pointing upwards.

4Cut a piece of EVA:

• width, calf circumference;
• length, leg length;
• thickness, 6 mm.

Heat the EVA at 120° for 3 to

5 minutes, depending on the
efficiency of the oven.

Drape the EVA over the plaster

model manually and hold it in place
until it has cooled completely.

22 ICRC Physical Rehabilitation Programme

4Cut off the excess with a cutter or a
pair of scissors.

Grind the distal trim line to

gradually reduce its thickness.

Staple the EVA onto the back of the

plaster model.

4.2 Orthosis trim line

4Mark the orthosis trim line as follows:

A The top must be horizontal, 2 cm below

the tibial tubercle.

B On the leg, 1 cm posterior to the

mid-line.

C On the ankle, at the top of the malleoli

to facilitate donning.

D On the forefoot, clear the sides and

top of the toes and the head of the
metatarsus completely, passing below
them. This will allow the polypropylene
to follow the movement of the metatarso-
phalangeal joints.

Manufacturing Guidelines Ankle-Foot Orthosis 23

 4.3 Plastic reinforcement

The presence of channels in the plastic significantly improves its strength. There are several ways of
making these channels.

4Cut two strips of EVA:

• thickness, 6 mm;
• width, 10 mm;
• length, 20 cm.

Grind both distal and proximal ends to gradually

reduce their thickness.

Glue the strips onto the plaster model, 1 cm anterior

to the lateral and medial longitudinal axes.

Reinforcements prolonged along the side of the

mid-foot increase the volume of the orthosis so that it
may no longer fit into the patient’s shoe.

4.4 Vacuum moulding of the polypropylene

The procedure described below ensures uniform thickness of the polypropylene all over the orthosis. Do
not try to make a single seam on the anterior side, because the creases gathering at the ankle will make
it necessary to stretch the polypropylene too thinly.

If this has not yet been done, pull a stocking over the plaster model. For maximum efficiency the EVA
used to channel the polypropylene must not be covered with a stocking.

Dust the stocking with talcum powder.

1
Measurement of the polypropylene sheet:

1 Calf circumference + 10 cm.

2 Instep circumference + 10 cm.
3 Leg and foot length + 10 cm.

PP thickness: 4 mm or 5 mm, depending on the patient’s weight.

3

24 ICRC Physical Rehabilitation Programme

Heat the polypropylene at 180° for 20 to 25 minutes, depending on the thickness of the
polypropylene and the efficiency of the oven.

Drape the polypropylene over the plaster model and stick it together along the posterior side and
under the foot.

Tighten the polypropylene around the suction cone with a rope or something similar.

Open the vacuum valve.

4Cut off the excess with a pair of scissors

while the polypropylene is still hot.

Keep the vacuum on until the polypropylene cools down.

4.5 Preparation of the polypropylene shell

Draw the trim line on the polypropylene as explained in section 4.2 (page 23).

Cut the orthosis with an oscillating saw, following the outline.

Remove the plastic shell from the plaster model.

Remove the stocking from inside the AFO.

Grind the orthosis trim line and smooth it.

If EVA has been moulded beforehand, transfer the trim line to the EVA and cut off the excess with a
pair of scissors.

Manufacturing Guidelines Ankle-Foot Orthosis 25

 4.6 Preparation of the straps

For the proximal strap, follow the procedure

described in section 2.6 (page 14).

In some cases the patient might need a distal strap.

If so, follow the procedure described in section 2.7
(page 15).

4.7 Initial fitting

If EVA foam is used, glue it temporarily inside the orthosis.

The initial fitting is performed in accordance with P&O standards.

4It is often necessary to flare the polypropylene

at the posterior part of the heel in order to
facilitate donning and to avoid painful contact
with the edge of the plastic.

4.8 Finishing

Carry out the required modifications on the polypropylene and smooth the trim line.

Glue the EVA inside the polypropylene, cut off the surplus and smooth the trim line.

26 ICRC Physical Rehabilitation Programme

List of manufacturing materials

Unit of
ICRC Code Description Quantity
measure
For negative and positive cast :
ODROSTOCOT60 Tubular stockinet, 60 cm cm 70
According to size: Plaster of Paris bandages Piece 3
• MDREBANDP10 10, 12 or 15 cm x 3 m
• MDREBANDP12
• MDREBANDP15
OTOOPLASPW40 Plaster of Paris powder Each As required
For EVA and plastic moulding :
If required, according to EVA 6 mm Each As required
colour: Terra, olive or beige colour
• OPLAEVAFERA06
• OPLAEVAFLIV06
• OPLAEVAFKIN06
None Nylon stockinet Piece 1
According to colour and Homopolymer Each As required
thickness: Terra, olive or beige colour
• OPLAPOLYCHOC03 3, 4 or 5 mm thickness
• OPLAPOLYCHOC04
• OPLAPOLYCHOC05
• OPLAPOLYLIV03
• OPLAPOLYLIV04
• OPLAPOLYLIV05
• OPLAPOLYSKIN03
• OPLAPOLYSKIN04
• OPLAPOLYSKIN05
For the TAMARACK Flexure JointTM:
According to size: Piece 1
• OCPOSOOTTAL Large size (740L)
• OCPOSOOTTAS Small size (740S)
EHDWGLUEL243 Glue, Loctite 243, blue, threadlock, 50-ml bottle As required 4
For the proximal strap:
OSBOSTRVP440 Strap, Velcro, PVC, with loop, brown, 400 x 40 mm Piece 1
OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2
or
OSBOVSBO30 Strap, polyester, black, 40 mm cm 25
None Strap, Velcro, 40 mm cm 20
None Loop, 40 mm x 100 pieces Piece 1
OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2
For distal/instep strap:
OSBOSTRVP325 Strap, Velcro, PVC, with loop, brown, 300 mm x 25 mm Piece 1
OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2
or
OSBOVSBO24 Strap, Perlon webbing, 25 mm cm 20
None Strap, Velcro, 25 mm cm 15
OSBOVSBO35 Loop, 25 mm x 100 pieces Piece 1
OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

Manufacturing Guidelines Ankle-Foot Orthosis 27

 MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of conflict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.

Acknowledgements:
Jean François Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
International Committee of the Red Cross Jacques Lepetit
19 Avenue de la Paix Bernard Matagne
1202 Geneva, Switzerland Joel Nininger
Guy Nury
T + 41 22 734 60 01 F + 41 22 733 20 57
Peter Poetsma
E-mail: [email protected] Hmayak Tarakhchyan
www.icrc.org
© ICRC, September 2006 and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
All photographs: ICRC/PRP
 Manufacturing Guidelines

Ankle-Foot Orthosis
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0868/002 09/2006 Physical Rehabilitation Programme