PT turns into craft time (again)

Addy has excess plantar flexion (toe pointing) in her right ankle, which is causing her AFO not to fit correctly on that foot. Her PT made a splint for her to wear at night to help stretch her ankle back out, but we've been having trouble getting it to work well because Addy is a tummy sleeper. (I blame it on the fact that she spent literally the first 10 days of her life sleeping on her tummy because of her back surgery, but that could just be a coincidence.) Not only is she a tummy sleeper, she usually sleeps with her knees tucked in. Add in limited skin sensation that keeps her from knowing she needs to shift her position and a night splint that holds her ankle at a proper, 90-degree angle and it adds up to a pressure point forming on her knee.

Unfortunately, we can't just scrap the splint. She really needs to keep as much flexibility in her ankle as possible, both in general and because her AFOs need to fit right. So it's either splint or surgery to address the tightness, and I'm just not ready to jump to surgery (yet). In no particular order, we've tried:

• Modifying the AFOs to make them work with her stiff ankle.  We've gone back 4 times now, trying different tweaks.  I'm hoping we've finally found something that works, but it still doesn't address the fact that her ankle is stiff.  The current version includes an enormous viewing window at the heel so we can verify when her ankle is seated properly.
• Using with a longer splint (to prevent her from bending her knee).  It kept the pressure off her knee alright, but it never really fit right since gravity and her stiff joint joined forces to pull her foot out of the splint.  Plus, she slept terribly in it, probably because she couldn't tuck her knee in the way she likes.
• Trying to train her to sleep on her back.  Even when we've been successful at getting her to fall asleep on her back--which is not often--she rolls over in her sleep and spends the rest of the night on her tummy with her knees tucked under her.

Next up: knee pads, which can actually be found in tiny, infant/toddler sizes, but they're intended for use by kids with normal skin sensation to allow them to crawl on hard, rough surfaces (and if the reviews are at all accurate, they don't stay in place very well anyway).  My kiddo has sensitive skin with limited sensation, so hers need to be super soft, super adjustable, and super secure. 



I got my hands on some crazy thick felt, so that should take care of the super soft requirement and I added a Velcro strap to one side of it in order to meed the super adjustable requirement (btw, stitched by hand because the felt was too thick to go through the sewing machine).  The "secure" quality is going to come in the form of a pair of leggings, to which I will attach the actual knee pad using even more Velcro, but making sure to place it such that the Velcro doesn't create any hard edges.  It's kind of slow going--did you catch the part where most of it can't be done by machine??--but here's the current progress: