Sunday, October 26, 2014
Tips for Breaking in Orthotic Devices
Breaking into full time wear of custom made functional foot orthotic devices should occur over a period of 10 to 14 days.
Picking Up Your New Orthotic Devices
On the day you pick up the orthotic devices, wear them for 1 hour if tolerated. This hour should only include active walking or standing. Do not count sitting time. Therefore, 1 hour of orthotic wear may actually occur over 2 to 6 hours in real time. If even 1 hour is difficult, attempt (2) 30 minute sessions, or (4) 15 minute sessions, with an hour off between the sessions. So much will depend prior use of orthotic devices, the amount of change of structure built into the design, the weakness of your intrinsic or extrinsic foot and ankle muscles needed to adapt to the change, and the nerve sensitivity or hypersensitivity to this new pressure sensation on the bottom of your foot.
The breaking in process continues by adding 1 more hour each day until you are up to 8 hours of wear by the 8th day. Of course, due to many factors, it may take more than 8 days to build up to these 8 hours. Once you are at 8 hours, you should be able to go as long as you desire on any given day. Runners should run 1 mile longer with the orthotic devices each day (starting at 1 mile on the first day). Other athletic activities, like baseball, etc., should progress in 30 minute intervals daily (starting with 30 minutes the first day).
The doctor/therapist prescribing the orthotic device should dispense them, watch you walk and/or run, and attempt to make the devices stable and comfortable. This is the perfect time to learn power lacing. Power lacing is a must for orthotic devices. You can find my Youtube video at drblakeshealingsole power lacing in the search engine at Youtube.
If you get discomfort anywhere (foot, ankle, knee, hip or back) while breaking in the device, immediately remove the device, and leave it out of your shoe for the next 2 hours. If there is still time later in the day, you can try to re-wear them if you have not met your time allotment.
It is important during the adjustment period to always have the regular shoe inserts with you in case you have to take out your Orthotic devices for this 2 hour period. The accommodation period is partially for foot comfort, but mainly for knee, hip, and back adjustment to the new positioning of the body and the new use of many muscle groups. Plus, there can be a sensitive area in your knee, etc, that we will find only by placing a new pressure on it. Lucky us!!
Golden Rule of Foot: Always blame any new ache or pain on the new Orthotic devices. Never push through any pain. The breaking in process must be pain free.
Adjustments May Be Necessary
Normally, patients are told to get used to the orthotic devices and to return in 6 weeks. I love when they bring in some old and new shoes to check how the inserts fit and function in gait. However, 30% of patients return to the office in 2 weeks or so since they are having some problem with the devices.
Adjustments are normally routine, and part of normal office visits. Occasionally, the orthotic devices or impression molds must be returned to the laboratory for further fine-tuning. Sometimes I can predict which patients are going to need adjustments, and sometimes I can not. It is common to recommend different shoes at times, and there may be problems with fit. Many patients need an intermediary pair of orthotic devices, before the final pair is made, since the correction needed is too severe.
The prescribing practitioner may use his/her judgment in allowing some discomfort, if further adjustments may lead to loss of stability.
Wear socks with orthotic devices if the devices have no smooth top cover. Some practitioners dispense only the plastic device.
Squeaking Orthotic Devices
If the devices squeak with certain shoes, remove the orthotic device from the shoe and apply powder (any type, although corn starch is the best) to the inside of the shoe. Rub the powder along the sides of the inner liner where the orthotic device will be in contact with the shoe. This normally takes care of the squeaking for several months. Some of my patients slip hose (thin nylon) over the orthotic devices which accomplish the same function. Others spray a silicon based sealant or rub on Body Glide.
When the orthotic device has a top cover, occasionally a noise will be created from an air pocket developing under the material at the heel. Carefully pull up the top cover if possible in the heel area. Use Barge cement to initially glue both sides needing glue. Let air dry for 15 minutes. Then apply ample dabs of Superglue or one of its knockoffs to the bottom of the heel and the side walls. Place the top cover back down, and hold for one minute to let the top cover reattach.
When given orthotic devices with a top cover, it is helpful to check the device bimonthly to reattach any loose sections with Superglue with or without Barge cement. The practitioner may not tightly attach the top cover initially since multiple adjustments for improved function and comfort may be necessary. Monthly application of foot powder to the top of the orthotics and inside of the shoes utilized and biweekly removing the inserts from the shoes can prevent fungus from colonizing.
If the shoe utilized has a removable insert, and that insert has some form to it, remove it completely. You want the orthotic device to sit down in the shoe as low as possible for stability. However, if you need more padding, apply a thin insole to the full foot or just the forefoot (like those sold in Dr. Scholl’s foot care areas of pharmacies or Spenco product in athletic stores).
Dress Shoe Orthotic Devices
When receiving dress orthotic devices, you need some short insoles for the front of the shoe in order to hold your foot from slipping out of the heel in some shoes. The orthotic device itself should not be wider than the shoe because this pushes the shoe away from your foot.
Dress orthotic devices normally require little time to get used to, so breaking it in is quick. However, listen to your body and remove the orthotic device for at least 2 hours if you have any discomfort. If you find that you need to grip with your toes in order to hold the shoes on with the inserts, more front padding must be used, or you just can not use this shoe.