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November, 2010

New Orthotics: A Little at a Time

By K. Jeffrey Miller, DC, MBA

I just returned from an orthodontic visit with my daughter. She is my fourth and final child who requires braces. I feel sorry for her, as I did for the rest of my children when they were in this early stage of correction.

The first few months are especially difficult. Each adjustment of the braces and the resulting increased tension brings new pain.

Luckily, the braces are tightened only a little at a time. Can you imagine if they tried to move everything all at once? That would be exceedingly painful. Even though the correction is necessary, there is a need for gradual movement. The body must be allowed to adapt to the changing position of the teeth.

My daughter's recent trip to the orthodontist reminds me of the break-in process needed for the application of flexible, custom-made stabilizing foot orthotics. It is best to break orthotics in gradually. They should not be placed and then worn continuously in their early application. Patients' problems seldom develop overnight. When problems do develop, healing, support and correction take time. The body must be allowed to adapt.

Once a patient has been scanned or casted and you have received their orthotics, there are important steps you should follow in order to assure optimum function and patient acceptance. I recommend you take the following steps:

  • After you have removed the orthotics from the package and shown them to the patient, demonstrate how the orthotics can be switched from one pair of shoes to another. Be sure to point out that the heel of the orthotic needs to fit snugly against the counter of the shoe.
  • Explain that the orthotics need to be worn all the time and that in the beginning, the patient may experience brief periods of minor discomfort.
  • Instruct the patient that if discomfort occurs, the orthotics should be removed from the shoes for about a half hour and then re-inserted. Reassure them that the break-in period can last as long as 45 days. Reduce break-in symptoms by improving the patient's muscle and foot flexibility.

Help With Break-in

Improved balance and joint mobility may elicit some muscle soreness in the lower extremities due to trigger points and myofascial restrictions in the feet and legs. Improving muscle compliance with the use of devices such as a self-massaging roller stick and a foot wheel device will address a vast majority of the symptoms that can be associated with the break-in period.

Self-Massaging Roller Stick: Roll the stick up and down, 20 to 30 strokes two times a day, focusing on the calf muscles, anterior compartment, quadriceps and hamstring muscles.

Foot Wheel Device: Roll the foot forward and backward on the wheel, using a comfortable amount of pressure, for 20 to 30 seconds two times per day for each foot.

Explain to patients that their bodies change with time. Just as they visit their optician for correction of their eye glasses, go to a dentist for a regular tooth checkup or (as my daughter has done) visit an orthodontist to have braces tightened, their orthotics should also be re-evaluated in roughly one year.

Final tips: Your patient's shoes play an important role in the postural complex. They are the housing and the structure that helps provide a foundation for one-quarter of the bones in the body (there are 26 bones in each foot). The very best stabilizing orthotics are custom made for the patient, but shoes are not and there may be some shoes that the orthotics will not fit in correctly because the patient's shoes vary in size. Always make sure the shoe size is correct for the orthotic.

Stabilizing orthotics will also mold to the shoe to a degree and will slip in and out easier after several days of wear. The method of the shoes' construction, fit and condition all play a role in how good a job they do in helping support the body.

When shoes fit incorrectly, wear unevenly or are just overall wearing out, it affects the patient's posture and their ability to hold adjustments.

Should problems arise with the orthotics, look first to the shoes. This is likely where you will find the problem.

Time is a factor in all healing and correction, whether in orthodontic correction or spinal and postural care. Slow and steady wins the race.

Click here for more information about K. Jeffrey Miller, DC, MBA.

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