Introduction to Lower Limb Corrective Bracing – Part Three: Correct brace fitting

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Introduction

As we discussed in Part One: “Do I need corrective lower limb bracing?”, corrective lower limb bracing is devoted to helping people whose lower limbs have deformities, injuries and/or are affected by various diseases that make it hard and/or painful to walk. Many people who seek to improve their walking with corrective lower limb bracing (CLLB) are often disappointed with the results due to one or more of the following factors:

  • Improper diagnosis
  • Improper brace selection
  • Incorrect brace fit

If you have yet not read Part One, we strongly encourage you to do so, because proper diagnosis is generally the most important and hardest element to get right; if you’re not properly diagnosed, you cannot move to the second most important step: proper brace selection.

The same goes for Part Two:  Proper brace selection. In that post we reviewed the importance of first getting a proper diagnosis. Then we detailed a set of brace selection steps that will significantly increase your chances of picking the brace that works best for you. Those steps are:

  • Proper diagnosis
  • Initial filtering
  • Learn the market
  • Off-the-shelf or custom?
  • Create a Possibles list
  • Create a Probables List
  • Consult with your doctor and get your prescription
  • Purchase your brace!

If you have followed the processes and procedures outlined in Parts One and Two, then you most likely now possess the right lower limb corrective brace that will help you walk better with less pain. Now you have just one more process and procedure to complete to realize the full potential of your new brace to improve your life: correctly fitting your brace.

Yes, getting the right diagnosis is the most critical element, followed closely by choosing the proper brace for your needs. However, if your brace isn’t properly fitted, then having the right diagnosis and the right brace won’t meet your needs. Correct brace fitting involves three principal elements:

  • It must be comfortable
  • It must improve your stability and balance
  • It should give you confidence

We’ll look at these elements in more detail shortly, but before we do, let’s look first at two separate but equal parts of the brace fitting puzzle: Expectations and shoes.

Expectations

Perhaps the most important part of getting your brace properly fitted is knowing what to think and how to act when you start using it. No matter how well your brace does or does not fit, you must have realistic expectations about how quickly you will see improvement – and how far you can push yourself – or you will disappoint and maybe even injure yourself.

Improvement does not happen as soon as you put on your brace. In fact, most people take about two months to adjust to their brace. You should feel more comfortable and stable within a few weeks, but faster, smoother walking and greater endurance takes time. Remember, your brace doesn’t have muscles or nerves. That’s your department and, just like starting a new workout routine at the gym, you need to start slow and work up to the performance level you want. If you don’t, if you push it, you’ll not only get frustrated, you may injure yourself – and then it will take even longer to get to where you want to be!

Finally, when you understand that strapping on your new brace is more like a new workout regimen and less like putting new tires on your car, then the rest of the process will go smoother and give you better results.

Shoes

Strapping on your new brace is not like putting new tires on your car; it’s like getting a new car! And when you buy a new car, it does not come with old, worn-out tires, does it? Yet many people come into our offices with their shiny new brace wearing… you guessed it, old, worn-out, shoes.

The first thing that hits the ground is your shoes, so having the right shoes when you get your brace fitted is almost as important as having the right expectations. Think about it: if you wear pre-brace shoes to your fitting, they have a pre-brace “set” to them – and that pre-brace set will usually interfere with how your brace fits and functions.

You want to break in and get used to your new brace and new shoes as a unit. A second part of this, of course, is how the shoes look versus how they function. When it comes to the shoes you will wear with your brace, you need to choose comfort over style, and include stability as an added criterion when choosing the shoes you need to get the most out of your new brace.

Fitting the brace

Okay, you have your expectations dialed in and the right shoes on your feet. Now to the final step: getting your brace correctly fitted.

Perhaps the most important fitting parameter is making sure that nothing digs into bone anywhere. Bone cannot take sustained pressure; it will be uncomfortable and you can damage the bone. Muscle, on the other hand, can take pressure. If you can tolerate the pain that may come with it, your muscles can handle it. Skin can also handle pressure. The pressure may bother you at first, but your skin will adapt to it over time.

Other than always avoiding brace-in-bone, just make sure your other fitting parameters pass the common sense test: Your initial fitting should be reasonably comfortable, then get more comfortable through either a “break-in period” or through additional adjustments later on – either to the brace itself, or in terms of the type, amount and location of padding.

Followup visits

For most people, a “one-and-done” adjustment will not be enough. Along with the expectations discussed above, you should plan on doing at least one followup even for the most simple of braces and conditions. If you have a more complex brace and/or condition to be corrected, plan on at least two followup visits, and plan your schedule accordingly.

The key factor in most followup visits is pressure and friction reduction. Some  people will notice that brace pressure increases as they walk after their initial fitting, or that the brace rubs somewhere. Pressure increases and friction generally indicate the need for adjustment, and the higher the level of deformity and/or joint deviation, the more likely you’ll need adjustment of the brace and/or the padding.

Ortho Rehab Designs stocks many types of padding and lining materials made of different densities, materials, and shapes. Sometimes your choice in this area will be driven by medical and performance needs; other times it will be personal preference. To use the car analogy again, some people like leather seats, some like vinyl, some like cloth.  Again, the idea is to pick what works best for you.

You can take proactive steps yourself to make your return visit more productive, and maybe eliminate the need for further followup. If you’re feeling pressure or friction, keep a log of when it happens and under what conditions. You can even mark the spot on your brace or padding where you’re experiencing the discomfort. Take your log with you to your followup fitting and it will give your brace therapist more data to work with.

Another expectation you may need to adjust: Out-the-door “perfection.”  Your brace will fit very well, but it may not be perfect. In fact, you don’t want it to be perfect the moment you walk out the door; you want it to “wear into” perfection. That’s because the foam we use adapts to the pressure and shape of your foot and lower limb over time.

Post-brace fitting activity levels

Next on the correct fitting menu is how to act after you start wearing your new brace. The main guideline here is: Don’t push it. Yes, we know you feel lighter than air and ready to run a race or at least play a round of golf or take a long walk in the park.

Please don’t. We’ve all heard stories about people who start going to the gym after a long period of inactivity – and hurt themselves quickly. Then they have to quit working out until they heal. This happens all the time to new brace wearers, too. After months or years of being restricted in your movements, your new brace allows you to do much more than you were able to do before.

And that’s great because that’s the reason you bought a brace in the first place! But if you try to go hard-core from Day One, you will not like the results. Our advice is a careful, measured, steady increase in activity until your brace and body are all ready to do what you want to do.

Here’s a sample familiarization/acclimatization regimen that can guide your activity in the first weeks after you start wearing your new brace:

Day One: Wear it around for one hour, period.

Day Two: Two hours.

Days Three through Seven: Add one hour of activity a day until you can wear your brace all day without significant discomfort.

Then give it another week or two before you start running, playing golf or even walking in the park. Keep in mind also that these recommendations are a guideline, not a hard and fast schedule. Depending on your unique circumstances, you may only be able to add an hour every other day, or every third day – or you may be ready for all-day wear in just a few days.

We’ll repeat the critical guideline one more time: Don’t push it. Use common sense and tune in to what your body is doing. Your brace will give you a new lease on life generally, and easier, more comfortable and more stable movement specifically. Don’t mess up all your hard work by getting impatient. Now relax and enjoy your new “freedom machine.”

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