Summer's Here!

(Assessing fit and making adjustments to extend wear time over the summer)

During the summer, families take a break from school schedules. Summer can bring extra activity levels, added growth and increased heat, all of which can affect the fit of a child’s orthosis. Thus, DAFO fit and skin health become more important than ever. Be on the lookout for: “hot spots” that may become blisters, redness on the foot, ankle or leg that doesn’t fade within 20 minutes after taking off the brace, short toe length, edge pressure or general complaints of discomfort. Here are some common issues related to growth and summertime activity, and how to help alleviate them.

Short toe length? Move the toe rise pad so it extends the effective length of the toe shelf.

• Warm the plastic slightly with a heat gun on the underside of the brace toe shel

• As the glue loosens, peel the toe pad up and move it distally.

• Cover the underside with duct tape or moleskin and trim it to the shape of the toe rise.

• If you find you need a new toe pad, call Customer Service (800/848-7332) to request one.

Tight width at metatarsal heads? Heat and shape the plastic for more room.

• Start at either the medial or the lateral side and heat the outside of the brace at the metatarsal head area just until it becomes shinier than the surrounding plastic. (Avoid applying heat to straps or foam.)

• Position a wooden dowel, tool handle or chair leg along the length of the inside of the brace and apply pressure to stretch the plastic outward where you have heated it.

• Repeat this on the opposite side. A little relief goes a long way: you can always stretch the plastic further if needed, but you can’t make it smaller. Note: this strategy works for softening edge pressure as well. Flare the plastic by pressing and rolling its edge against stable resistance (like a table top).

Tight volume over instep and/or dorsum? Add flexibility to this area of the DAFO. • Make “feathering” cuts in each side of the dorsal wrap at the affected areas. The cuts, made at a 90 degree angle to the dorsal trimline, will be about ¾” to 1” long and about ¼” to ½” wide, depending on the size of the foot. For added comfort, trim off the corners of the tabs. • This adjustment will allow the plastic to ease out around an increase in volume.

Tight over specific point? Contour the DAFO for a better fit over the boney prominence.

This procedure is very similar to the met head relief (page 4), but your target is the medial or lateral malleoli, the navicular, 1st MP joint, or base of 5th metatarsal.

• Heat the outside of the plastic at the problem area, avoiding any velcro hook, straps or foam, just until it becomes shinier.

• Push from the inside out using a rounded dowel or chair leg. Again, remember that a little relief goes a long way. Don’t overdo it.

Motion-related blistering? Use good socks, and apply the DAFO carefully.

•Trace the motion issue to the source. Is the brace donning technique correct? The heel should be seated properly in the heel pocket and the straps secured snuggly. Heel lock pads or a thickened instep pad can help. Call Customer Service to have them sent out for your specific patient. • To relieve the site of the blister, add more volume as described above for specific boney prominence relief.

Leg circumference too small? Add more volume to the leg portion.

• Use the heat gun to warm the plastic in a vertical line down the center of the back of the brace.

• When the plastic has become warm enough to change to a shiny appearance, pull the medial and lateral sides of the leg section away from each other. The line of softer plastic will act like a hinge, allowing you to enlarge the overall circumference.

• Be sure to hold it open long enough for the plastic to cool; otherwise, it will ease back into the previous, smaller shape.

Skin problems related to excess heat Be sure feet are getting adequate ventilation.

• Use wicking-action polyester blend socks (found at outdoor sports stores or through our Customer Service department). • Change socks frequently. • Make extra ventilation holes in the brace. • Air out bare feet with regular break times.

Minor adjustments for fit like these can buy you just enough time to put the wheels in motion for the next round of bracing and leave the summer free for families. Fall will be here soon enough, and with it come casting appointments, break-in schedules, homework and early bedtimes. In the meantime, if the problems are small the solutions can be too. By the way, don’t be afraid to alter a DAFO. Once you’ve tried it a little, you’ll gain a whole new level of freedom in making a DAFO work. For practice, when you fit a new DAFO, keep the old, worn DAFO (unless it’s suitable for donation) and try these techniques out on it. We can send you a discarded DAFO to practice on if you need one; just call Customer Service and ask. —Loretta Sheldon Loretta Sheldon is an ABC Registered Orthotic Assistant and a member of Cascade’s management team. She has been with Cascade since 1998.