Five Facets of a Fine Fit

It’s not that hard to get a good brace fit; you just have to know what to look for. This article focuses on five signs of good fit that deal mainly with the foot. Other aspects such as posterior height are also important (although, except for hyperextension and crouching, height is not as important as many people think). These five signs are an attempt to start at the foundation. They apply to relevant FastFit products and custom DAFOs.

1. The heel fits nicely into the heel cup.

If the fit is too small, the heel will not be fully seated in the cup, throwing the brace contours out of alignment with the foot and inducing redness. If the brace is too loose, the heel will piston.

2. The contours of the brace’s plantar surface match well to the patient’s plantar surface.

If arch contours are misaligned, the patient won’t want to walk in the brace. A good plantar fit respects the foot’s arch contours.

3. The met-head width under weight bearing is correct.

If the brace is too wide for the weight-bearing met-heads, the patient will be able to use the extra space to move into uncorrected position (e.g., to abduct, if the child is a pronator). Shoe fit will also be more difficult. If the met-head width is too small, there will be pinching and redness.

4. The brace closes snugly over the instep and dorsum with some "give" for growth.

If the instep area is too tight, there will be redness. If too loose, the foot can rattle around and will probably land distal or proximal to where it should be, causing discomfort.

To test the instep-dorsum fit, press gently on the instep trimline and feel for a little "give" or bounce. There should be some. This is very important for both comfort and growth.

5. The toe shelf length under weight bearing leaves ¼ to ½ in. for growth.

If too long, the child will trip easily and shoe fit will be difficult. If too short, there is no room for growth.

Break-in Tips

Our classic break-in schedule for a patient new to DAFOs is:

• begin with an hour per day.
• add an hour or two per day based on the patient’s ability to tolerate the brace.
• after each wearing period, check for redness. If the redness is still there after 20-30 minutes, stop the wear and explore possible fit challenges.