The importance of custom stabilization inside and out
It is a privilege helping patients understand the role the feet play in overall body stability. On a daily basis, we have opportunities to explain to patients about the presence of the three arches of the foot, the existence of excessive foot pronation and the subsequent effects on the axial kinetic chain of the body. We see patients’ eyes light up when they finally understand that their feet (which often are not hurting them) are a root cause or contributory factor to so many aches and pains people seek treatment for.
I have found that the custom, flexible, 3-arch support provided by the Foot Levelers orthotics are the best solution. In fact, when patients are wearing the orthotics consistently, you can tell. Their symptoms improve; their leg length inequality issues improve; their muscles are less tight, and the patient can often tell they are standing or performing their weight-bearing activities differently.
As the healthcare provider prescribing the orthotics for the patients, we know that wearing them consistently is the key to stabilizing the feet and the body. For optimal care results, patients should use them during all weight-bearing activity. That includes work, sports, and leisure.
Being unsupported works against your care
Patients are typically compliant when they are doing activities outside of their house. But what about when a person is in their home? Do they wear their custom orthotics faithfully while on the job or playing sports but leave them behind as soon as they take off their work or athletic shoes? If they aren’t stabilized in the home too, they won’t get the full benefits from their orthotics and your care.
There are a small percentage of patients who wear their shoes all day, every day, even in their house. I do meet patients who don’t mind wearing shoes at home. This is wonderful in terms of breaking the orthotics in faster and becoming accustomed to the arch supports quicker. I also know they are protected any time they stand for long periods inside of their house. I find these folks, however, to be in the minority.
Many patients whom you prescribe orthotics to will not wear them inside their house. It’s not that they don’t realize how important they are. These folks often have their orthotics resting by the shoes they wear the most, so they slip them right in when they leave the house. But if we don’t actively explain and remind them to wear them at home, these same patients forget to wear their orthotics inside of their house.
This is a very important realization because many patients spent half to most of their day indoors working from home. Even though some people are returning to the workplace, some will never go back and will work remotely from home part- to full-time.
To put it simply, patients often do not like wearing shoes in their house. Period. They get home and want to relax. The shoes and socks come off and people go barefoot because they want their feet to rest. Some patients have their comfortable house slippers or moccasins they wear only inside the house. These are symbols of comfort and it’s part of their lifestyle. Practically speaking, people take their shoes off when they get home to keep the floors and carpets clean. Shoes will track in debris, dirt, and allergens like pollen. My mother always made us take off our shoes for that very reason.
Think about how many hours your patients spend barefoot or in poorly supportive slippers in their homes. You may be this person also. How many hours are they standing cooking? Cleaning? Working at their stand-up desk? Or just standing around for whatever reason? That adds up to a lot of weight bearing on flat, un-supported feet. This works against them and your care. Remember the words I always try and teach you “Flat feet pull out your adjustments”.
Start the continuous support conversation early
How do we combat this? Plant the seeds of wearing the orthotics in their house early on during the Report of Findings, when you are explaining the importance of custom stabilization to your patients, and when you are ordering their orthotics. Get them thinking about how they will integrate the orthotics into their home life right away. Once their orthotics arrive, now is the time to give them the right instructions when you fit them. Let them know that to get the optimal results from their orthotics, they will need to maintain continuous support during all their activities. That means both in and out of their homes.
Orthotic fitting becomes an art form for you and your staff, and your efficacy increases with each pair that is prescribed. Either you or a trained staff member should always be the one to fit your patients with their very first pair of orthotics when they are delivered. Subsequent pairs or reorders are obviously easier since they have already gone through the process before.
When the orthotics are delivered, have the staff suggest the patient bring 2-3 pairs of shoes in so you can see how they fit. Ask them if they wear shoes in their house? If they do what kind? If it is a slipper or house shoe, then make sure they bring them along with a pair or two of their athletic or dress shoes. Once you fit them with the orthotics test them in their shoes (Recall the similar test method that we use when we have them stand on the proprioceptive test kit with orthotics and we test arm strength or do a squat) for strength and stability.
House shoe dos and don’ts
Because we want to encourage and remind the patient to wear the orthotics at home, give them ideas and acceptable options to make it easier for them to do so:
- People who hate wearing shoes in the house can get a pair of Foot Levelers custom flip-flops to use for house slippers. This gives the feeling of being barefoot but provides great arch support while wearing them.
- Some slippers, moccasins or house shoes are “slip on” and have a tighter toe box of fit around the foot. In this case, prescribing a Dress Luxury or 5th Avenue works well. These are thinner orthotics with the 3-arch support so the foot can fit and rest more comfortably in the slipper.
- A clean pair of tennis/athletic shoes specifically for inside the house. These are never worn outside so they won’t get the carpets or floors dirty. Take out the removeable insoles and replace with Foot Levelers custom orthotics.
Here are some popular examples of footwear that patients will utilize in their homes that are “Not acceptable” by my standards:
- Birkenstock-style shoes (They claim to have a medial arch, lateral arch, and metatarsal “bar”. These are not good enough and they are not custom). Expensive shoes.
- Flip-flops or sandals with a contoured sole for “arch support” (high instep only – no other arch support and not custom)
- Popular shoe brands with “ergonomic technology (high instep, very expensive, no other arches and not custom)
- Generic flip-flops (easy on and off but these are totally unsupportive)
- Ugg-style boots (especially for winter. Warm but absolutely no arch support by themselves) unless they have a pair of the Foot Levelers orthotics in them.
A final point to make is to ask your patient not to go back and forth between wearing the Foot Levelers custom, 3-arch, flexible orthotics in some shoes and wearing unsupportive shoes (like ones we talked about above) or off-the-shelf orthotics. The patient can’t vacillate between wearing bad shoes, sandals, flip-flops, and generic orthotics sometimes and wearing their custom orthotics at other times.
What’s wrong with this common lifestyle scenario?
Let’s look at an example of this:
Suzy has a pair of Foot Levelers InMotion orthotics in her Asics athletic shoes. She does well when she goes on walks around the neighborhood and hits the gym occasionally. She knows she needs to wear them. At times, she decides to go around town in cheap, generic flip-flops but since she only goes to the grocery store, she thinks that is fine. She also has a pair of Brooks Adrenaline shoes with an older off-the-shelf orthotic. She just keeps those in there if she is going to do some stuff around the house and thinks it’s no big deal. Suzy is making some errors that I am sure you can identify. Bottom line: Suzy needs to wear her custom orthotics all the time in any shoe she is weight-bearing in. She just needs your help to figure out which orthotics she needs.
Any period of switching over to an unsupportive pair of shoes will prolong the orthotic break-in process and often causes more or different pain in their body. Furthermore, the usual break-in period of 45 days could be lengthened and the reactions of the body during the break-in period could be worsened based on the confusion the feet go through from switching back and forth.
Remind patients that unhealthy foot function and plastic deformation are permanent conditions that require custom support for proper balance and alignment. Custom 3-arch orthotics restore healthy foot function to decrease pain and fatigue, support the entire body correctly and lessen their risk for injury. But for that to occur, they need to be worn continuously, indoors and out. Like a pair of prescription eyeglasses, the correction is gone when they’re not being worn. And when that correction isn’t present, their health and your care suffer.
By having the conversation about staying supported indoors and offering the simple and easy options in this blog, you’re helping your patients take a big step towards better health.
Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.
As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.