FAQs and Documentation

Common Problems

Patient Experience Foot Slapping (after heel strike)

Patient has decent calf strength and plantar flexion: Patient may need to adapt his gait by leaning his body slightly forward. This will move centre of gravity forward and reduce heel strike reaction. XTERN is a flexible brace that can help prevent calf muscle atrophy and allows a natural fluid gait. It allows easy plantarflexion and keeps full ankle full range of motion. Flexibility is a huge asset for its comfort.

Patient has very weak atrophied calf

XTERN is a very flexible brace, so you may need to install Extension Stopper Kit (rubber wedge blocks) to increase stiffness of the brace and decrease heel strike reaction. Heel strike reaction is main cause of foot slap (See Extension stopper kit).

Discomfort on top of foot (near lace-clip)

Shoelaces are too tight, keep the shoelaces loose at bottom near lace-clip to avoid any lace-clip pressure or foot choking.

Lace-Clip is installed too narrow and chokes the foot: If lace clip is installed too narrow, it may reduce toe box width and cause choking effect on foot’s lateral faces. You may need to re-install the lace-clip to release stress in the shoe. Choose wider outer set of holes on the lace-clip, so it keeps a natural eyelet width when patient wears the shoe. Its best to don the shoe to select correct lace-clip fixation holes. If lace-clip is reducing natural foot width of the patients shoe it can cause a choking effect which may cause discomfort, pressure, and foot numbness.

Brace length is too short, or Lace-clip is installed too low: Ensure you have a slight gap between rear end of the shoe sole and heel support when you wear the brace. Brace is pulling backward when loaded and lifting the foot, so if it is too tight the brace will cause the lace-clip to dig in the foot. We recommend keeping a 3mm gap at heel section when choosing the set of eyelets for lace-clip installation. Ensure the lace-clip is not installed too low and that heel section is not too tight. The heel gap from the sole at back should be 6mm-9mm so it doesn’t need to be a perfect snug fit.

Discomfort on outer edge of foot during long walk

Shoelaces are too tight: Keep shoelaces loose at bottom near lace-clip to avoid any lace-clip pressure or foot choking.

Lace-Clip install too narrow and chokes the foot: If lace clip is installed too narrow, it may reduce toe box width and cause choking effect on foot’s lateral faces. You may need to re-install the lace-clip to release the stress in the shoe. Choose the wider outer set of holes on the lace-clip, so it keeps the eyelets a natural width when patient wears the shoe. The best is to don the shoe to select correct lace-clip fixation holes. If lace-clip is reducing natural shoe shape for patient’s foot width it could create a choking effect and may cause discomfort, pressure on the foot.

Inappropriate footwear: We recommend stable shoes with a wide toe box, robust fabric, firm heel cap and fitted with ridges on sole contour, this will hold the orthotic in place. Avoid minimalist shoes with very light fabric and thin sole units. Keep in mind that the orthotic uses the shoe to lift and stabilise the foot. Poorly constructed shoes will impair and diminish the brace benefits. (NB, Asics, Brooks, Mizuno, Merrell, Salomon, Keen, Timberland and many other brands are perfect for the brace)

Brace is difficult to don/doff

Loosen shoelaces/shoe closure as much as possible. Open shoe tongue as wide as possible to make maximum room. Begin the foot insertion by the external lateral side of the orthotic. (Not from the top) Push the forefoot down while bending the brace backwards. (Don’t worry it won’t break). Complete foot insertion and then slowly release calf support on to your leg. Then tighten the shoelaces keeping them tight around ankle and leave them loose at bottom near lace-clip. Then tighten the strap at the calf band (See Donning video).

Lack of Dorsiflexion (Patient still drags the foot)

Laces are not tight (loose) around ankle, foot slides in the shoe: Shoelaces must be tight enough around ankle to prevent heel from moving up & down in the heel section. It will maximize dorsiflexion (foot lift), lateral stability and confidence during walking. Keep laces loose at bottom near lace-clip to prevent any discomfort.

Loose Lace-clip: Lace-clip installation has to be sturdy. Tighten the tie-wraps to the maximum “IN THE EYELETS”. Pull firmly on lace-clip and check that it's solidly anchored to the shoe and there is no gap between lace-clips and top of the shoe surface. NEVER ATTACH ZIP TIES FOR LACE-CLIP AROUND THE LACES.

If you have fabric eyelets type or metallic eyelets that swivel and align vertically when brace is loaded, try to install lace-clip flap under eyelets. Attach a tie-wrap from 1 eyelet to another to keep them close and flat position (See fitting instructions document).

Heel Support doesn’t grip properly and slips down to the ground: Heel Support should rest high and clear from the ground to avoid losing preloaded energy of the brace. Heel support stays in place by a friction grip on ridges on the side of the sole. If Heel support falls down to ground, it may because of a narrow/vertical sole design, or the brace heel support is too wide. Ensure the sole has a wide, tapered shape and has sufficient ridges to allow proper friction grip. Shoes with very narrow sole contours or flat vertical edges (Vans, DC, Converse, Skateboard shoes, Football boots) usually don’t offer proper support. This is very easy to fix by adding the bumper kit to create a ridge or a bump for the brace to sit on (See bumper kit instructions).

If shoe sole design is not the cause it could be the brace’s heel support may be too wide. You may need to ask your Orthotist to reform heel support to make the width narrower, this can be done by thermoforming with heat (See thermoforming instructions).

Patient has Spasticity: The brace can handle light-mild spasticity, depending on level of spasticity, you may need to install Extension stopper kit to increase stiffness of the brace (See Extension stopper kit).

Knee Pain while using the brace

Patient has Knee Hyperextension (knee recurvatum): Depending on level of knee hyperextension, you may need to install Extension stopper kit to increase stiffness of the brace (See Extension stopper kit).

Severe Ankle instability or deformity: You may need to use optional ankle strap for additional ankle stabilisation.