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Breaking In Your Custom Molded Orthotics
Upon receiving your pair of custom molded orthotics, there are a few things you should know about breaking them in.

1. The break-in period: orthotics will require break-in. You should start to wear these no more than an hour a day, and then increase this by another hour a day for each day they feel comfortable. When you first start wearing orthotics, be aware that there may be some discomfort in your feet, low back or anywhere in between. This is especially true for your knees. If you have this, you should take out the orthotic and wait a couple of hours or until the next day before putting them back in. Your goal should be to wear them for more and more each day until you can wear them full-time. Orthotic use for athletic or heavy activity should not be performed until they can be worn at least 8 – 10 hours a day without discomfort. This process may take up to 2 months. If this break in process is not going well, you should call our office. If it does go well, we would like to see you back for an orthotic check in 3 weeks.
2. Orthotic adjustments: most of the time, very few orthotic adjustments are needed, but there are many alterations that can be done to improve the comfort and function of these devices. This may include alteration in arch height, addition of cushioned layers and progressive posting to alter the tilt of the device. The decision on whether to alter the orthotic is made at the time of your first orthotic check 3 weeks after initial dispensing.
3. Fitting them into shoes: orthotics will fit in the some, but not all shoes. The stylish, female high-heeled shoe is the hardest to fit into an orthotic: the athletic is the easiest since this has laces and will allow for adjustment of the orthotic and your foot into the shoe. If you are having difficulty fitting the orthotic into a shoe, bring that pair with you to your first orthotic check at 3 weeks. Often it is beneficial to have a pair of custom molded orthotics made specifically for dress shoes. Shoes with laces allow for best fitting and many lacing modifications are available to improve the fit of the foot into a shoe.
4. Insoles: your orthotics may go directly on top of the sub liner of your shoe in most cases. Occasionally you will want to remove the sub liner or insole of the shoe and put the orthotics in their place. This is ideal if crowding of the toes or forefoot is appreciated. If you are orthotics are not full-length the best alternative is to cut the insole in half and put in just the front half into the shoe. The orthotic is then placed into the shoe so that the overlap of the insole is about a half an inch or so.
5. Squeaking: if your orthotics weeks in the shoe, we recommend that you use a lacing modification so that movement of the heel or the orthotic within the heel cup of the shoe does not occur. You can find this on our website of lacing modifications or on the Internet yourself. An alternative to this would be using foot powder. This can be done with talcum powder or does the next or virtually any powder generously applied underneath and on top of the orthotic.
6. Cleaning: your orthotics are best washed by hand with soap and water. The glues used in the device should withstand this, but not soaking or solvents.
7. New shoes: please bring your orthotics with you when you try on new shoes. It is sometimes helpful to buy shoes with easily removable insoles.
8. Slip on shoes or dress shoes: dress shoes without laces can be difficult to fit with orthotics. You may want to purchase new dress shoes that fit your orthotics. With shoes you already own your heel may want to slip up or down in the shoe. If this is the case, there are heel gripper additions you can purchase at the shoe repair store or convenience store to prevent this. This will be less of a problem when the shoe breaks into the orthotic. Be aware that the inside edge of the orthotic can increase the upper of a dress shoe. This may not be a noticeable problem with your dress shoe appearance.
9. Expectations: your expectation should be high regarding your orthotics especially after 2 months. They should decrease your foot/lower extremity pain, fit nicely into her shoes, and not cause any pain on their own. They should last for years with the need for a once a year, or every other year refurbishing. This can be accomplished by bringing them into our office. This usually takes one – 2 weeks. We expect to see you only once a year for orthotic re-checks. You should be very happy with your orthotics, and if not, we will want to adjust them to optimize their effects on your feet! While orthotics cannot solve all problems they often significantly reduce or eliminate problems without notice.
10. What if they are not working for me?  There are a couple of common issues that occur that prevent orthotics from being as successful as possible.  The first is orthotics are placed into shoe gear of inadequate construction.  If you have a full-length top cover the shoe liner can be removed should be.  This will allow the orthotic to sit flatly on the shoe last so that a stable situation occurs.  Please refer to our shoe fitting section on how to obtain appropriately fit shoes and the basic anatomy of shoes to better understand the plan to address these issues.
    
    The second is an adequate ankle joint range of motion and/or tight hamstrings.  This occurs more often than one would expect.  The heel at contact when walking or running is the first to meet the ground.  After this, the foot then loads and stays on the ground.  The foot needs to stay on the ground completely through loading.  If an adequate ankle joint range of motion or tight hamstrings are appreciated the individual will inappropriately load towards the forefoot.  The orthotic does not support the ball (metatarsal heads) to allow for appropriate transition.
    
    While forefoot striking only is appropriate for certain situations including sprinting dancing and other such activities this is inappropriate for normal activities of daily living or moderate to long-distance running hiking walking etc.  This creates uneven weight distribution and excessive pressure to the forefoot often causing pain with associated pathology.
    
    Please refer to our equinus section as this will help to better understand techniques to achieve a better range of motion.