Obtain Feedback From the Patient
Patient feedback is vital. Setting patient expectations is just as important. Do not let the patient leave without first testing the PCIs.
Observe the patient’s posture when wearing the PCIs. Observe ankles, knees, hips, etc. according to the SOAP (Subjective, Objective Appraisal Plan) form (see forms section). Note any changes you can see in their posture and tell the patient what you see. Ask questions to determine how the patient is reacting to the PCIs. The purpose of the feedback is to identify that the PCIs work properly and to ensure that the patient does not slide or twist off the medial column support. If the patient is comfortable with the PCIs, begin the break-in phase.
Have the patient walk up and down the hall a few times with the PCIs in their shoes. Ask the patient to describe how the feet and shoes feel. Find out if there are any pressure points. Are the pressure points tolerable, or is their instinctive reaction to want to remove their shoes?
Some patients will be very sensitive to the changes under their feet and others will hardly notice. Try to establish their level of sensitivity. Ask more questions about specific areas of the foot. Many patients prefer to compare their experience with a “normal,” so setting an expectation is helpful. It may also be helpful to share with the patient how the PCIs will feel after wearing them for a while.
For example: “Right now I expect that you feel the ground forces as an increased pressure under your big toe. This is normal; because for the first time your big toe is receiving the support it needs to stabilize your foot, preventing it from hyperpronating. It will not take very long before your feet adapt to the Posture Control Insoles™ and you will no longer notice them.”
Be sensitive to pressure points. Too much pressure against the outside of the shoe may indicate that the patient is sliding off the ground forces (the shoe could be too wide, or the shoe last too curved). Follow-up with the patient: Inquire if it feels like the big toe is sliding on the PCI, or if it feels like the foot is twisting (a narrower or a straighter lasted shoe may be needed).
If you follow this process carefully, you should not have any problems with the arch support being too high, or the patient twisting off the medial ground forces. If you suspect that the patient is sliding off the ground force, it may be a sign of having applied too high ground forces. It is better to be less aggressive rather than risk losing the patient’s cooperation. Twisting off the ground force can lead to blisters.
Make sure the patient does not feel any edges of the insole. If they do, the PCI is not fitted correctly in the shoe (too short or too narrow). Impress upon the patient the importance of following the break-in schedule.