"Dear Chris, I am in Greece and wearing my jogging shoes with the pad you made for (me) as well as the orthotic as I write this email. In fact the only reason that I am thinking about the pain I used to have is that I am writing you! Thank you, G.A."
The above is a pleasant and informative email sent to me that introduces my next topic quite nicely. How and Why the body is able to conform and tolerate an orthotic device to the point they are "forgotten" are questions clients often ask but receive few specific answers on from healthcare professionals. What my patients are mostly looking for is useful information, based in science, that explains why we recommend they slowly get used to their orthotics.
Well, it's not for functional ability of the orthotic device to 'break-in', but for the body's comfort to increase compliance in using the device. I tell them, "The foot can get used to just about anything, but we want it to get used to the RIGHT environment."
Here's HOW that happens:
Nerves of sensation are found in abundance in the Dermis layer of the skin. Meissner Corpuscles are responsible for signaling light, fast touch. Pascinian corpuscles sense deep pressure and vibration. Free nerve endings are responsible for pain and temperature changes. Proprioceptive nerves sense positional and rotational changes at the joints. These nerves work independently and in groups to let the brain know what the physical changes of the skin are and where the limb is in space. Placing an orthotic under the foot and inside a shoe has been shown to alter joint position, plantar pressure distribution, and pressure magnitude. Changes in these variables are detected by the nerves in the foot and if an abrupt or large change is experienced for too long a time, a pain threshold may be reached. This means that a device may place the foot in a desired corrective position but may also induce a pain response if the brace is not anatomically correct and is not introduced slooooowly.
So I do not say a word of the above to my client unless they ask in a way that leads me to believe they would understand those complex concepts. Instead a reply such as, ">>>To be continued<<< - CG
Chris Gracey MPT, Cped