FAQs and Documentation
Common Problems
Patient has foot slapping but has decent calf strength
Patient has decent calf strength and plantar flexion: Patient may need to adapt his gait by leaning his body slightly forward. This will move the centre of gravity forward and reduce the heel strike ground reaction force. The XTERN is a flexible brace that can help prevent calf muscle atrophy and allow a natural fluid gait. It allows easy plantarflexion and keeps the full ankle range of motion ensuring comfort.
Patient has foot slapping and a very weak atrophied calf
The XTERN is a very flexible brace, so you may need to install the Extension stopper kit (rubber wedge blocks) to increase the stiffness of the brace and to decrease the heel strike ground reaction force. (See Extension stopper kit).
Discomfort on top of the foot near the lace-clip
This is a result of the shoelaces being too tight near the lace-clip.
Lace-clip is installed too narrow and chokes the foot
If the lace clip is installed too narrow, it will reduce the toe box width and cause a choking effect on the foot. You may need to re-install the lace-clip to release the stress in the shoe. To do this choose the wider set of holes on the lace-clip, to keep a natural eyelet width when the patient wears the shoe.
Brace length is too short, or lace-clip is installed too low
We recommend keeping a 6-9mm gap between the back of the shoe and the heel section of the XTERN. Without a sufficient gap the lace-clip will dig into the foot. This ensures the XTERN has enough loading distortion space to lift the foot.
Inappropriate footwear
We recommend good supportive footwear with a flared sole unit to hold the XTERN in place to avoid it slipping off the back of the footwear. Keep in mind that the XTERN uses the shoe to lift and stabilise the foot. Poorly constructed shoes will impair and diminish the benefits (NB, Asics, Brooks, Mizuno, Merrell, Salomon, Keen, Timberland and many other brands are perfect).
If shoe sole design is not the cause it could be the XTERN’s heel section that is too wide. You will need to ask your Orthotist to reform the heel section.
Brace is difficult to don/doff
Loosen the shoelaces/shoe closure as much as possible. Open the shoes as wide as possible. Insert the foot from the lateral side of the XTERN (not from the top). Push the foot into the shoe whilst bending the brace backwards (don’t worry it won’t break). Once the foot is in the shoe, slowly release the calf section on to your leg. Tighten the shoelaces, keeping them tight at the top leaving them loose at the bottom near the lace-clip. Fasten the strap at the calf band (See Donning video).
Lack of dorsiflexion (Patient drags the foot)
The laces are not tight enough to prevent the foot sliding in the shoe. The shoelaces must be tight enough to prevent the heel from moving up and down. This will maximise dorsiflexion (foot lift), lateral stability and confidence during walking.
Loose lace-clip
The lace-clip installation must be sturdy so tighten the tie-wraps to the maximum. Pull firmly on the lace-clip and check that it is solidly anchored to the shoe and there is no gap between the lace-clips and the top of the shoe. Never attach the tie wraps around the laces.
If you have fabric eyelets or metallic eyelets that swivel and align vertically when the brace is loaded, try to install the lace-clip flap under the eyelets. Attach a tie-wrap from one eyelet to another to keep them close and in a flat position (See fitting instructions document).
Heel section doesn’t grip properly and slips down to the ground.
The heel section should rest high and clear from the ground to avoid losing the preloaded energy of the XTERN. The heel section stays in place by a friction grip on the side of the sole. If the heel section falls to ground, it may because the sole of the shoe is unsuitable. Ensure the shoe has a wide flared sole unit to allow a proper friction grip. Shoes with very narrow soles (Vans, DC, Converse, Skateboard shoes, Football boots) can be worn by adding the bumper kit to create a ridge or a bump for the XTERN to sit on. (See bumper kit instructions).
If shoe sole design is not the cause it could be the XTERN’s heel section that is too wide. You will need to ask your Orthotist to reform the heel section
Patient has spasticity
The XTERN can handle light-mild spasticity. Depending on the level of spasticity, the extension stopper kit maybe required to increase the stiffness of the brace (See Extension stopper kit).
Patient has knee hyperextension
Depending on the amount of knee hyperextension, you may need to install the extension stopper kit to increase the stiffness of the XTERN (See Extension stopper kit).
Ankle instability or deformity
You may need to use the optional ankle strap (See additional ankle stabilisation).