How to get an Xtern?

Patient has decent calf strength and plantar flexion: Patient may need to adapt his gait by leaning his body slightly forward. This will move center 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)

Shoe Laces are too tight: Keep shoe laces loose at bottom near lace-clip to avoid any lace-clip pressure or foot choking.

Lace-Clip is install too narrow and choke 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 (outter) sets of holes on the lace-clip, so it keep natural eyelets width when patient wear the shoe. The best is to don the shoe to select correct lace-clip fixation holes. If lace-clip is reducing natural shoe for patient’s foot width, choking effect may cause discomfort, pressure and foot numbness.

Brace length is too short or Lace-clip is installed too low: Look that you have a slight gap between rear end of shoe sole and heel support when you wear the brace. Brace is pulling rearward when loaded and lifting the foot, so too tight brace will cause the lace-clip to dig in the foot. We recommend keeping a 3mm gap at heel section when choosing sets of eyelets for lace-clip installation (when possible). Look that lace-clip is not installed too low and that heel section is not too tight.
The heel gap from the sole at back of the shoe doesn’t need to be perfectly snug fit. If gap doesn’t exceed 15mm (5/8”) it’s mostly aesthetical issue.

Shoe Laces are too tight: Keep shoe laces loose at bottom near lace-clip to avoid any lace-clip pressure or foot choking.

Lace-Clip is install too narrow and choke 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 (outter) sets of holes on the lace-clip, so it keep natural eyelets width when patient wear the shoe. The best is to don the shoe to select correct lace-clip fixation holes. If lace-clip is reducing natural shoe for patient’s foot width, choking effect may cause discomfort, pressure and foot.**

Inappropriate footwear: We recommend stable shoes wide toe box, robust fabric, firm heel cap and fitted with ridges on sole contour to hold the orthotic in place. Avoid Minimalist shoes with very light fabric and thin sole ! Keep in mind that the orthotic uses the shoe to lift and stabilize the foot. Poor shoe sturdiness will impair and diminish brace behavior. (NB, Asics, Brooks, Mizuno, Merrel, Salomon, Keen, Timberland and many other brand are perfect for the brace)

(Look at donning video). Loosen shoe laces/shoe closure the more you can. Open shoe tongue widely to make maximum room. Begin foot insertion by external lateral side of the orthotic.(Not from the top) Push down with forefoot while bending the brace very far backward. (Don’t worry it won’t break). Complete foot insertion and then slowly release calf support on your leg. Tighten shoe laces. Keep them tight around ankle and let them loose at bottom near lace-clip. Tighten the calf band.

Laces are not tight (loose) around ankle, foot slide in the shoe. Shoe Laces must be tight enough around ankle to prevent heel from moving up & down (“pistoning”) in the heel cup. 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 Tie-Wraps at maximum “IN EYELETS”. Pull firmly on lace-clip and validate 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 & clear from the ground to avoid losing preloaded energy of the brace. Heel support stays in place by friction grip on ridges each side of the sole. If Heel support falls down to ground, it may be cause by narrow/vertical shoe sole design or by Heel support too wide.

Look that shoe sole is wide, tapered shape and have sufficient ridges to allow proper friction grip. Shoes with very narrow sole contour or flat vertical edges (vans, DC, Converse, skateboard shoes, football cleats) usually doesn’t offers proper support. They are very easy to fix and make them supportive enough. You can easily create ridges and bump with Sugru or any other rubber type compound and small wood screws as achors. (See fitting instructions document).

If shoe sole design is not the cause and seems ok, brace’s Heel support may be too wide. You may need to ask an orthotist to reform Heel support width narrower by Thermoforming (heat with propane blowtorch). If you are handy you may attempts thermoforming yourself. (See thermoforming guideline document)

Patient has Spasticity. The brace can handle light-mild spasticity. Depending on level of spasticity, you may need to install Extension Stopper Kit (rubber wedge blocks) to increase stiffness of the brace. (See Extension Stopper Kit)

Patient has Knee Hyperextension (knee recurvatum): Depending on level of knee hyperextension, you may need to install Extension Stopper Kit (rubber wedge blocks) to increase stiffness of the brace. (See Extension Stopper Kit)

Loose Lace-clip: Tighten Tie-Wraps at maximum “IN EYELETS”. Pull firmly on lace-clip and validate 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)

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

Heel Support doesn’t grip properly and slips down to the ground: Heel Support should rest high & clear from the ground to avoid losing preloaded energy of the brace. Heel support stays in place by friction grip on ridges each side of the sole. If Heel support falls down to ground, it may be cause by narrow/vertical shoe sole design or by Heel support too wide.

Look that shoe sole is wide, tapered shape and have sufficient ridges to allow proper friction grip. Shoes with very narrow sole contour or flat vertical edges (vans, DC, Converse, skateboard shoes, football cleats) usually doesn’t offers proper support. They are very easy to fix and make them supportive enough. You can easily create ridges and bump with Sugru or any other rubber type compound and small wood screws. (See fitting instructions document)

If shoe sole design is not the cause and seems ok, brace’s heel support may be too wide. You may need to ask an orthotist to reform Heel support width narrower by Thermoforming (heat with propane blowtorch). If you are handy you may attempts thermoforming yourself. (See thermoforming guideline document)

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