556 chapter 58
Making sure plastic braces fit well and are comfortable
The most common problem with
plastic braces is that they press
on bony bumps. To avoid this,
put small pads over
bony bumps before
casting foot. Or, put
the pads on the mold,
and add a little fresh
plaster to the bony
bumps before molding
the plastic.
When the child wears the plastic brace.
if it presses too much on bony places,
or elsewhere,
heat a small area over
the spot where the bone
presses, and with a
smooth, rounded stick
push the hollow deeper.
(Use a heat gun if you
have one.)
Soft padding
inside the brace
can make it more
comfortable.
Places that
may need to be
padded are:
edges
upper part
over bony
places or
points of
pressure
For padding you can use a product called
‘moleskin’, or a special foam plastic material
available from orthopedic supply stores. Or
you can glue in pieces of cotton blanket or car
inner tube (but make sure the child wears cotton
stockings to avoid skin problems).
The sole of the brace can
end at the ends of the
toes (or slightly beyond
to allow for growth).
Or the sole can
end at the base
of the toes.
The side of the brace at the
foot can extend to the toes if
necessary for support.
For better comfort and
shoe fit, the side can
dip down around the
base of the big toe.
AVOID brace edges
that stop at
middle of toes.
AVOID brace
edges that
pass across the
middle of bony
bumps. The
edge should be
either behind
or in front of
the bump.
Avoid an edge that curves
in (better to heat it and
bend it out a little).
Deciding how wide or narrow to make the sides of the brace at different points will
depend on the needs of the particular child.
A child whose ankle
or foot is floppy
or deformed, or who
needs a stiff ankle
brace to help push
back a weak knee
(see p. 557) may
need a brace
with wide
sides at
the ankle
and foot.
A child who
needs only the
ankle stabilized
may walk better
with a brace
that lets the
front of the
foot bend
up and
down a
little.
Many children benefit
by a brace that allows
some up and down ankle
movement but prevents
sideways movement.
This can be done
by cutting back
the sides of the
brace here.
This will be the weak point
in the brace. So, the
plastic must be extra thick
here.
Or you can strengthen it by
putting extra strips of hot
plastic on the back of the
plaster mold before stretching
the whole plastic over it.
Disabled village Children