Implementation of the Treatment Plan
Implementation steps
Implementation turns the plan into a safe, wearable device. Capture the foot with the method your training and the device require, such as casting, scanning, or measurement, and record weight-bearing status, socks, and time of day. Modify the model or design to match the goals: arch fill, heel cup, trim lines, posting, cushioning, or shoe alteration. Fabricate or select the device, then fit it with the patient's usual socks and shoes. Check length, width, depth, heel lock, toe clearance, edge smoothness, and contralateral fit. Observe standing and walking, ask about comfort, and inspect skin before discharge. Provide written wear schedule, cleaning, and warning signs.
Traps
Common question traps include fitting while the patient sits, checking only the device and not the shoe, forgetting sock thickness, leaving sharp trim lines, and discharging without a skin check. Another error is failing to document measurements, modifications, serial numbers, and instructions.
Worked example
After dispensing a custom orthosis, have the patient don usual socks and shoes, stand, and walk. Check the heel cup, arch, trim lines, toe box, and skin. If there is pinching or a pressure point, adjust before the patient leaves rather than asking them to break it in.
Rule of thumb: fit the foot, then the shoe, then the activity; recheck skin before discharge.