SIMS Medical Corp * 1-888-655-4499 * SIMS Medical Corp. © 2006 Dr. Comfort Professional Shoe...

SIMS Medical Corp * 1-888-655-4499 * www.simsmedicalcorp.comSIMS Medical Corp. © 2006

Dr. Comfort

Professional Shoe Fitting Workshop

The Finest Quality Extra-Depth Footwear… PERIOD!!


Dr. Comfort

Thank you for your interest in Dr. Comfort Shoes!!! Take a few minutes to look at the shoes presented here… You’ll see smartly presented, stylish extra-depth orthopaedic footwear in many styles, colours, and sizes. What you can’t “see” is how lightweight and downright comfortable they are. Slip your foot into a Dr. Comfort shoe and know that we live up to our name.


Proper Shoe Fitting

Proper fit is essential for long-term foot health.

Do not assume that a person’s everyday shoes are the correct size!! Many people wear shoes that are the wrong length or width. This workshop will provide you with guidelines to help you determine your patient’s correct shoe size, which Dr. Comfort shoe will best suit their foot, and how to get your patient’s feet happy and healthy!


Using the Brannock


Using the Brannock

Use the Brannock Device to measure your patient’s feet. The Dr. Comfort Brannock is designed to measure both men’s and women’s feet. The patient should wear socks while measurements are being taken.

Note: all men’s measurements are in BLUE and women’s are in YELLOW.


Using the Brannock

Take three separate measurements:

1) Heel to Toe Length

2) Heel to Ball Length (Arch)

3) Width


Heel to Toe

With the patient seated, place the first foot in the correct position with the heel against the cup Have the patient stand Press the toes flat against the base of the Brannock Device and look straight down over the longest toe (not necessarily the first toe) to read toe length. Make sure the patient’s socks are snug against the toes (without drawing the toes back) to get an accurate measurement. Use the handy Shoe Fitting Form to write this number down


Heel to Ball (arch)

Place your thumb on the ball joint of the foot. Slide the pointer forward so the inside curve of the pointer fits the ball joint of the foot and the two high ribs come in contact with your thumb When the pointer is properly located, the lower middle rib will be against the center of the ball joint on the side of the foot. This yields the arch measurement. Write this number down on the Shoe Fitting Form


Width

Slide the width bar to just touch the edge of the foot On the sliding width bar, locate the length To determine correct length, use the midpoint between the heel-to-toe length and the heel-to-ball length (i.e. midpoint is defined as ½ way between heel to toe measurement and heel to ball measurement) Find the width measurement that lines up to the shoe length on the width bar.


Width

If the shoe size falls between widths, choose the wider width If the foot is extremely fleshy or has a high instep, it may be necessary to fit an extra width wider Make sure you use BLUE letters for men and YELLOW for women!! Translate this letter to correct width (Medium, Wide, Extra Wide) and write this width down on the Shoe Fitting Form


Dr. Comfort Widths

Men’s Women’s

Narrow AA

Medium D Medium B

Wide EE Wide D

Extra-Wide EEEE Extra-Wide EE


Next Foot!!

Reverse the Brannock end to end and measure the other foot. It is common for people to have feet of different sizes Always fit shoes to the larger foot If one foot is significantly larger or wider, consider splitting pairs to acquire the right size and width for each foot SIMS Medical offers split pairs at a surcharge


The Fitting Tower

The fabulous Dr. Comfort Fitting Tower holds 27 split pairs (i.e. 54 singles) of Dr. Comfort’s most popular shoe styles. Functional as both an attractive display and a comprehensive fitting centre, the Dr. Comfort Fitting Tower is sure to be a positive addition to your office!!


Fitting Tower??

Tower sets up quickly in four easy steps On castors, so you can move it wherever you need to Shelves rotate Sample shoes include every size in women’s and in men’s in different shoe styles All shoes come in Wide width – if the shoe fits length wise but is narrow, order an extra wide in the shoe of choice; or if too wide, order a medium E.G. Your patient is a size 8 women’s, and the “Lily” is available to try on in size 8, however she wants a “Move” instead – you’ve measured her feet, had her

try on a size 8, and it fits just great – so you order the Move in the right size/width!!


Check FitDetermine if fit is correct

1. Check to see that the ball of the foot is at the widest part of the shoe. If ball is forward (toward toes), shoe is too short. If ball is back (towards ankle) shoe is too long. The area from the ball of the foot to the toes should NEVER be tight.

2. Check toe location. There should be 1/4 to 3/8 inch room at the toe for proper fit. Shoe can feel snug around the instep as leather will shape and form, but the shoe should not feel excessively tight at the instep. If it does, patient may need a half size longer or one size wider.

3. Note: as a general rule, longer is usually better. Never fit short!!!!


Choose Your Style

Help your patient select an appropriate style and colour

You may also consult the Dr. Comfort full-colour catalogue or Quick Reference Index Card for more colour choices


Specific Shoe Pointers

• Dr. Comfort shoes are all made on very similar lasts (if not the same) although design of a particular shoe's upper can affect the way it fits.

• Keep in mind that fitting the right size for your patient does not only involve a quick Brannock measurement of length! Be sure to measure heel-to-ball, heel-to-toe, AND width.

• In conjunction with Brannock measurements, be sure to note the gait of the patient. For example, their degree of overpronation/oversupination and whether or not they will be wearing orthotics in their footwear.

• We suggest taking a static impression of your patient’s feet to note where the pressure points lie, and to determine foot flat stance.

• Take into consideration any foot deformities that may affect the fit of the shoe style selected

• REMEMBER – if you proceed with a full analysis of your patients’ feet before you order their shoes, you will decrease your exchange rate and increase your patient satisfaction rate!


• Please remember that normally you never want to fit a highly symptomatic patient, and more particularly a diabetic patient, shorter or narrower than measured.

• However, by keeping in mind the following guidelines, you will be achieving a fit comparable to other shoes in our line.

• It is very important to remember that when you are fitting patients that have narrow heels, it will be easier to accommodate their needs with a lace shoe. Refer to the Lacing Guide for tips on different lacing techniques to achieve the best fit for your patient.

• NEVER sell the wrong size shoes. Remember – YOU KNOW BETTER! Even if your patient insists, for example, that she always wears a size 7M but you measure her as a size 8W, go with YOUR expertise! That patient has visited you because she has foot problems – she NEEDS your expert advice whether she’s willing to admit it or not!

• Advise your patients to wear moisture-wicking socks. Cotton blend socks cause blistering, even when the shoe is the right size. Cotton, as you know, absorbs moisture. Moisture plus friction results in a blister. Have your patients wear moisture-wicking socks, and blister problems are solved!

Specific Shoe Pointers


Men’s Shoes

PATRICK & MIKE the Patrick & Mike are classic deck-style shoes. They have a lower heel counter than all of the other men's shoes and do not push the foot as far distally. Order these styles a ½ size shorter or one width narrower to achieve a similar fit. *NB: Mike is the Velcro version of the Patrick


CHAMPION & ENDURANCE the fantastic athletic shoes absolutely will not slip in the heel! Based on the same last as the rest of our product line, these light-weight athletic shoes are lasted to fit full in the forefoot, but snug in the heel. The firm heel counter ensures that the back of the shoe will not break down like some counters used in lower quality footwear. In addition, the lightweight EVA and rubber outsole contains a composite shank and a stabilizer bar for extra plantar support and is sufficiently wide to provide stability on all surfaces. Both styles are available in Velcro and Lace versions.

Men’s Shoes


BRIAN the Brian shoe has an upper made of Lycra® to fit patients with hammer toes, bunions, and other similar forefoot deformities. Lycra® is a stretchable material comprised of fibres which move easily with the body’s natural movements. In turn, this upper can make the shoe feel roomy. If you feel this shoe is too loose, order the Brian one width narrower to achieve a better fit.

Men’s Shoes


DOUGLAS the Douglas shoe has two Lycra® strips that run distally on the sides of the shoe. This shoe is designed to stretch from plantar to dorsal. The Douglas is great for patients that have thick, swollen feet, high insteps, or wear an internal brace. The throat of the shoe is more open to allow the foot easier entry. If you have a patient that likes this shoe but does not have any of the above criteria, order this shoe one width narrower to achieve a great fit.

Men’s Shoes


MERRY JANE the Merry Jane is an open top shoe and can fit very roomy for the patient’s foot. It is very important to order the Merry Jane at least one width narrower and in some cases, depending on the foot, ½ size shorter. This shoe is not recommended if you think heel slippage is going to be a problem.

Women’s Shoes


LULU The Lulu shoe is another open top shoe that allows room for a high instep foot. It is important to order this shoe one width narrower to achieve proper fit in those patients who do not have a high instep. This shoe is NOT recommended for pes planus foot deformities.

Women’s Shoes


ANNIE like the men’s Brian, this shoe has a Lycra® upper to fit patients with hammer toes, bunions and other forefoot deformities. As Lycra® is a stretchable material comprised of fibres which move easily with the body’s natural movements, this upper can make the shoe feel roomy. Order the Annie one width narrower if you feel this shoe is too loose.

Women’s Shoes


BETSY The Betsy women’s dress shoe has a unique styling and functional design on the lateral side of the shoe called a “gusset”. This feature allows the shoe to flex and stretch dorsally by adding breadth, reducing metatarsal stress, and increasing breathability. This gusset appears as a triangular “flap” and is a sewing technique used to reinforce the connection on the lateral border.

Women’s Shoes


BETTY highly similar to the men’s Douglas, the Betty also incorporates two distally running Lycra® strips. If your patient does not exhibit a swollen foot or high instep (for example), order the shoe one width narrower.

Women’s Shoes


SPIRIT & VICTORY these women’s athletic shoes are lasted to fit full in the forefoot but snug in the heel, which means they won’t cause heel slippage! The firm heel counter ensures that the back of the shoe will not breakdown. As with the men’s athletic shoes, the lightweight EVA and rubber outsole contains a composite shank and a stabilizer bar for extra plantar support and is sufficiently wide to provide stability on all surfaces.

Women’s Shoes


Order Time!!

For single patient orders, use our Single Patient Shoe Order Forms For multiple shoe orders, use our Stock Shoe Order Forms These can be faxed to 1-866-933-2922 or emailed to [email protected] If the patient you are ordering for requires custom foot orthotics, please do not fax your order!! Send all paperwork, for both the footwear and the custom orthotic (use the Prescription Orthotic Form) with the plaster cast or foam impression to our head office For shoe modifications, include the Shoe Modification Order Form with the Shoe Order Form (this can be faxed or emailed) The specially designed Dr. Comfort inserts are also available for purchase should you require extra for your patient or for stock purposes


Single Patient

Shoe Order •Use this form to record your order, fax to head office, and keep in your patient’s file for future reference


Stock Order Form

•Use this form to order inventory for stock purposes


Prescription Orthotic Order

Form•We can manufacture orthotics specific to your patient and fit them directly in the footwear selected – we accept plaster, foam or STS impressions


Shoe Modification Order Form

•We can modify the footwear for you externally

and internally


Tricks of the Trade

Size Variation• If the right and left foot vary by more than ½ or 1 full size or width and cannot be filled in, consider ordering two different sized shoes

• NB: Split Pairs @ 50% surcharge

• If your patient’s sizing variation is significantly large, such as with a post-polio or amputee, SIMS can create a transmetatarsal filler on a custom orthotic or on the existing Elite Dr. Comfort Inserts


FITTING

• If the instep of the shoe feels slightly snug when trying on a sample shoe from the Tower, that should not pose a problem as the leather will shape to the foot

• However, if the shoe feels extremely tight, patient should wear the same length shoe, but one size wider.

• Patients frequently wear shoes that are too short and wide. • Do not be influenced by a patient’s stated shoe size –

YOU ARE THE EXPERT!!

Tricks of the Trade


HEEL COUNTER

• If the heel counter feels stiff, or digs into the patient’s heel, then remove the shoe and flex the counter of the shoe with your palm but pushing it forward towards the end of the shoe

• Remember to tell your patients to use the Dr. Comfort shoehorn (provided with each pair of Dr. Comfort shoes) to place their heel inside the shoe – this will avoid any damage to the heel counter caused by slipping the heel in and out of the footwear

Tricks of the Trade


FILLING

• If the patient’s shoe is slightly too large (e.g. too deep, too wide), but the variation does not constitute increasing the size or width, you can snug it up by placing a Dr. Comfort blue flat EVA filler under the Elite Heat Mouldable Insert.

• Complimentary pair of blue EVA fillers is included with each pair of shoes ordered.

Tricks of the Trade


Elite Insert Moulding

• First and foremost, verify that the insert is the correct size for the patient’s foot and that it matches the size of the Dr. Comfort extra depth orthopaedic shoe. • During the direct moulding process, the patient may be seated or standing depending on how you are creating their customized insole (weight-bearing or semi weight-bearing).


Heating Process

Please wear heat-resistant gloves!!1. HEAT GUN: using a heat gun at a minimum of 230 degrees

Fahrenheit, heat the prefabricated insert on the top and the bottom of the device until it is soft and malleable (approximately 2-4 minutes)

2. OVEN: heat the convection oven to 250 degrees Fahrenheit and place the device until it is soft and malleable (approximately 1-2 minutes)

• Both heating methods normally take a few minutes maximum per insert.• DO NOT place inserts in the microwave!! • Word of Caution: do not heat the inserts to a point where they can be

dangerous to the patient!!


Heating Process


Positioning & Moulding

• Cover the patient’s foot with a sock or other protective material

• Place the heated insert on a foam block that is a minimum of two inches thick

• Position the patient’s foot on top of the heated insert • Have the patient step down on the insert (standing or

sitting) • Allow the insert to mould to the patient’s foot and arch

while the insert is warm • Remove the patient’s foot from the insert after the insert has

cooled down (approximately 2 minutes)


Positioning & Moulding


Check for Total Contact

• Remove the insert from the foam block and place on the floor

• Position the patient’s foot on top of the moulded insert

• Check to see if the arch on the insert is high enough to achieve total contact with the weight bearing surface of the foot including the arch


Check for Total Contact


Modifications

• The EVA base (blue material or sometimes beige colour) of the Dr. Comfort insert will maintain its shape (mouldable)

• In the case of a patient with a high arch or a heavy patient, you may determine that additional support material should be added under the arch for support (e.g. rubber scaphoids)

• Glue (cyanoacrylate preferred – such as in Dermabond or Traumaseal, Super Glue or Krazy Glue – although Barge cement is ok) the appropriate size latex, poron, sponge rubber or moulded rubber scaphoid pad (longitudinal arch pad) onto the bottom of the EVA portion of the insole

• The pad may be cut or tapered for better fit and comfort • Once complete, check to see that you have a properly fitted insert


Modifications


Additional Protection for pre-ulcerative or healing site

• Cut a piece of 1/8” rubberized cork, slightly larger than the diameter of the lesion, or the area to be protected, and tape it directly to the foot of the patient on the area that you want to provide extra protection;

• Put the sock on the patient’s foot and heat the insert as previously described, utilizing the heat gun or oven method, then place the warm insert on the moulding pad;

• Have the patient step down on the insert for about 30 seconds, and then verify that the depression matches the lesion site


Additional Protection for pre-ulcerative or healing site

You have just accurately offloaded the site without adding any extra loading or pressure to the adjacent sites

To remove the cork and tape from the bottom of the foot, it is important to begin at the area closest to the toes, and gently push the skin away from the tape, remove the tape and cork from the top, down toward the heel.

NEVER start at the bottom and go upwards, as that could cause the skin to tear. It is strongly advisable that only a health practitioner (podiatrist, chiropodist, pedorthist, orthotist) apply and remove the cork and tape from the patient’s foot.


What if it STILL doesn’t fit?

• Fortunately, SIMS Medical accepts returns and exchanges! • Within 30 days of purchase, if the shoe is unworn (i.e. Outside

wear), all components are included (i.e. Shoehorn, insoles, etc.), and the footwear is in resaleable condition, it will be accepted for FULL credit – no restocking or surcharges as long as you follow the simple Shoe Return Policy

• Exchanges are permitted and are processed the same as a Shoe Return and Shoe Order would be

• Keep in mind that footwear returned after an excessive period of time will be credited 75% (minus 25% of original value)

• Footwear that has been worn will not be credited


Shoe Return Form

•Use this form to return footwear for exchange or credit


Dr. ComfortWell that was EASY! It was meant to be!!!

SIMS Medical Corp * 1-888-655-4499 * SIMS Medical Corp. © 2006 Dr. Comfort Professional Shoe...

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Transcript of SIMS Medical Corp * 1-888-655-4499 * SIMS Medical Corp. © 2006 Dr. Comfort Professional Shoe...