By: Alishah Gillani BSc. KIN, Dip. Ped, C.K., C PED (C) The University of California Biomechanics Laboratory (UCBL) orthosis is a specific custom-molded orthosis that closely embraces the heel and midfoot to optimize medio-lateral stability (1).
It was named after the laboratory where it was researched and developed in 1967 (2).
As we are all aware, foot orthoses are fabricated for individuals who have abnormal joint alignment in the foot, causing inappropriate motion during stance and gait. Abnormal mechanics may lead to pain and increased stress in the joints of the foot, leg and even the back.
The UCBL foot orthosis is used to stabilize a flexible foot deformity often know as the ‘flexible pes planovalgus foot’. The UCBL is a closely fit orthotic device that completely encircles the heel in a deep heel cup, controling the hindfoot in a neutral vertical position. It is based on the belief that the calcaneus is the fundamental structure for subtalar joint funtion. The orthosis realigns the calcaneus, acting to improve the angle of pull of the achilles tendon, and provide a more stable base for the articular surfaces of the talus, navicular, and cuboids (5). The UCBL differs from the biomechanical foot orthosis in it's secure rear foot fit which cradles the medial column and also controls the entire rearfoot Following a thorough biomechanical assessment of stance and gait, As with any other custom orthosis, the UCBL begins with the patients limb casted in a subtalar neutral position to provide a negative mold and create a positive mold of the foot ,. Once the positive model is appropriately modified, thermoplastic material is heat molded, cooled, and trimmed to form the UCBL orthosis. Standard Structure:
The UCBL is made out of a rigid material, usually a plastic that is pressed on to the cast. The insert usually ends just proximal to the toes by the ball of the foot. This allows for natural propulsion at the toes during gait.
The shell can be constructed of polypropylene, polyethylene, or a copolymer that allows for a deep (high) heel cup, high medial and lateral flanges, and a rear foot post. Personally, I have had success with Subortholene 4.0 mm shells and Extrinsic White High Density EVA, for rearfoot or forefoot posting. The goal is for the orthosis to hold the calcaneus it in a neural or even slightly inverted position, eliminating excessive pronation.
In order for successful intervention with a UCBL, it is imperative that the foot be lax enough to be manipulated in to neutral alignment. If the foot is inflexible, the role of a UCBL at this time is to adapt and accommodate the foot, preventing further deformity (2).
Tips and Problem Solving:
The UCBL is a good choice for the hypermobile flat foot in the pediatric patient. Extra stability in pediatric orthotics is provided by extending the heel-post trim line farther distally, and having a flatter and wider shell just behind the metatarsal heads (4). Complete biomechanical control can be accomplished with this clinical device. High medial & lateral flanges that extend just proximal to the 1st & 5th met heads control severe pronation, accessory navicular and collapse of midtarsal joints.
When putting the UCBL on a child’s foot, calcaneal position should be minded of making sure the heel is properly seated inside the orthosis. The patient/guardian should be advised that if any red marks, bruises, or blisters are apparent on the skin seen they should discontinue wearing the device and call to schedule an appointment.
A patient that I saw recently presented with the following: * 12 year-old female: complaints of increased foot pain corresponding to increased levels of activity. * Grade 7 student who enjoys a fairly active lifestyle and especially enjoys water polo, skiing, skating and badminton. * discomfort in her arches and stretching of the fascia bilaterally * finds increased...