The Present Use Of The Ucbl Foot Orthosis
Michael J. Quigley, C.P.O. *
In August 1971, the Committee on Prosthetics Research and Development (CPRD) of the National Research Council completed an evaluation of four lower-limb orthoses. They were the VAPC Single-Bar Knee-Ankle-Foot Orthosis (KAFO). the UCBL Dual Axis Ankle-Foot Orthosis (AFO), the New York University insert Ankle-Foot Orthosis, and the UCBL Shoe Insert Foot Orthosis (FO) (Fig. 1 and Fig. 2 ). The latter two orthoses were considered to be valuable additions to patient services, and it was recommended that they be included in orthotics education programs .
To determine the acceptance of the UCBL shoe insert foot orthosis, how the technique was learned, and something about the experiences in the field, a limited survey was conducted. Thirty-five certified orthotics and prosthetics-orthotics facilities were selected randomly from the 1974 Registry of Accredited Facilities . This represented an equal distribution of practitioners from twenty cities. The questionnaires (Appendix A, Appendix A (cont.) ) consisted of a section to be completed by the physician and a section to be completed by the orthotist. The orthotist was requested to forward the questionnaire to the physician after his section was completed. The questionnaires were sent out in January 1974. By March 1974. twenty-nine of the forms were returned. The following information was taken from these forms.
The UCBL foot orthosis was used by 75 percent of the surveyed practitioners. However, only seven of the twenty-one practitioners who use this orthosis do so regularly. Of the remaining fourteen respondents, five use the orthosis only when it is requested by a certain physician, five rarely use it, two use it for special conditions only, and one stated he uses the orthosis only as a last resort.
An attempt was made to determine how the practitioners were made aware of the UCBL foot orthosis. The literature rated as the most common source of information. Articles on the UCBL foot orthosis appeared in the Bulletin of Prosthetics Research in September 1969 and in Orthotics and Prosthetics in March 1972. In addition. New York University published an evaluation report on the orthosis in 1969. The prosthetics-orthotics education courses were the second most common source of information on the subject. Word of mouth rated as the third main channel of communications, since some respondents stated that orthotists, podiatrists, etc., had informed them of the technique.
Eight areas considered to influence the prescription and use of the UCBL foot orthosis were covered in the questionnaire. The most common prescription was bilateral orthoses for a patient 25-40 years old with pes planus.
The pathologies most commonly treated with the UCBL foot orthosis are pes planus and arthritis. Following these, in order of frequency, are plantar fasciitis, metatarsalgia, polio, cerebral palsy and peroneal palsy.
Respondents indicated that the orthosis is used equally on males and females and is fitted bilaterally the vast majority of the time. The age groups that use the UCBL foot orthosis most often are between 1-12 years of age and between 25-40 years of age.
The major disadvantage of using this orthosis is the expense, a fact that was underscored by half of the respondents. The other disadvantages checked off by the practitioners are that a wider shoe is sometimes needed, that the orthosis slips up and down in the shoe, and that breakage occurs. Two practitioners felt the orthosis is difficult to fit.
The major advantages of using this orthosis is that is provides proper foot support, allows the patient to change shoes, eliminates shoe modifications and the need for orthopedic shoes. The practitioners also felt that the UCBL foot orthosis provides improved cosmesis and gives consistent relief from pain.
Most of the respondents indicated that the orthosis usually lasts longer than a year before replacement is necessary, although a few practitioners stated that it only lasts up to one year. The major reason that the UCBL foot orthosis needs replacement is a loss of fit with time. Breakage is the second most common reason replacement was needed. One practitioner stated that he replaces the orthoses in cases when he wants to increase progressively the amount of foot correction.
CASTING, FABRICATION AND FITTING
This part of the survey was structured to determine if the original technique is still practiced, what materials and methods are presently used for fabrication, fitting problems encountered and solutions to these problems.
Nearly every practitioner stated that he uses the same method of wrapping to obtain the mold as was described originally in the literature. Manual alignment of the foot and ankle is practiced by all respondents, as is the use of the contoured casting boards for positioning the patient. One-quarter of the orthotists use standard plaster bandage rather than the elastic type originally recommended, and one-third of the orthotists no longer use the balloon method for casting.
Polyester resin is used exclusively by eight of the orthotists, four use both polyester resin and polypropylene, five use polypropylene exclusively, one uses polyethylene and one uses acrylic.
It is interesting that of the seven practitioners that had breakage problems, six use polyester resin for fabrication and one uses polyethylene. None of the orthotists that utilize polypropylene exclusively mentioned breakage problems.
The most common fitting problem is pain at the location of the navicular (scaphoid) bone, which is located medially at the apex of the arch of the foot. Shoes being too tight when the orthosis is worn is the next most common problem, followed by pistoning of the foot in the shoe, and difficulties in establishing the trimline at the metatarsal area. One practitioner stated that he has his patients acquire a pair of shoes that will accommodate the orthosis.
None of the orthotists do any shoe modifications in addition to using the UCBL foot orthosis.
Six orthotists consistently modify the foot orthosis. Wedges and metatarsal relief pads are added by two practitioners. One orthotist uses Spenco* buildups, presumably for better weight distribution and reduction of shear stresses. Another adds a Velcro strap over the dorsum of the foot to prevent the foot from pistoning. To decrease the sliding of the foot orthosis on the insole of the shoe, one orthotist lines the bottom surface of the orthosis with moleskin or thin non-skid rubber.
The UCBL foot orthosis was first publicized in September 1969, and introduced in the education programs in late 1971. The fact that 75 percent of the surveyed practitioners had used the orthosis by January 1974 is a testimony to the speed that proven research in this field is applied to the patient. Probably no other medical or paramedical specialty can realize these patient benefits from research only four and one-half years after the initial introduction of a technique.
The utilization of this orthosis may decrease in the future as thermoplastic, thermoformed lower-limb orthoses gain acceptance. However, the UCBL foot alignment principles still apply to , the foot section of thermoplastic ankle-foot orthoses and knee-ankle-foot orthoses, and should be used whenever possible.
*A foam rubber that is impregnated with nitrogen bubbles.
- American Board for Certification in Orthotics & Prosthetics, Inc., 1974 Registry of Accredited Facilities and Certified Individuals in Orthotics and Prosthetics, Washington, D.C., 1974.
- Committee on Prosthetics Research and Development, A Clinical Evaluation of Four Lower-Limb Orthoses, National Academy of Sciences, Washington, D.C., 1971.
- Henderson, W.H., and J. W. Campbell, UC-BL shoe insert: casting and fabrication. Bull. Pros. Res. 10-11:215-235, Spring 1969.
- LeBlanc, Maurice A., Aclinical evaluation offour lower-limb orthoses. Orth. and Pros. 26:1:27-47, March 1972.
- Mereday, C., C.M.E. Dolan, and R. Lusskin, Evaluation of the UCBL Shoe Insert in "Flexible" Pes Planus. New York University, September 1969.