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UCBL or Rearfoot Varus Posting?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kahuna, May 23, 2010.

  1. Kahuna

    Kahuna Active Member


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    Hi all

    I contacted a few Orthotic Labs and found that several only offer 'shallow heel cup' shells, with the rationale being that more rearfoot varus posting can be added extrinsically to help with 'rearfoot eversion' (I appreciate 'rearfoot eversion' as a term has mixed opinion!!) Those particular labs stated that UCBL 20mm requests were rare these days...................

    however..............

    I contacted a few other Orthotic Labs (interestingly, including two university pod school orthotic manufacturing depts) and found that they *primarily* offer UCBL as their shells, and have "little regard for 7-14mm heel cup depths" in mechanical control.

    SO,

    I thought I'd put the question out to pod-arena.

    Do you tend to favour a UCBL design, or a shallower heel cup?

    and more importantly (as orthotic material, design, depth, etc, etc is based on clinical assessment) what are YOUR indications for using one above the other?

    A quick straw poll I put out among colleagues and pod lecturer friends yielded a diverse range of opinion, so I hope this thread will be interesting!


    Thanks
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Re: UCBL or Rearfoot Varus Posting !!??

    UCBL type design or similar design features are awesome when the motion is predominantly in the transverse plane.
     
  3. Jeff Root

    Jeff Root Well-Known Member

    Re: UCBL or Rearfoot Varus Posting !!??

    A true UCBL type orthosis has no intrinsic forefoot cast correction and no extrinsic rearfoot post. A "modified UCBL" is a true functional orthosis in that it has intrinsic forefoot cast correction and an extrinsic rearfoot post, plus a "deep" heel cup of approximately 20 to 30 millimeters. These two types of devices need to be differentiated. The modified UCBL type orthosis “borrowed” the deep heel cup design of the original UCBL device. In all other respects, it’s a functional orthosis.

    The only reason to use a UCBL type orthosis is due to the fact that you’re attempting to resist more extreme forces (in magnitude, direction, or both). As Craig correctly pointed out, deep heel cups and lateral clips or flanges help resist transverse plane forces (motion). But you can augment this correction with minimal arch fill, a flat (zero degree) rearfoot post, heel post flares, a heel skive, etc. So, design the device to address the pathology and forces you can recognize clinically and forget about what everyone else is doing if it isn't logical for the individual patient in question!

    Your question is akin to asking an optometrist if they treat their patients for near or far sightedness. Examine the individual patient and determine what is best for them based on the results of your exam.

    Respectfully,
    Jeff
     
  4. Footoomsh

    Footoomsh Active Member

    Re: UCBL or Rearfoot Varus Posting !!??

    I have found orthopaedic surgeons to have a strong bent towards UCBL devices. It seems to be the predominant type of device they recommend.
     
  5. Kahuna

    Kahuna Active Member

    Re: UCBL or Rearfoot Varus Posting !!??



    Hi Jeff

    Thanks for your reply - I tried to convey in my first post that an orthotic prescription has to be based on clinical assessment. Of course it should..........

    What I'm trying to convey is that there is a HUGE gulf between the starting point of "Lab Standard" between different Labs - and I find this interesting and disconcerting.

    These are well respected labs too ......... two large UK labs told me they supply 95% of their prescriptions as 7mm shallow heel cups.

    However, two other large labs told me they supply nearly all of their prescriptions as modified UCBL types (with a 20mm min depth).

    So what I really want arena readers to discuss is this:

    Does the Lab standard (and their preferred device design) influence their client's prescriptions?

    OR,

    are podiatrists working hard to insist on the correct prescription, and find a suitable lab that supplies that indicated prescription for their patient (based on a clinical exam)?



    Hope that clarifies things
     
  6. Kahuna

    Kahuna Active Member

    Re: UCBL or Rearfoot Varus Posting !!??

    I agree!!

    In two NHS trusts locally, the pod surgeons exclusively use modified UCBL types; the community podiatry dept uses 7mm shallow heel cups only (from a different lab!! ) Sometimes, the patients are common to both departments!!!!!

    Prescriptions need to get away from being "Lab-driven".
     
    Last edited: May 25, 2010
  7. Jeff Root

    Jeff Root Well-Known Member

    Re: UCBL or Rearfoot Varus Posting !!??

    Kahuna,

    The answer to your question is yes, no, maybe, all of the above, none of the above, but more than likely, C. I'm in the middle of writing an article for Podiatry Management about this exact subject!

    Labs have defaults. The practitioner can either accept those defaults or he/she can modify them to create a customized Rx for the patient in question. Labs have tendencies to produce certain types of orthoses. Some labs try to make their orthoses more "controlling" than average while others do not. Some labs focus heavily on aesthetics while others may not.

    Just as labs are somewhat individual in nature, so too are the practitioners they serve. Some are much more aggressive with their Rx while others are not. Some take excellent cast and do thorough patient exams while others do not. Some use very simple orthoses while others create very complex and elaborate devices. Many are very habitual in how they prescribe, in part, because of how they learned to practice and because they learn what works for them in practice.

    The bottom line is that it is the practitioner's duty to create the prescription for their patient and they can do so by accepting the lab’s defaults or by customizing them. It is the lab’s duty to manufacture exactly what the practitioner has order. If the lab sees a problem with or has a concern about how the practitioner prescribed, they have a responsibility to inform the practitioner. This is like the pharmacist calling the doctor to inform him/her that the medication they prescribed is incompatible with another medication that the patient is taking.

    Practitioners use a lab or labs for a variety of reasons, including price, product appearance, function, location, defaults, etc. As a result, some labs serve a smaller niche and other are broader based.

    Does that help answer your question?

    Respectfully,
    Jeff
     
  8. Graham

    Graham RIP

    Orthoses should NEVER be Lab driven! Send them the cast, with the Rx details and get back what YOU asked for, not what the LAB thinks you asked for. I use one Lab only and have worked hard, as has the Lab, to ensure I get the device I ask for, not what the lab thinks it should be.

    If we let the Labs make the decision re: RX then what did we train for?!
     
  9. Jeff Root

    Jeff Root Well-Known Member

    "If the lab determines the prescription then they become the professional and the practitioner then becomes the technician who dispenses the orthosis" A quote by John H. Weed, DPM from a personal conversation we had in the early 1980"s. Gone but not forgotten. May you rest in peace.

    With great respect,
    Jeff
     
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