UCBL Foot Orthoses Flashcards

UCBL Overview

• Indicated for hindfoot angulation greater than 10 degrees, mild spasticity, and flexible foot structures.
• Contraindicated in cases of severe spasticity, vertical talus (over 45 degrees), and very severe midfoot break (dropped navicular).

UCBL Design Features

• High medial and lateral trimlines are designed to avoid impinging on the malleoli.
• Includes external posts for medial and lateral support to enhance stability.

UCBL Clinical Applications

• Effective for treating flexible pes planus and hindfoot deformities (varus/valgus).
• Addresses forefoot transverse deformities (abduction/adduction) in patients.

UCBL Trimline Specifications

• Trimlines encompass the 1st and 5th metatarsal shafts, positioned 2-3mm proximal to their heads.
• Full coverage of the calcaneus is necessary, featuring a dorsal wrap and hindfoot post for support.

Carlson Modifications

• Innovative features include sustentaculum tali support, an internal medial heel wedge, and an external medial heel post.

SMO Characteristics

• Increases lever arms compared to UCBL, providing better coronal plane correction.
• Enhances swing phase stability through a broader base of support.

SMO Trimline Specifications

• Trimlines are positioned superior to the malleoli with a dorsal wrap that bisects the metatarsal heads.
• Full footplate support is included, descending posteriorly to permit plantarflexion.

Managing Hyperextension in AFO

• Use a more proximal posterior trimline to avoid impeding fibular neck flexion.
• Consider adding a posterior stop and setting AFO initially in a few degrees of dorsiflexion.

Dorsiflexor and Plantarflexor Weakness

• For dorsiflexor weakness, a three-point force system applies superior force at met heads and distal pressure at the instep strap.
• For plantarflexor weakness, inferior force at met heads and anterior proximal force at the heel are crucial.

Full Length Foot Plate Indications

• Indicated for conditions like claw toe and mid-foot fractures, especially when spasticity or tone is present.
• Promotes knee extension during gait.

Three-Point Pressure Systems

• Valgus management employs medial forces at specific metatarsals and directed forces around the malleoli.
• Varus management requires similar directional forces, specifically focusing on the first metatarsal.

Callus Management

• Discomfort at the 1st met head may indicate excessive pronation; a medial sabloch tab may assist.
• Discomfort at the 5th met head suggests excessive supination; a lateral sabloch tab is recommended.

Posterior Leaf Spring Specifications

• Trimlines should be positioned 1 inch distal to the fibular neck and behind the malleoli, allowing useful rigidity adjustments.

Establishing Forces in AFOs

• The posterior leaf spring can prevent plantarflexion during swing and manage dorsiflexion during stance through a structured three-point force system.

Solid AFO Design and Application

• Solid AFOs cover 60% of the gastrocnemius and require full footplate integration to prevent pressure on the navicular area.
• Suggested for poor balance, significant muscle tone issues, and various gait abnormalities.

GRAFO Applications

• Primarily used in conditions like crouch gait and knee instability; serves as an alternative to KAFO.
• Full footplate support is essential for effective dorsiflexion stops and knee extension.

Other AFO Types

• Articulated AFOs focus on dorsiflexion weakness with specific indications for knee flexion control.
• PLS is indicated in patients with dorsiflexion weakness and no significant stability issues, providing minimal influence at the knee or hip.

Specialty Orthotic Features

• Metal double uprights are suggested in cases of fluctuating edema or personal preference.
• Drop locks are indicated for patients with significant quadriceps weakness to enhance stability.

Key Measurements and Clearances

• Knee clearances should be 3mm laterally and 6mm medially, while ankle joint clearances are 6mm medially and 5mm laterally.
• Stirrup length is derived from specific anatomical measurements, ensuring a tailored fit for each patient.