Re: Pediatric UCBL stiffness inquiry
Jennifer Wolbach
Description
Collection
Title:
Re: Pediatric UCBL stiffness inquiry
Creator:
Jennifer Wolbach
Date:
1/4/2021
Text:
Thank you all who have responded so far. This has been a lot of fun and I appreciate the responses from everyone!
Please see below on other responses that was not posted directly to the LIST-SERV.
* Interesting discussion - I look forward to hearing people's views. I use 2mm subortholen and a moderately stiff durometer EVA. I can carve the EVA and even thin the plastic in areas where I want more flexibility. Obviously the lighter the child the harder this is - sometimes I use 1mm for really small children. I am a believer that the foot needs to flex and move during each step - intrinsics are important!
* Hi Jennifer, You pose a good question regarding UCBL's - and foot orthotic design in general. There are several schools of thought and different theories regarding biomechanical function and appropriate orthotic intervention. When there are differing points of view on a problem it usually indicates that there is some level of truth behind each approach but none encapsulates the entire subject. In such cases it is vital to first accurately describe the initial conditions. For example, you mention the patient's weight. Also, the correctability of the foot: is it rigid or flexible? Is there pain, or is the foot asymptomatic? The patient's age is also critical as it is known that children between the ages of 2 - 8, the time before growth plates close, respond very well to orthotic therapy - and often tolerate rigid devices quite easily. This suggests a decision matrix or flow chart that can help guide choices. An excellent reference text are the pediatric chapters in Ronald Valmassy's Clinical Biomechanics of the Lower Extremities. I adapted an article from that book to try and simplify the decision-making process: <URL Redacted> If you are unsure about the proper rigidity of a device I suggest you carry a set of prefabs in the lab. By having the child take a few steps in them you will quickly know if they can tolerate firm support or not. Working with children can be very rewarding and many academic podiatrists believe it is a golden age where correct orthotic therapy can guide growth and provide benefits that literally last a lifetime.
* I use 5'32 modified polyethylene and it gives a little while still providing good correction in my opinion.
Happy 2021 everyone!
From: Steve Fletcher < <Email Address Redacted> <mailto:<Email Address Redacted>>>
Sent: Thursday, December 31, 2020 7:27 AM
To: Jennifer Wolbach < <Email Address Redacted> <mailto:<Email Address Redacted>>>
Subject: Re: [OANDP-L] Pediatric UCBL stiffness inquiry
Hi Jennifer
Thought I would add some brief thoughts to your discussion. The decision as to how rigid the UCBL needs to be begins for me with the underlying pathology you are treating. If the patient has a milder, developmental delay presentation, then I would lean towards a somewhat more flexible material. Like you said, I would want their muscles to have to continue to develop with the main goal being protection of their developing joint surfaces and soft tissues. If the clinical presentation is more severe (i.e. notable weaknesses), I would opt for more rigid materials.
I think you are correct that the patient's size/weight is an important factor. Their activity level is also relevant. If they have other comorbidities that impact their activities, it may be appropriate to aim for more control than to try and allow some motion.
Happy New Year!
Steve Fletcher, CPO, LPO
<Email Address Redacted> <mailto:<Email Address Redacted>>
On Thu, Dec 31, 2020 at 9:20 AM Jennifer Wolbach < <Email Address Redacted> <mailto:<Email Address Redacted>>> wrote:
Hello All,
This is a question for my colleagues, my practitioners. I know we all have our own principles and school of thoughts. But I want to pose a discussion on what are people's thought on UCBL/Pes Planovalgus orthotic stiffness choice.
Since exact rigidity needed to properly treat a diagnosis, is not something (exactly) is taught at school and is mainly anecdotal based on the patient's body weight. My coworker and I differ is our opinion/treatment of pediatric kiddos regarding the choice of plastic/thickness. These are typically a personal choice of the practitioner and how they assume the patient will be able to tolerate and accept orthotic treatment. There is so many variables regarding one's long term effectiveness such as natural biology, the patient's compliance or age or comorbidities. I just want to discuss pediatric pes planus/PPV and do you believe its better to allow some movement of the foot/muscle activation at the expense of full alignment correction or do you try to achieve maximum tolerable correction and hope for (possible) long term alignment therapeutic correction?
I'm under the thought that Less is More. I prefer to do co-poly shells for my UCBL unless the child is 100 lbs or more. I feel that I still want the patient to have some movement to develop the intrinsic foot muscles.
From school I learn that it is preferrable for young children (I believe under the age of 5) to have flexible shoes to allow the child's intrinsic foot muscles to develop. So why would I want to fully hold/reduce movement a child foot. I will admit my co-worker can correct a child's alignment better with the polypro than I can necessarily with co-poly ( I will remade a device stiffness if I feel that my alignment correction is insufficient).
Maybe the discussion should be to use PP if the child is over 5 or over 100 lbs (at least for me). I just want to hear what my fellow colleagues are doing, and what their thoughts are.
I'm not saying there will be one correct way. But I feel this is how the List Serv should be better used at times.
Thank you,
Jennifer Wolbach LCPO
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Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
--
Steve Fletcher, CPO, LPO
<Email Address Redacted> <mailto:<Email Address Redacted>>com
[cid: <Email Address Redacted> ]< <URL Redacted> >
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Please see below on other responses that was not posted directly to the LIST-SERV.
* Interesting discussion - I look forward to hearing people's views. I use 2mm subortholen and a moderately stiff durometer EVA. I can carve the EVA and even thin the plastic in areas where I want more flexibility. Obviously the lighter the child the harder this is - sometimes I use 1mm for really small children. I am a believer that the foot needs to flex and move during each step - intrinsics are important!
* Hi Jennifer, You pose a good question regarding UCBL's - and foot orthotic design in general. There are several schools of thought and different theories regarding biomechanical function and appropriate orthotic intervention. When there are differing points of view on a problem it usually indicates that there is some level of truth behind each approach but none encapsulates the entire subject. In such cases it is vital to first accurately describe the initial conditions. For example, you mention the patient's weight. Also, the correctability of the foot: is it rigid or flexible? Is there pain, or is the foot asymptomatic? The patient's age is also critical as it is known that children between the ages of 2 - 8, the time before growth plates close, respond very well to orthotic therapy - and often tolerate rigid devices quite easily. This suggests a decision matrix or flow chart that can help guide choices. An excellent reference text are the pediatric chapters in Ronald Valmassy's Clinical Biomechanics of the Lower Extremities. I adapted an article from that book to try and simplify the decision-making process: <URL Redacted> If you are unsure about the proper rigidity of a device I suggest you carry a set of prefabs in the lab. By having the child take a few steps in them you will quickly know if they can tolerate firm support or not. Working with children can be very rewarding and many academic podiatrists believe it is a golden age where correct orthotic therapy can guide growth and provide benefits that literally last a lifetime.
* I use 5'32 modified polyethylene and it gives a little while still providing good correction in my opinion.
Happy 2021 everyone!
From: Steve Fletcher < <Email Address Redacted> <mailto:<Email Address Redacted>>>
Sent: Thursday, December 31, 2020 7:27 AM
To: Jennifer Wolbach < <Email Address Redacted> <mailto:<Email Address Redacted>>>
Subject: Re: [OANDP-L] Pediatric UCBL stiffness inquiry
Hi Jennifer
Thought I would add some brief thoughts to your discussion. The decision as to how rigid the UCBL needs to be begins for me with the underlying pathology you are treating. If the patient has a milder, developmental delay presentation, then I would lean towards a somewhat more flexible material. Like you said, I would want their muscles to have to continue to develop with the main goal being protection of their developing joint surfaces and soft tissues. If the clinical presentation is more severe (i.e. notable weaknesses), I would opt for more rigid materials.
I think you are correct that the patient's size/weight is an important factor. Their activity level is also relevant. If they have other comorbidities that impact their activities, it may be appropriate to aim for more control than to try and allow some motion.
Happy New Year!
Steve Fletcher, CPO, LPO
<Email Address Redacted> <mailto:<Email Address Redacted>>
On Thu, Dec 31, 2020 at 9:20 AM Jennifer Wolbach < <Email Address Redacted> <mailto:<Email Address Redacted>>> wrote:
Hello All,
This is a question for my colleagues, my practitioners. I know we all have our own principles and school of thoughts. But I want to pose a discussion on what are people's thought on UCBL/Pes Planovalgus orthotic stiffness choice.
Since exact rigidity needed to properly treat a diagnosis, is not something (exactly) is taught at school and is mainly anecdotal based on the patient's body weight. My coworker and I differ is our opinion/treatment of pediatric kiddos regarding the choice of plastic/thickness. These are typically a personal choice of the practitioner and how they assume the patient will be able to tolerate and accept orthotic treatment. There is so many variables regarding one's long term effectiveness such as natural biology, the patient's compliance or age or comorbidities. I just want to discuss pediatric pes planus/PPV and do you believe its better to allow some movement of the foot/muscle activation at the expense of full alignment correction or do you try to achieve maximum tolerable correction and hope for (possible) long term alignment therapeutic correction?
I'm under the thought that Less is More. I prefer to do co-poly shells for my UCBL unless the child is 100 lbs or more. I feel that I still want the patient to have some movement to develop the intrinsic foot muscles.
From school I learn that it is preferrable for young children (I believe under the age of 5) to have flexible shoes to allow the child's intrinsic foot muscles to develop. So why would I want to fully hold/reduce movement a child foot. I will admit my co-worker can correct a child's alignment better with the polypro than I can necessarily with co-poly ( I will remade a device stiffness if I feel that my alignment correction is insufficient).
Maybe the discussion should be to use PP if the child is over 5 or over 100 lbs (at least for me). I just want to hear what my fellow colleagues are doing, and what their thoughts are.
I'm not saying there will be one correct way. But I feel this is how the List Serv should be better used at times.
Thank you,
Jennifer Wolbach LCPO
********************
To unsubscribe, send a message to: <Email Address Redacted> <mailto:<Email Address Redacted>> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted> <mailto:<Email Address Redacted>>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
--
Steve Fletcher, CPO, LPO
<Email Address Redacted> <mailto:<Email Address Redacted>>com
[cid: <Email Address Redacted> ]< <URL Redacted> >
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Jennifer Wolbach, “Re: Pediatric UCBL stiffness inquiry,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/255262.
