Heel Cups - Supramalleolar Orthoses (SMO)/UCBL

Custom Suprmalleolar orthoses (SMOs)/ University of California Biomechanics Laboratory (UCBLs) are beneficial for treatment of many medical conditions and injuries. Sometimes UCBLs are referred to as heel cups.

These conditions can be (but are not limited to):

Anatomy and Biomechanics of SMO & UCBL	There are two bones in the lower leg and 26 bones in the foot that create many joints. There are many muscles, tendons, ligaments and nerves in the foot and ankle. There are two ankle joints: Talocrural joint Subtalar joint The foot can be broken into three parts: Rearfoot/hindfoot Midfoot Forefoot Arches of the foot: Medial longitudinal arch Lateral longitudinal arch Transverse metatarsal arch
Goals of SMO & UCBL Treatment	Provide ankle and foot stability in stance Provide foot clearance in swing phase of gait (walking) Control biomechanical alignment of the foot and ankle in locomotion (pronation, supination) Aid in adaption to surfaces Redistribute pressures on the foot Resist external forces on the foot and ankle Limit excessive movements in the foot and ankle Protect the foot and ankle Provide shock absorption Produce a more energy efficient gait pattern
Design of SMO & UCBL	A Certified Orthotist will assess the foot and ankle and take a 3-D cast/mould of the foot and ankle if needed. This can be performed with the patient in a prone position or in a seated position. The Certified Orthotist will ensure the foot and ankle are in a corrected position and the subtalar joint will be in neutral. Certified Orthotists can accomplish corrections to the foot with intrinsic and extrinsic modifications. Intrinsic modifications are changes made to the positive mold of the foot and ankle. Extrinsic modifications are accommodative padding added to SMO/UCBL orthosis Examples of accommodative padding: Metatarsal pad 2-5 bar Metatarsal head cutout Morton’s extension Heel cushion Forefoot extension Scaphoid pad Malleolar padding There are a variety of SMO/UCBL designs. The Certified Orthotist will determine which design is best for treatment based on individuals’ needs and goals. Articulating SMOs will have ankle joints. All SMOs have straps to help ensure correct application of the orthosis.
SMO & UCBL Application	SMOs/UCBLs work best when used within a neutral shoe with an appropriate heel counter. SMOs/UCBLs can be switched between shoes. It is best to remove the insole of the shoe to allow space for the orthosis.
Living with SMO & UCBL (follow up)	The corrections provided by the orthosis may take some time to get used to. The SMO/UCBL should not be painful; however, it is not uncommon to feel some initial discomfort. The break-in period should not last more than two weeks. If you experience rubbing or blisters, please book an appointment with your Certified Orthotist for immediate attention. If you are experiencing pain after two weeks please book a follow up appointment with your Certified Orthotist. It is always recommended to book a follow up appointment with your Certified Orthotist if you experience any changes in condition (pain, growth). The Certified Orthotist can determine what changes need to be made or make recommendations for alternative treatment. Custom SMO/UCBL orthoses can often be modified or refurbished. The Certified Orthotist can reassess to determine the course of treatment with you.
Funding for SMO & UCBL	Alberta Aids to Daily Living (AADL) does provide funding for custom SMOs/UCBLs for Alberta Residents with valid Alberta Healthcare. AADL will pay 100% for the cost for Alberta Residents over the age of 65. AADL will pay 75% of the cost for Alberta Residents under the age of 65. A prescription from a physician is required. There is coverage for persons with low income. WCB may provide coverage with a copy of a prescription from a physician. NIHB may provide coverage with a copy of a prescription from a physician. Private insurance may pay for a portion of the cost of your custom orthosis. It is important to consult your insurance company to determine the coverage that they provide. Many insurance companies require a physician's prescription for custom orthoses benefits. Some insurance companies may request a biomechanical analysis from the Certified Orthotist. There may be an added cost for the Certified Orthotist to provide this report.