Heel Lift for substantial Leg Legth Difference

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Hoping for some advice - I have a patient who one year ago had a hip replacement which has left him with a LLD of around 4cm. He is quite unstable as a result and I intend to add a lift to the shorter leg. My querie is as to the pro's and con's of a heel lift, as opposed to a full length shoe lift. He has normal ROM in the ankle of the shorter leg. Thanks

 

Probably a combination of both

 

4cm is a big difference I would be looking to do 90% or more of any lift with shoe and maybe some fine tuning with a heel lift.

 

If the limb length difference (LLD) is indeed 40 mm, which is a lot for a hip replacement (normal hip replacements normally cause less than a 10 mm LLD), then some of the "lift" should be put into the shoe sole, and some put into the shoe. In general, I put no more than 6 mm heel lift inside the shoe and then put the rest into the shoe sole. The shoe sole lift, if it is for a 40 mm LLD, should be about 34 mm in thickness (with a 6 mm in-shoe heel lift) with a rocker sole modification in the shoe shoe (due to the increase in forefoot shoe sole stiffness that will occur with the sole lift) and with a slight sole flare (to improve frontal plane stability of the shoe).

Before you do that, I would remeasure the LLD. A 40 mm LLD is an awful lot for status-post hip replacement. My bet is that the LLD is significantly less than that.

 

The reason why you can't put it all on the shoe is that it will lift the foot out of the shoe and it will be hard to keep on. With some high top basket ball shoes you can add quite a bit of lift. This is the cheap fix and is not as good as adding some in shoe and some full length lift with a rocker tip and flare as the others have suggested.

Eric

 

Thank you for your advice. On the day I first saw this patient (Nov 10)I sent him for imaging to accurately determine LLD. The rocker sole to address a stiffer sole is a good point I would not have considered. Just one further point I would like to raise - when I studied I was advised that we should only initially introduce 66% of the actual difference, and then progress at a later date to the full 100% - i.e. move with caution so as to not cause any problems further up the skeletal chain. Thereby giving the patient a window to acclimatize to the change. Can you comment on this approach. Thanks

 

For a recent change in LLD, such as from trauma or surgery, I tend to go the full amount I measured since it is assumed that the body has not yet adapted to the LLD yet. This would not apply, however, if, for some reason, I thought there might have been a preexisting LLD before the trauma or surgery. If, however, the person has been living with the LLD for more than 10+ years already, then I will do 50% of the LLD initially and then slowly add to the lift over time.

Make sure you also add a lateral sole flare for a sole lift of this size or you will tend up with a shoe that may cause inversion ankle sprains fairly easily.

Hope this helps.

 

Agree was about to say to Mic the amount of LLD you correct depends a lot on how the body is compensating for the LLD in this case the body may not be " working out " yet how to compensate

FWIW Mic I tend to go closer to 70% and work up or down from there but there should not be a hard a fast rule of what % you use and there are many way the body compensates for a LLD and that will effect how aggressive you need to be, and if there is an injury on the Long leg or not

 

I'd have asked my lecturers why 66% as opposed to 65% or 67%... Think of a number... look at it, say what it is....