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I am writing a report on the footwear needs of a 24 year old man with severe road traffic injuries to one femur leaving that leg 38mm shorter with some knee pain that is now chronic.

The defense claim is that although he can no longer run, he can walk and given a simple lift added under a shoe, together with an orthotic, he should be all right.

My concern is that if he has knee pain now, it will degenerate faster than the normal degeneration that we all undergo as we age. By the age of say, 60, he is more likely to have serious problems than otherwise would be the case. That probability should be budgeted for in the claim.

Can I only rely on common sense to put forward that view or does anybody know of more definitive research?

 

A 4cm LLD is near the extremity of that bell shaped curve.


This fellow will need to do 2 things to attain "neutrality". Wear one stilletto with a 4cm heel OR wear a shoe with a full foot 4cm build. The latter will be as heavy as a bowling ball. Imagine the work and overload of his hip flexors in swing etc. I have read that weight distally (foot/shoe) compares to huge loads proximally.



The former (heel raise only) will demand more ipsilateral knee flexion, and more ipsilateral ankle plantar-flexion. As a result, you have more posterior talus WB; short calf muscles; less venous/lymphatic pump....and the list goes on and on. As for the knee, more quads mechanism overload, and short popliteal and hamstring structures.



With common sense, you should be able to make a meal of this.




Ron Bateman
Physiotherapist (Masters) & Podiatrist

 

Thanks Ron.

That's some helpful thinking. I will develop those points along with what I have already. I just want to make sure this young man is adequately provided for in the future. It's a bit like post polio syndrome. All the small extra stresses add up over time.

Could you explain the bell curve with respect to LLD. I understand the concept of the bell curve very well generally.

Bill Bird