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Heel raise vs whole foot raise.

Discussion in 'Biomechanics, Sports and Foot orthoses' started by lucycool, Nov 24, 2011.

  1. lucycool

    lucycool Active Member


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    Hi Guys,

    I have a pt who has a LLD of 1.5 cm and has had back pain on and off for years . I corrected it with a 6mm heel raise on a basic insole as he has no hyper pronation and he has been less symptomatic since.. (yay I thought!)

    but now he's been to the physio and the physio has advised him that the heel raise isn't enough, it needs to be full foot raise, all the way along.

    This wasnt what I was taught at uni, so wanted your opinion. My pt is now pretty convinced thats what he needs!!

    thanks in advance!

    Lucy
     
  2. Peter

    Peter Well-Known Member

    I would balance the lot with a full through raise. I have seen many pts use a heel-raise from other practitioners, and when you review them, the heel-lift adds no correction whatsoever. I have no hesitation balancing this amount, but they need careful wearing in!
     
  3. Lorcan

    Lorcan Active Member

    I would tend to only add 50% of the difference and this seems to work although I modify this depending on feedback. I never add full length raise as this blocks sagittal plane motion at MTPJs.
     
  4. Peter

    Peter Well-Known Member

    in our phraseology with our orthotists Lorcan, full length refers to tapering to behind the met heads, so i would agree with you, its the terminology with our orthotists thats the only difference.
     
  5. It does not block it - it increases the dosiflexion stiffness if this has a positive, negative or no effect on the patient will be dependent on many issues and will be patient specific
     
  6. Lorcan

    Lorcan Active Member

    Hi Peter, Mike

    I have seen patients attend with "full length" raises to the very end of the shoe which stopped all met flexion,not usually from Podiatrists though.

    Would you always use a 2/3 length raise? For example I recently had a patient with a 30mm LLD from a car accident. A 15mm 2/3 length raise would not fit in any shoe so I provided normal 3mm orthoses with 15mm heel lift. Resolved his symptoms.

    Lorcan
     
  7. Boots n all

    Boots n all Well-Known Member

    Mostly l do a full length raise, if you want to do a 1.5 heel raise only and you think its not much, put into the calculation the existing heel pitch of the shoe first.

    As for flex at the fore foot, lets say you taper to 6mm at the MPJ, plus the thickness of the existing sole and the changes made by bonding at two surfaces(lamination), lamination creates strength, l doubt it will flex much and no where near the same as the other unaltered shoe.

    So what are you achieving with the tapering ?.

    Ps, the toe needs to be rolled off of course
     
  8. Lawrence Bevan

    Lawrence Bevan Active Member

    I would make it sulcus length, inside the shoe. It's much better than just a heel raise - this can flex the knee and limit the effect.

    At the met head level make some horizontal slashes in the material (not all the way through) to allow it to flex.
     
  9. efuller

    efuller MVP

    Is he paying for the lift? I am not aware of any studies on preference of type of lift versus amount of lift needed. In absence of any studies it gets back to what the patient likes better. This is a great chance to do an N = 1 study. Tell him that there is no evidence that one way is better than the other and you'd love to know which one he likes better. Also ask why he likes one better than the other.

    Eric
     
  10. BEN-HUR

    BEN-HUR Well-Known Member

    Depending on the amount of lift required & the type of condition treated, I tend to use a full length lift, thickness of which is clearly dependant on the depth of the patient's preferred choice of footwear. You can only fit so much is some shoes & if more is required then midsole/sole build up may need to be considered (possibly with rocker bottom sole). However, the full length lifts should be tapered towards the toes (avoid cramping of toes in footwear). My lifts are usually made up of 350 EVA & poron (hence flexible) - thickness of which dependant on the amount of lift needed (which usually is a max of 10mm within a shoe).
     
  11. Peter

    Peter Well-Known Member

    Lorcan

    I find than most mens shoes can accommodate 10-12mm loose raise inside the shoe, if not, we send the shoe to an orthotist company for them to splice the midsole and put it in there.

    Womens shoes are trickier, trainers 6mm loose in shoe, otherwise midsole raise again.
     
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