Psoas syndrome

NewsBot · Nov 18, 2008

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There is no abstract for this, but the title says it all:

Chronic psoas syndrome caused by the inappropriate use of a heel lift.
J Am Osteopath Assoc. 2008 Nov;108(11):629-30.
Magoun HI Jr.

David Smith · Nov 19, 2008

Re posted with paper attached

Chronic Psoas Syndrome Caused by the Inappropriate Use of a Heel Lift

JAOA • Vol 107 • No 9 • September 2007 • 415-418

CASE REPORT

Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies. However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty. Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome. Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain.

Christopher M. Rancont, DO
Address correspondence to Christopher M. Rancont, DO, Pontiac Osteopathic Hospital, 50 N Perry St, Pontiac, MI 48342-2217. E-mail: crancont@yahoo.com

Dave

NewsBot · May 21, 2009

Here is a follow-up letter to the editor on this.

....I am in agreement with Dr Magoun1 that it is important, to correct pelvic dysfunctions before obtaining standing postural radiographs. This correction is, indeed, a necessary first step for postural radiographs to translate accurately a patient's leg length discrepancy into the sacral base unleveling that is measured using this technique. It is for this reason that—as I described in the three paragraphs before "Radiographic Findings" in my case report4—I note that the patient's pelvic dysfunction was corrected with restoration of pelvic symmetry before the postural radiographs were obtained.

I am fascinated by Dr Magoun's disregard for standard postural radiographs, which he refers to as "an unnecessary technicality" after pointing out the importance of administering osteopathic manipulative treatment before obtaining them.1 Although I congratulate Dr Magoun on his ability to prescribe heel lifts based solely on clinical evaluation, I will continue to use the quantitative measurement of sacral base unleveling to prescribe heel lifts, as described by Willman,5 Kuchera and Kuchera,6 and others.

Dr Alsager2,3 noted in his letters that, for postural radiographs to be valid, sacral base unleveling must be measured in reference to a vertical plumb line. The use of such a plumb line is an extremely important part of this technique. In my clinical practice, I use lead wire (like that used for tying flies for fishing), with a lead weight at the end, suspended from the ceiling, allowing gravity to provide a true vertical reference. Dr Alsager3 also expressed concern about the lack of a plumb line in the radiographic images shown in my case report.4 I would like to note that these radiographs were taken using a leveled bucky, and the markings and measurements in the radiographic images are merely representations of the actual markings and measurements used during evaluation of the patient.

Another concern expressed by Dr Alsager3 is important to discuss: where does the clinician draw the horizontal reference lines for femoral head height on a radiographic image when there is an artificial hip? And perhaps a more important, related question might also be asked: where does the clinician draw the vertical reference lines off the femoral heads when there is an artificial hip in the radiographic image? These are two conundrums to which I believe my case report4 provides ready solutions. ...
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Psoas syndrome

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David Smith Well-Known Member

Attached Files:

Chronic Psoas symptom caused by heel lift.pdf

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Attached Files:

256[1].pdf

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Psoas syndrome

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David Smith Well-Known Member

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