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Limb-Length Discrepancy as a Cause of Plantar Fasciitis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Griff, Nov 27, 2010.

  1. Griff

    Griff Moderator


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    Article in latest edition of JAPMA:

    Limb-Length Discrepancy as a Cause of Plantar Fasciitis
    Sadia Mahmood, DPM *, Lanie K. Huffman, DPM * and John G. Harris, DPM *
    Journal of the American Podiatric Medical Association, Volume 100 Number 6 452-455 2010

    Am I missing something here with respect to the title? This was a cross sectional study of 26 subjects, yet the title hints at causation?

    Also, absolutely no reliability stats for the measurement methods they used were presented. Given the ongoing debate regarding repeatability of anthropometric measurements how was this allowed?
     
  2. Seems a bit... other doesn't it. I look forward to reading the full text on monday. I wonder what the inclusion criteria were.
     
  3. Griff

    Griff Moderator

    Inclusion criteria:
    1. At least 18 years old
    2. Presented with unilateral heel pain diagnosed as plantar fascitiis... or... bilateral heel pain with one being worse

    Want a copy emailed over now squire?
     
  4. Yes please.
     
  5. Interesting study. A few points to consider

    Don't know what that is. Anyone help with that?

    eh?

    But If I was going to make a criticism of this study (apart from the causation / correlation no brainer) it would be that it was not blinded.

    Manual measurement of LLD is notoriously subjective. The people doing the measuring knew what the study was about and knew which side was painful.

    I Know I would struggle to be entirely objective under those circumstances.

    And the raw data is rather an interesting distribution. There are huge differences between the measured LLDs between the methods. 2.5 cms in several cases and while i'm not geeky enough to work out the average variation it seems to be between 0.5 and 1 cm at a glance.

    And yet only two patients have their LLD "straddle" the midpoint (so that one method measures L longer and the other R longer).

    and 21 (rough count) of the patients "straddle" a point 0.5cm one side or the other of even.

    Is that odd? Or am I doing the gunslinger fallacy.
     
  6. Interesting Data so I thought i'd plot it graphically. I made R longer a + value and L longer a - value.

    [​IMG]

    Interesting patterns. Several things strike me.

    How many data values are at whole number intergers. Out of 78 measurements there are 23 which measure 0. there are NONE which measure -0.3, -0.2 -0.1, 0.1, 0.2 or 0.3.

    There are 13 patients whose range measures between 0 and <+/- 0.4

    This may, as I say, be me falling victim to the gunslinger fallacy. But it is very NEAT data. I'd be less worried about that if it was blinded.
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Theoretically the longer leg will have a longer stance phase than the shorter leg??? --> greater risk for plantar fasiciitis????
     
  8. musmed

    musmed Active Member

    But
    there is enough data out there to say you cannot measure leg length difference without using a CT leg length.
    Thus they can procrastinate till the cows come home. It is a false data set and thus useless.
    Even if blinded the interobserver reliability data is hopeless
    bit like looking for comets ona couldy night
    Musmed
     
  9. Alex Adam

    Alex Adam Active Member

    I love this, yep if you are looking for something and disregard all that does not contribute to your hypothesis!! Sounds familiar, been going on since the dark ages, C. Oxnard discusses this at length in his papers.
    Could it be that the proprioceptors produce a force that causes the calcaneous to evert on the long leg to reduce the hip height while inverting the short leg. This allows the leveling of the pelvis thus reducing the stresses on the spinal cord, Just a thought.
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Nope. Three studies gave looked at that and none of them found more calc eversion in the long leg.
     
  11. I'm inclined to agree.
     
  12. Robyn Elwell-Sutton

    Robyn Elwell-Sutton Active Member

    My 25 years of pondering this has lead me to measure the heel height i. e plantsar surface to inferior tip of medial malleolus. Many legs are equal to the posterior tip, but the overall heel (and usually) foot is bigger , longer higher. The shorter heel/side usually has a more mobile first ray which plantar flexes to gain fore foot contact then at mid stance, the medial column collapses, the first ray elevates and the foot pronates at mid and r then rear foot. Result: long side >> plantar fasciitis, short side Tib post tendon inflammation.
    Question - this assymmterty is very common but it is not a foregone conclusion that these people will develop pathology. There are other triggers - often 5 kg weight gain, life style, work environment, foot wear etc.

    Robyn Hood:pigs:
     
  13. RobinP

    RobinP Well-Known Member

    If this wasn't printed in JAPMA, would we be giving it such a fair trial?

    Haven't read anything but the abstract but it would appear to have more holes than Rab C Nesbitt's string vest.
     
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