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Scoliosis discussion

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Jess Tennant, Oct 4, 2011.

  1. Jess Tennant

    Jess Tennant Member


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    Hi guys, our clinic has a patient that we can't seem to agree on what to do.

    Pt is 20 year old female with 15 degree scoliosis that was 17 degrees but with physical therapy improved in first 6 months of treatment, but for 2.5 years of subsequent therapy no improvement. Pt refuses to have surgical intervention for scoliosis. Her scoliosis is very rigid and will most likely not improve any further with conservative treatment.
    The patient has a subsequent 2cm LLD which causes her to walk with very obvious limp which is causing some pain in the upper back. There is only a structural LLD of 2mm from X-Ray examination.
    What we all can't seem to agree on is the treatment from podiatry perspective.
    Should we add a heel raise on the lower hip side to try to push the hip straight
    OR
    Should we add a small heel raise on the side where the hip is higher, to reduce the limping that is present during walking and to reduce pain in the upper back
    OR
    Just provide insoles which control her excessive pronation?

    Currently she has an insole which reduces her limp by adding a 5mm heel raise on the side where the hip is higher (due to scoliosis), and she now has no more pain in her upper back, however we raised the issue of is this making her scoliosis worse?
    What do you think our clinic should do for her?
     
  2. Hi Jess what does her back specialist say ?

    ie will the heel lift make the scoliosis worse - if it is rigid ( there can not be degrees of rigid ) then dealing with the pain by adding to the hip higher side might be the way to go, but if the scoliosis is not rigid and may get worse then I guess you need to know what the future will be before starting anything - I really not sure you can look at this from a Podiatry perspective only.

    I would be consulting her back specialist and discussing your 3 different treatment option with them before I started here.

    Hopefully David Wedemeyer will see this and help out - his is a chiro.
     
  3. David Wedemeyer

    David Wedemeyer Well-Known Member

    If this is a confirmed, structural scoliosis that is rigid a lift will be hit and miss; it may make her symptoms worse keep in mind.

    The most important factor to remember is not to place a lift on the side of the concavity. Example; in a dextrorotary (right) lumbar scoliotic curvature (when viewing the patient from behind), the lumbar curve will be prominent to the right. Placing a lift on the left side will aggravate her condition.

    Which ilia is higher and on which side is the curvature?
     
  4. efuller

    efuller MVP

    ?????

    How does a scoliosis change the length of the leg? It obviously didn't change the length of the leg.

    What are you measuring to get a 2cm difference when the x-ray says you are wrong? Why should you be treating that measurement?

    Eric
     
  5. grahammoore26

    grahammoore26 Member

    Hi Jess,

    There are a few issues you need to note, I’m assuming that she presented initially as an idiopathic scoliosis and not postural and is now a risser 4, and so conservative intervention will make no real difference. In reality 15 degrees is generally below the level for surgical intervention, assuming there are no other effects.

    Assuming that it is a simple c curve and not an s curve and that there is no rotational element involved, I would still be very wary about adding a raise, especially if you are putting it on the concave side; you may find it makes no difference as the pelvis will tilt to the curve.

    I’m not sure how you’ve graded the rigidity of the spine, but rigid curves are very rare and I think you will find that forward flexion may not resolve the curve giving the impression of rigidity, but if you add a raise the curve angle and rotation will increase.
    Your trying to treat the pelvic alignment caused by the spinal alignment, if you compensate for this you are maintaining this position

    I’m unsure how you worked out the leg length, but you need to ensure that the asymmetry is not giving an apparent difference and that you don’t treat this.

    Graham
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    It doesn't, Kevin and I went over this in another thread. Scoliosis does cause an apparent Leg Length Inequality just as a functionally short leg can cause spinal compensation to occur. It is only a true Leg Length Difference if determined by scanogram via measurement of the femur and tibia

    Idiopathic Scoliosis is a 3-Dimensional entity and not merely a coronal plane deformity, hence there is almost universally vertebral body rotation in the lumbar spine. A simple C curve often exhibits this finding as well. Structural scoliosis is considered pathologic if greater than 10 degrees by Cobb.

    You make a good point here Graham. I think we should begin over and define if this is a structural vs. a functional scoliosis and not a Leg Length Inequality that has caused pelvic/spinal compensation. What method was used to determine the leg lengths and is this a documented Idiopathic Juvenile Scoliosis or spinal compensation that developed as a result of a structurally or functionally short leg?

    Either way as Graham and I have both stated think twice about putting a lift on the side of the convexity.
     
  7. Admin2

    Admin2 Administrator Staff Member

    Scoliosis

    Scoliosis is a medical condition in which a person's spine has a sideways curve.[2] The curve is usually "S"- or "C"-shaped.[2] In some, the degree of curve is stable, while in others, it increases over time.[3] Mild scoliosis does not typically cause problems, while severe cases can interfere with breathing.[3][5] Typically, no pain is present.[6]

    The cause of most cases is unknown, but is believed to involve a combination of genetic and environmental factors.[3] Risk factors include other affected family members.[2] It can also occur due to another condition such as muscles spasms, cerebral palsy, Marfan syndrome, and tumors such as neurofibromatosis.[2] Diagnosis is confirmed with X-rays.[2] Scoliosis is typically classified as either structural in which the curve is fixed, or functional in which the underlying spine is normal.[2]

    Treatment depends on the degree of curve, location, and cause.[2] Minor curves may simply be watched periodically.[2] Treatments may include bracing or surgery.[2] The brace must be fitted to the person and used daily until growing stops.[2] Evidence that chiropractic manipulation, dietary supplements, or exercises can prevent the condition from worsening is lacking.[2] However, exercise is still recommended due to its other health benefits.[2]

    Scoliosis occurs in about 3% of people.[4] It most commonly occurs between the ages of 10 and 20.[2] Girls typically are more severely affected than boys.[2][3] The term is from Ancient Greek: σκολίωσις, translit. skoliosis which means "a bending".[7]

    1. ^ "scoliosis". Merriam Webster. Archived from the original on 11 August 2016. Retrieved 12 August 2016. 
    2. ^ a b c d e f g h i j k l m n o p q r s "Questions and Answers about Scoliosis in Children and Adolescents". NIAMS. December 2015. Archived from the original on 25 August 2016. Retrieved 12 August 2016. 
    3. ^ a b c d e "adolescent idiopathic scoliosis". Genetics Home Reference. September 2013. Archived from the original on 16 August 2016. Retrieved 12 August 2016. 
    4. ^ a b Shakil, H; Iqbal, ZA; Al-Ghadir, AH (2014). "Scoliosis: review of types of curves, etiological theories and conservative treatment". Journal of back and musculoskeletal rehabilitation. 27 (2): 111–5. doi:10.3233/bmr-130438. PMID 24284269. 
    5. ^ Yang, S; Andras, LM; Redding, GJ; Skaggs, DL (January 2016). "Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions". Pediatrics. 137 (1): e20150709. doi:10.1542/peds.2015-0709. PMID 26644484. 
    6. ^ Agabegi, SS; Kazemi, N; Sturm, PF; Mehlman, CT (December 2015). "Natural History of Adolescent Idiopathic Scoliosis in Skeletally Mature Patients: A Critical Review". The Journal of the American Academy of Orthopaedic Surgeons. 23 (12): 714–23. doi:10.5435/jaaos-d-14-00037. PMID 26510624. 
    7. ^ "scoliosis". Dictionary.com. Archived from the original on 16 August 2016. Retrieved 12 August 2016. 
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Influence of the structural deformity of the spine on the gait pathology in scoliotic patients.
    Syczewska M, Graff K, Kalinowska M, Szczerbik E, Domaniecki J
    Gait Posture. 2011 Oct 4;
     
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