Shoe Lifts for Leg Length Discrepancy

NewsBot · Dec 12, 2017

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Shoe Lifts for Leg Length Discrepancy in Adults with Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature
T Mark Campbell, et al
Archives of Physical Medicine and Rehabilitation

Objective
To determine whether shoe lifts effectively treat leg length discrepancy (LLD)-associated morbidities in adults with common painful musculoskeletal conditions.

Data Sources
TRIP, CENTRAL, PubMed, PEDro and National Guideline Clearinghouse databases. The search was performed in September 2017, limited to English-only, and had no time constraints.

Study Selection
Two reviewers independently determined study eligibility. Inclusion criteria were: (1) participants ≥18 years-old with musculoskeletal-related complaints and LLD, (2) a shoe lift intervention was used, and (3) the study reported on pain, function, range of motion, patient satisfaction, quality of life, or adverse events. Randomized controlled trials (RCTs), controlled intervention, cohort, before-and-after, case-series and case report studies were included. Three-hundred-and-nineteen articles were screened and nine guidelines reviewed.

Data Extraction
We extracted data pertaining to participant demographic characteristics, study setting, recruitment, randomization, method of LLD measurement, shoe lift characteristics, treatment duration, and outcome measures. We included ten studies, including one RCT.

Data Synthesis
LLD was associated with low back pain, scoliosis, and osteoarthritis of the hip and knee. Description of LLD correction strategy was often inadequate. Study quality was very low or poor. In non-RCT studies reporting on the proportion of participants who improved with a shoe lift, 88±3% of 349 participants treated had partial or complete pain relief (effect size range 66.7-100%). All 22 RCT participants receiving treatment experienced pain relief (mean pain reduction 27±9mm on a 150mm visual analogue scale). Two of nine guidelines recommended shoe lift use based on consensus, and were of moderate-to-high quality.

Conclusions
There is low-quality evidence that shoe lifts reduce pain and improve function in patients with LLD and common painful musculoskeletal conditions. High quality research evaluating a threshold LLD to correct and a strategy to do so is necessary. Developing an appropriate comparison group to test clinically-relevant outcome measures would make a valuable contribution in this regard.
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Dr Rich Blake · Nov 18, 2019

NewsBot said: ↑

Shoe Lifts for Leg Length Discrepancy in Adults with Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature
T Mark Campbell, et al
Archives of Physical Medicine and Rehabilitation
Click to expand...

This is a good study documenting the use of lifts for low back and hip issues. It is Podiatry that prescribes the most lifts and we can not forget this important tx.

NewsBot · Mar 18, 2020

Indications of sole lift and foot orthoses
in the management of mild idiopathic scoliosis
—a review
Diego Rothschild et al
J. Phys. Ther. Sci. 32: 251–256, 2020

[Purpose] Leg length discrepancy is common among patients with scoliosis. Some studies reported
reduced functional scoliosis curves with correction of leg length discrepancy. Others, however, have shown that
induced leg length discrepancy has little effects on spinal deformities. Also, small number of studies assessed the
use of foot orthoses in patients with faulty foot biomechanics and their impact on idiopathic scoliosis. In this context, a review of the literature is needed to determine the current evidence for the appropriate use of sole lift and
foot orthoses in a context of scoliosis. [Methods] A literature review was performed. [Results] It appeared that sole
lifts are indicated for functional lumbar scoliosis when the level of the sacrum is parallel to that of the hips. Sole
lifts may not be indicated for patients with structural scoliosis, seemingly inducing a compensatory curve. Custom
foot orthoses were found to reduce spinal curves in juvenile patients with mild idiopathic scoliosis and concomitant
abnormal foot biomechanics. [Conclusion] Sole lift appeared to be indicated in the presence of certain types of functional scoliosis. Custom foot orthoses can be considered in the management of mild idiopathic scoliosis in juvenile
patients. Evidence, however, is low and quality studies are needed to validate these findings.
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NewsBot · Apr 9, 2022

Effect of shoe insole on the dynamics of lower extremities in individuals with leg length discrepancy during walking
Fereshteh HabibiTirtashiaMansourEslamiaMohammadTaghipourb
Journal of Bodywork and Movement Therapies 23 March 2022

Introduction
The aim of the present study was to investigate the effect of Internal and External Heel Lift Insoles (IHLI, EHLI) on pelvic kinematics and lower extremity joint moments in subject with mild leg length discrepancy (LLD) during the Stance Phase of walking.

Methods
From twenty-eight men with mild LLD, kinematic and kinetic data were collected while they walked under each of three conditions (IHLI, EHLI and shoe). Data were collected for both limbs using a six-camera system synchronized with a force platform. For comparisons the dependent variables among the conditions, repeated measures ANCOVA and Bonferroni's post hoc test were used (P ≤ 0.05).

Results
For both IHLI and EHLI, there were significant decreases in peak long leg lateral and anterior pelvic tilt, long leg hip and knee abduction moments, and short leg ankle plantar flexor moment (P ≤ 0.001). Furthermore, significant increases in peak lateral and anterior pelvic tilt of the short leg were observed in the IHLI and EHLI conditions as compared to the shoe (SH) condition (p ≤ 0.01). In addition, a significant difference was observed between the IHLI and EHLI conditions in the peak values of anterior pelvic tilt of the long leg (p = 0.043) and ankle plantar flexor moment of the short leg (p = 0.044).

Conclusion
Findings suggest that the use of IHLI and EHLI may be effective in improving pelvic movements (lateral and anterior tilt) and gait dynamics in individuals with LLD. The EHLI could reduce more the peak plantar flexor moment of the short leg and peak anterior pelvic tilt of the long leg than IHLI during stance phase of walking.
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NewsBot · May 17, 2022

Topological Structure and Biomechanics of Three-Dimensional Printed Height Increasing Insoles for Leg Length Discrepancy
Qian DENG; Yuanjing XU; Kang ZHAO; Wenhao WANG; Haoxin WEI; Kun ZHENG; Jinwu WANG; Kerong DAI.
Journal of Medical Biomechanics ; (6): E045-E051, 2022.

Objective To study topological structure of a new type of three-dimensional (3D) printed height increasing insoles for leg length discrepancy (LLD) and its effect on biomechanics of lower limbs. Methods Topological structure for middle and rear part of the insole was optimized by solid isotropic microstructures with penalization (SIMP), the force was loaded and the boundary conditions were set according to force area of the insole, and the height increasing insole with thermoplastic polyurethanes (TPU) materials was printed by selected laser sintering (SLS). The insoles were used in 9 patients with LLD, visual analogue scale (VAS) and Maryland foot function scores were used to compare pain and foot function changes of patients before and after using the insole, and the 3D gait analysis system was used to compare spatiotemporal parameters and vertical ground reaction force (vGRF) of both lower limbs. Result sAfter the patient wore 3D printed insole, VAS scores decreased, Maryland foot function scores increased, vGRF of both lower limbs decreased, and the difference of cadence, stance phase and swing phase in both lower limbs decreased. Conclusions The 3D printed height increasing insole after topology optimization can improve coordination of lower limb movement, reduce ground impact, relieve pain and improve foot function, thus providing an effective personalized orthopedic plan for LLD treatment in clinic.
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NewsBot · May 2, 2023

Impact of Bilateral Motion Control Shoes with Outsole Adjustment on Gait Asymmetry in Individuals with Mild Leg Length Discrepancy
Amornthep Jankaew et al
Gait & Posture; 28 April 2023

Background
Footwear adjustment is recommended in the management plan of leg length discrepancy. However, it is not clear how the outsole of motion control shoe adjustment influences trunk symmetry and walking performance.

Research question
Does bilateral adjustment of the outsole affect trunk and pelvis symmetry and ground reaction force during walking in individuals with leg length discrepancy?

Methods
20 mild leg length discrepancy participants were recruited into a cross-sectional study. All subjects performed a walking trial with their habitual shoes to determine the outsole adjustment. Four trials of walking were carried out in the order of unadjusted and bilateral adjusted motion control air-cushion shoes. Shoulder level differences and trunk and pelvic motion were assessed, while the ground reaction force at the heel strike was reported. A paired t-test was performed to compare the differences between the conditions with a significance level at p < 0.05.

Results
During walking trials, mild leg length discrepancy participants with the adjusted shoe displayed lower variations in the maximum shoulder height differences (p = 0.001) and trunk rotation angle (p = 0.002) than those with the unadjusted shoe. Also, there was a significant reduction in the vertical ground reaction force (p = 0.030), but not in the anteroposterior or mediolateral directions, during walking in the adjusted shoe condition compared to the unadjusted shoe condition.

Significance
The outsole adjustment of the bilateral motion control shoes can improve trunk symmetry while decreasing the ground impact at the heel strike. The study provides additional information to prescribe or recommend footwear adjustment to improve walking symmetry in leg length discrepancy participants.
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Brian A. Rothbart · May 2, 2023

A heel lift for functional leg length discrepancy - another problematic and kinetically illogical approach.

I suggest

(1) A heel lift directs the ipsilateral innominate to rotate forward (easily demonstrated)
(2) An unilateral heel lift destabilizes the stability of the pelvis in all 3 planes
(3) Instability of the pelvis destabilizes the spine
(4) Resulting in postural distortions and ensuing musculoskeletal pain

But if your heart is set on treating symptoms (FLLD is a symptom), and not the cause, use a heel-to-toe platform on the short side. This will bypass the above consequences of using a heel lift

But the earth is flat, right?

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Dr Rich Blake Active Member

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Brian A. Rothbart Well-Known Member

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