Shoes raises for leg length differences following hip replacement

NewsBot · May 10, 2014

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Shoe Raises for Symptomatic Leg Length Discrepancy after Total Hip Replacement: Do Patients Find Them Useful?
B Akinola, H W Jones, T Harrison, K Tucker
The Internet Journal of Orthopedic Surgery; Volume 22; Number 1

Purpose:
The aim of our study was to assess the effectiveness of shoe raises for managing symptomatic leg length discrepancy (LLD) after total hip replacement (THR).

Method:
We searched our hospital theatre and orthotics databases to identify patients that had undergone a THR and subsequently required an appliance for a LLD. 4270 patients were identified of which 75 (1.8%) required an orthotic appliance for a LLD. 72 patients were alive and were sent a postal questionnaire.

Results
61 (84%) questionnaires were returned. 65% of patients found the appliances to be effective in managing their symptoms of a LLD. 31% of patients no longer wore a raise. The overall satisfaction following THR was lower in patients with persistent symptoms despite the use of a shoe raise.

Conclusion
Shoe raises are effective in managing symptomatic LLD in two thirds of patients. Patient satisfaction with THR is lower when the shoe raise proved ineffective.
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David Smith · May 12, 2014

"Patient satisfaction with THR is lower when the shoe raise proved ineffective" Duuuh!

People with a problem that's not resolved are less satisfied than people who's problem is resoved - wow that really needed some research to establish

David Smith · May 12, 2014

Purpose:
The aim of our study was to assess the effectiveness of shoe raises for managing symptomatic leg length discrepancy (LLD) after total hip replacement (THR).

Method:
We searched our hospital theatre and orthotics databases to identify patients that had undergone a THR and subsequently required an appliance for a LLD. 4270 patients were identified of which 75 (1.8%) required an orthotic appliance for a LLD. 72 patients were alive and were sent a postal questionnaire.

Results
61 (84%) questionnaires were returned. 65% of patients found the appliances to be effective in managing their symptoms of a LLD. 31% of patients no longer wore a raise. The overall satisfaction following THR was lower in patients with persistent symptoms despite the use of a shoe raise.

Conclusion
Shoe raises are effective in managing symptomatic LLD in two thirds of patients. Patient satisfaction with THR is lower when the shoe raise proved ineffective.
Click to expand...

Really what was the point of this research?

Leaving aside the fact that it sems unlikely that there were only 75 peopleout of4270 that had an LLD after hip replacement but rather there were only 75 identified. And that the protocol for defining LLD is not shown or probably even known e.g. was it actual, functional, wa sit correctly identified or were some incorrectly identified or if some might have been given heel lifts for the right when the short leg was the left. Leaving aside all that:

If one has a patient who after hip replacement has been identified as having an LLD then if you fit a heel lift and it works then good and if it doesnt then take it out, simple. Even if this research showed that no patient reported any benifit in having a heel lift to address LLD then it does not follow that no patient ever will or that the patient that is presented to the clinician at the time of intererst will not respond well. Its a clinical decision not a statistical one.

Dave

Dennis Kiper · May 14, 2014

If one has a patient who after hip replacement has been identified as having an LLD then if you fit a heel lift and it works then good and if it doesnt then take it out, simple. Even if this research showed that no patient reported any benifit in having a heel lift to address LLD then it does not follow that no patient ever will or that the patient that is presented to the clinician at the time of intererst will not respond well. Its a clinical decision not a statistical one.

Finally, a correct biomechanical answer, without peer reviewed study.

Dennis Kiper · May 14, 2014

David,

Good thinking out of the box, don't get lost now.

musmed · May 17, 2014

Dear team

I will offer a reason why some do not do well by altering a shoe.

The late great Vladamir Janda told the workshop that thos who cannot be helped are those with the assymetrical face, bigger boob, hand and foot.

The way to see assymetry of the face is to:
1. place a dot between their eyes
2. frenulum of the lip
3. middle of the chin.
They should be in a straight line
if not they the assymetrical is present.

Still great weather autumn weather= hard to take
regards
Paul Conneely
www.musmed.com.au

NewsBot · Sep 8, 2021

Changes in plantar pressure, contact area and contact time symmetry during the gait 4 weeks before and 12 and 24 weeks after unilateral total hip arthroplasty
Marta Gimunová et al
Clin Biomech (Bristol, Avon). 2021 Aug 30

Background: Foot to ground pressure changes in total hip arthroplasty patients' gait are not widely described, although they are sensitive to gait abnormalities and the distribution of plantar pressures may differ before and after the surgery. This study aimed to analyse longitudinally differences in plantar pressure during gait in total hip arthroplasty patients compared to healthy controls.

Methods: Eighteen males participated in this study. Eight males, who underwent unilateral total hip arthroplasty, participated at the data collection three times: 4 weeks before the surgery, 12 and 24 weeks after, and ten healthy controls. All participants were asked to walk over Emed platform. To compare differences between the affected and unaffected limbs, Kolmogorov-Smirnov test was used. Kruskal-Wallis test was used to compare the difference between total hip arthroplasty patients and healthy controls.

Findings: Statistically significant differences between the affected and unaffected limb were observed only during the preoperative measurement in peak pressure at MH4 area and in the contact area at MH4 and big toe. When comparing total hip arthroplasty patients and controls, a difference in the contact time at MH2, MH3 and MH4 areas 12 weeks after surgery and at MH2 and MH4 24 weeks after the surgery were observed.

Interpretation: The shorter contact time at forefoot areas may indicate an alteration in the propulsive phase of the gait of both the affected limb and unaffected limb in total hip arthroplasty patients as a result of decreased terminal hip extension during the stance phase described in previous studies.
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NewsBot · Feb 21, 2024

Effect of heel lift insertion on gait function in a patient with total hip arthroplasty with patient-perceived leg length difference: a case report
Toru Shiwa et al
J Phys Ther Sci. 2024 Feb;36(2):81-86

[Purpose] The effect of heel lift insertion on gait in patients who have undergone total hip arthroplasty (THA) with patient-perceived leg length difference is seldom referenced in the literature. We used an AB design to investigate the alterations of gait function before and after inserting a heel lift on the non-operative side. [Participant and Methods] The participant had a patient-perceived leg length difference after THA and presented with gait disturbance. The survey phase was 10 days (phase A: normal physiotherapy for five days, and phase B: normal physiotherapy and heel lift insertion for another five days) from the 17th day following THA. The ambulatory task was conducted at a self-determined, comfortable pace and objectively assessed using an inertial sensor. [Results] The insertion of a heel lift partially improved the gait symmetry and the ratio of lumbar acceleration in three directions; it also corrected the patient-perceived leg length difference. [Conclusion] An investigation was carried out to examine the impact of a heel lift on gait in a single case of THA with patient-reported leg length difference. The application of a heel lift may enhance the relationship between the patient-perceived leg length difference, gait symmetry, and the ratio of lumbar acceleration in three dimensions.
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David Smith Well-Known Member

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