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The In-shoe Matterhorn

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Wedemeyer, Sep 17, 2009.

  1. David Wedemeyer

    David Wedemeyer Well-Known Member


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    A gentleman walked into my office today complaining of foot and leg pain with a script in hand for an orthotic evluation. Diagnosis is Right Leg Limb Inequality. On exam he had an obvious LLD on the Right. I measured an approximate 2" LLD of the right limb and referred him out for imaging to get a more exact measurement. He was told he had a 3" LLD.

    What surprised me was what was in his shoe I wrestled out with some effort. It measures 1 3/4" high and is expertly glued atop an inexpensive pair of orthoses made at a very well known California lab that to my knowledge only manufactures prefab devices. Total cost of this delightful shoe Matterhorn: $500.00 USD!

    [​IMG]

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    Last edited: Sep 17, 2009
  2. phil

    phil Active Member

    what's the point of putting all that eva ON TOP of a prefab shell? why isn't it just flat on the foot bed of the shoe?

    what kind of shoe was it in? a big deep boot? i've never seen that much IN a shoe before. much better to raise the heel height of the shoe.
     
  3. brevis

    brevis Active Member

    Do many Pod's in Oz utilise radiology to assess LLD's?
     
  4. I would say that It probably even better to get the whole sole of the shoe increased so your not creating a plantarflexed position of the forefoot on the rearfoot and changing the position of COP and COM of the body
     
  5. Perthpod

    Perthpod Active Member

    I agree m weber. That's unbelievable! I hope that wasnt just placed there on one visit, or even within a month! I dont think I need to tell anyone why
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    Phil one picture is the insert upside down ;). The EVA is underneath the shell as in a heel lift (only much more extraordinary). He is a gardener and wears high top work boots.

    Not surprisingly one of his complaints is that his shin on the unaffected side hurts badly in new boots (duh). His main complaint though was left metatarsal pain and numbness. His COM is so pitched forward it seemed logical to me that this was the etiology of his complaint. He basically walks on the balls of his feet regardless of what side we are discussing = pain.

    The films came back as a 7cm LLD due to surgical intervention for a fracture 30 years prior in another country. I had a cobbler add 3.5cm of sole to the right shoe and removed the lift from his insoles, which he wears. So far so good, he reports that he is doing much better. His pelvis appeared much more level and much less nutated on the left. This had to hurt, what an aggressive lift the size of which has zero logic to it.

    I just thought I would share because every once in a while you run into something in the wild so obtuse, you have to share :bang:.

    regards,
     
  7. Perthpod

    Perthpod Active Member

    Thanks David, that's a great case study. Nice to see the theory in practice.
     
  8. David Wedemeyer

    David Wedemeyer Well-Known Member

    Michael hit the proverbial nail on the head, this is way too much correction in-shoe and it did shift his COM/COP to the rays of the left (unaffected ) foot. His pelvis was a mess as well although he wasn't complaining of lumbosacral pain. I think this is a man who had to be in a great deal of pain to complain in the first place and was focused on his foot complaint.

    Perthpod it was dispensed in one visit. 1 3/4" correction for a 2.8" LLD. He eyeballed it according to the patient and informed him it was a 3" difference. Glad you enjoyed it. :D

    Regards,
     
  9. Perthpod

    Perthpod Active Member

    You need to find out who issued it. God knows what their ideas are in other areas, ie people walking around with bread poultices LOL!
     
  10. Ian Linane

    Ian Linane Well-Known Member

    Hi David

    I once had a chap come to me, who in a phone conversation, said he had a 1.5 inch leg length difference. I asked him if anything had been done to address this to which he said yes and would show me when he came. He did. On removing his shoe there in the heel was a just over 1.5 inch block of wood with a small area slightly ground down to accommodate his heel shape! He'd walked in this for years and made it himself.

    Ian
     
  11. David Wedemeyer

    David Wedemeyer Well-Known Member

    Actually bread poultice is quite good with raisins and milk ;).

    I know who prescribed the lift, it was printed on a tag on the device and the DPM is local to me.

    Ian that's classic. I really enjoy some of the homemade devices that make their way into my office. Some are quite creative, duct tape seems to be a favorite adhesive/bonding/layering material!
     
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