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The Outcome Effect of Shoe Lift for Individuals With Low Back Pain and Pronated Foot Due to Anatomic

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Aug 24, 2010.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    This clinical trial has just been registered:
    The Outcome Effect of Shoe Lift for Individuals With Low Back Pain and Pronated Foot Due to Anatomical Leg Length Discrepancy
    Link to study
  2. Admin2

    Admin2 Administrator Staff Member

  3. Craig Payne

    Craig Payne Moderator

    I guess I will weigh in first ...... this is NOT the case.

    here is what I blogged on this a year ago:
  4. Boots n all

    Boots n all Well-Known Member

    l have seen a few with the opposite, with the shorter limb in supination, l raise this one as l have a good picture of it, 1 cm LLD, the left leg the shorter, you can see the wear on the sole.

    l have also seen the longer limb pronated, no picture but l will see what l can sort out over the next month or so for you if you like.

    l guess the really BIG question, is the reason of the pronated/supernated foot that we often see in young clients with LLD, is this a result of the clients attempt at correction of LLD or a result of the under laying condition that has caused the LLD in the first place ?

    Attached Files:

  5. PodAus

    PodAus Active Member

    This is an exam question from National Board of Podiatric Medical Examiners 2005.

    "A runner presents with Hx of posteromedial shin splints due to overuse of the deep posterior muscles of the leg as a compensation for a structurally long limb on the involved side. Evaluation of the patient's shoe wear pattern on the involved side would reveal:

    A) excessive lateral forefoot outsole wear
    B) heel counter tipping medially in a valgus position
    C) compression of the lateral rearfoot midsole
    D) abnormal wear of the uppers in region of the fifth digit due to lateral crowding"

    What do you think is recorded as the 'correct' answer, with reasoning?
    Last edited: Aug 26, 2010
  6. Craig Payne

    Craig Payne Moderator

    Thats the point, you see just as many supinated feet as you do pronated feet on the long limb side. If the long limb actually caused a pronatory compensation then you wpuld expect to see more pronated feet on the long limb side, which is not the case.
    Scary isn't it as to how the myth only gets perpetuated in the podiatric literatures ...
  7. Welcome to my world!:craig:

    Since when has the term "posteromedial shin splints" been used? 20 years ago?!
  8. PodAus

    PodAus Active Member

    I had to do a double take when I was typing out the question. 1956 written on front of the paper was the year the examination board was established - not the year of the exam!

    The 'correct' answer was given as:
    B) compensation for a structurally long limb produces excessive pronation of the foot of the involved side. The wear pattern of the shoe on the involved foot would, therefore, be greatest on the medial side.

    Thank goodness for pod arena...
  9. drsha

    drsha Banned

    Although I agree with you that the long sided subtalar joint is more often inverted to vertical (not pronated) than everted (pronated) I maintain that there is a way to utilize subtalar joint compensation of long/short to decide on the need for care clinically.

    With 85% accuracy for me and others using The FEJA Test described on The TIP Thread of The Arena:

    There is a relative subtalar joint varus on the short side when compared to the long side although both sides are often inverted to vertical (not pronated).
    Jeff Root's Rules #22

    That's what I explain to my students for many years when asked the question that you raised as to the lack of the long side being pronated. That seems to calm the waters.

    Dr Sha
  10. Sally Smillie

    Sally Smillie Active Member

    Craig is absolutely right. I had always believed it to be true (that unilateral pronation is a form of compensation for LLD), because that it what we've all been taught, but I since I first heard Craig mention it, but I went back to clinic and evlauated it all and he is so right.

    I see gazillions of LLD's. I work full-time in paeds in a MD team and see loads of kids with LLD's for one reason or another, as everyone refers them to me. JIA, hemiplegia, post CTEV, post Perthes, knee pain, back pain etc.

    After measuring multiple times, multiple ways non-weightbearing, I then check it functionally in weightebearing, assessing the effect on knee flexion, ASIS and PSIS leves and spinal alignment (latter jointly with physio) on various height full length blocks. You get an immediate effect on knee posture, ASIS and PSIS, on each block but NEVER have I seen pronation, of any sort change in any way in response to altering the effective leg length.

    Let's just bury the myth once and for all. Why is it perpetuated so with no evidence at all?

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