lower limb shorter responses
Daniele Franchini
Description
Collection
Title:
lower limb shorter responses
Creator:
Daniele Franchini
Date:
1/22/1999
Text:
Thank you to everyone who responded to my question.
This is my original question:
Dear Sirs,
I have a patient with left lower limb 2 cm shorter. He always use
appropriate shoes (with a rise) on the job, but only slippers (without
rise) at home. Can someone tell me the risks.
Sorry for my English
Daniele Franchini
t. ortopedico - Italy
These are the answers I got.
Sorry for the incomplete mail that was sent earlier. What I was saying
is I believe it depends on the activities of the individual during the
times when the shortage is not corrected. If he is engaged in strenuous
activity or long walks it would stand to reason that a leg length
discrepancy of 2 cm. could cause stress on the hip and spine. Over the
years I have seen several amputees with symptoms of Sciatica and /or
other hip and lower back pain that seemed to
be related to the length of their prosthesis. I have also seen the same
symptoms arise when a new prosthesis that was appropriate in length was
worn following years of walking with a shortage on the amputated side.
Eddie
<Email Address Redacted>
Dear Daniele,
Many studies have concluded that a leg length discrepancy of less than
2.5
cm does not need to be treated. If your patient has a 2 cm LLD and is
using
a lift in his shoe for work and daily activity, then it does not seem
like
he is in any danger of doing damage to his spine of lower extremity when
at
home wearing slippers without a lift. Of course I am assuming the
individual is not experiencing any new pain. You may want to check out
the
literature yourself. There is a good article on the subject of LLD in
the
December issue of Biomechanics Volume V Number 12. There are also good
references listed.
Sincerely,
john burger
john burger < <Email Address Redacted> >
The primary risk is that over the long term your patient may develop a
scoliosis and or associated back pain.
Ted A. Trower < <Email Address Redacted> >
What I am about to say is not news to you. It probably just confirms
your opinion. With a 2cm discrepancy I would imagine that the patient
had complained of hip or low back pain prior to using the lift. Pain
that was reduced or eliminated using the lift would probably return
without the lift. That is the risk of not wearing a lift in the flat
house shoes. Otherwise, if there is no pain, there is no need to treat
for pain. However, why take the risk when the risk management is easy.
I would advise the patient to wear a lifted house shoe so that he evens
out the biomechanics of gait in as many hours of the day as he can.
During normal walking we clear the toe in swing phase by only 2cm. If
he is barefooted for a few minutes each day it should not be a problem.
Joe Harvey < <Email Address Redacted> >
Dear Daniele,
as far as I know, you should recommend that your patient will get a shoe
raise on his slippers and all other shoes he wears in his free time. I
have learnt that a leg length difference of more than 1cm should be
compensated for at all times. Otherwise this will have a bad effect on
the upper body, especially the spinal collumn, which will deviate in the
frontal plane (scoliosis). This is a pre-arthrotic factor, which might
result in low back pain and other problems in later life.
In Germany, where I am working at the moment, the health insurances pay
for up to 4 pairs of shoes to be adjusted for leg length differences at
one time (e.g. after a total hip replacement which resulted in a leg
length descrepancy). Should the patient get new shoes after a while, the
insurances pay for another (up to) three pairs every few years. This
should illustrate the need for ALL shoes to be adjusted. Two cm is just
bejond the borderline. Experience tells that below one cm, it is not
absolutely necessary to wear a shoe raise at all times (natural leg
length differences are in that scope). However, two cm should be enough
to justify a consequent orthotic management, including paste time
footwear.
Hope this will help you!
Regards,
Christoph
Christoph Lappe < <Email Address Redacted> >
Risks are possible back pain long leg foot problems/knee/hip but all of
this is not certain Pt should know how it feels without lift--- treat
with common sence Some pt. function fine without any lift ever but...
in theory always better to be level
T.J. Emiley DPM
<Email Address Redacted>
Some of our orthopedists in Arkansas actually don't believe in
correcting leg length differences, even fairly good sized ones, like
your patient's. I do, just to improve efficiency and cosmesis of gait.
A neurologically intact person will usually compensate a leg length
difference by excess
knee flexion on the long side and will have excess up and down excursion
of the center of gravity, so there is some loss of efficiency and
probably primarily a bit more stress on the knee. One school of thought
is also that at least some people with minor leg length differences have
some back pain and sacro-iliac pain due to uneven stance, and I think
this may be true from clinical experience. Some of my kids with
CNS/upper motor neuron problems will have equinus on the short side
noticeably aggravated when the leg length difference is not
compensated, and may have other really undesirable proximal deviations.
Of course some will hold the short side of the pelvis higher due to
increased tone in the low back muscles, and I don't often compensate
those. Pain does not seem to a predominant problem for these children.
I would tend to think that short distance indoor ambulation without the
lift is not terribly likely to cause this fellow any real problems- he
will probably let you know if he is tired or hurting, and ask you for a
lift on the slipper! If he does, good luck.
Vikki Stefans, pediatric physiatrist
Vikki A. Stefans < <Email Address Redacted> >
Dear Mrs.Franchini,
it will always depend on the amount of time he spends with slippers.A
two cms shortness is really significant and depending on the time not
compensated,he probably will develop strong lumbar back pain.I wouldn`t
recomend more than two hours of use of those slippers each day.Even that
amount could be sufficient to promote pain and depending on age and
clinical
conditions,a scoliosis.Try to compensate a slipper or another soft
shoe.It will be better.
Sincerely,
Mario Cesar Carvalho Biomedical engineer
Ortopedia Camponez Ltda < <Email Address Redacted> >
Without any more details from you, Daniele, I would be thinking about
lower back pain being a possible problem, scoliosis to a pathological
degree and a poor gait, which would use more energy, so making your man
fatigued. The development of a lot of the problems would depend on the
relative time that he spends on the shoes with a build-up and on the
un-built-up slippers. Why not built up the slippers?
Richard
ecat < <Email Address Redacted> >
--
This is my original question:
Dear Sirs,
I have a patient with left lower limb 2 cm shorter. He always use
appropriate shoes (with a rise) on the job, but only slippers (without
rise) at home. Can someone tell me the risks.
Sorry for my English
Daniele Franchini
t. ortopedico - Italy
These are the answers I got.
Sorry for the incomplete mail that was sent earlier. What I was saying
is I believe it depends on the activities of the individual during the
times when the shortage is not corrected. If he is engaged in strenuous
activity or long walks it would stand to reason that a leg length
discrepancy of 2 cm. could cause stress on the hip and spine. Over the
years I have seen several amputees with symptoms of Sciatica and /or
other hip and lower back pain that seemed to
be related to the length of their prosthesis. I have also seen the same
symptoms arise when a new prosthesis that was appropriate in length was
worn following years of walking with a shortage on the amputated side.
Eddie
<Email Address Redacted>
Dear Daniele,
Many studies have concluded that a leg length discrepancy of less than
2.5
cm does not need to be treated. If your patient has a 2 cm LLD and is
using
a lift in his shoe for work and daily activity, then it does not seem
like
he is in any danger of doing damage to his spine of lower extremity when
at
home wearing slippers without a lift. Of course I am assuming the
individual is not experiencing any new pain. You may want to check out
the
literature yourself. There is a good article on the subject of LLD in
the
December issue of Biomechanics Volume V Number 12. There are also good
references listed.
Sincerely,
john burger
john burger < <Email Address Redacted> >
The primary risk is that over the long term your patient may develop a
scoliosis and or associated back pain.
Ted A. Trower < <Email Address Redacted> >
What I am about to say is not news to you. It probably just confirms
your opinion. With a 2cm discrepancy I would imagine that the patient
had complained of hip or low back pain prior to using the lift. Pain
that was reduced or eliminated using the lift would probably return
without the lift. That is the risk of not wearing a lift in the flat
house shoes. Otherwise, if there is no pain, there is no need to treat
for pain. However, why take the risk when the risk management is easy.
I would advise the patient to wear a lifted house shoe so that he evens
out the biomechanics of gait in as many hours of the day as he can.
During normal walking we clear the toe in swing phase by only 2cm. If
he is barefooted for a few minutes each day it should not be a problem.
Joe Harvey < <Email Address Redacted> >
Dear Daniele,
as far as I know, you should recommend that your patient will get a shoe
raise on his slippers and all other shoes he wears in his free time. I
have learnt that a leg length difference of more than 1cm should be
compensated for at all times. Otherwise this will have a bad effect on
the upper body, especially the spinal collumn, which will deviate in the
frontal plane (scoliosis). This is a pre-arthrotic factor, which might
result in low back pain and other problems in later life.
In Germany, where I am working at the moment, the health insurances pay
for up to 4 pairs of shoes to be adjusted for leg length differences at
one time (e.g. after a total hip replacement which resulted in a leg
length descrepancy). Should the patient get new shoes after a while, the
insurances pay for another (up to) three pairs every few years. This
should illustrate the need for ALL shoes to be adjusted. Two cm is just
bejond the borderline. Experience tells that below one cm, it is not
absolutely necessary to wear a shoe raise at all times (natural leg
length differences are in that scope). However, two cm should be enough
to justify a consequent orthotic management, including paste time
footwear.
Hope this will help you!
Regards,
Christoph
Christoph Lappe < <Email Address Redacted> >
Risks are possible back pain long leg foot problems/knee/hip but all of
this is not certain Pt should know how it feels without lift--- treat
with common sence Some pt. function fine without any lift ever but...
in theory always better to be level
T.J. Emiley DPM
<Email Address Redacted>
Some of our orthopedists in Arkansas actually don't believe in
correcting leg length differences, even fairly good sized ones, like
your patient's. I do, just to improve efficiency and cosmesis of gait.
A neurologically intact person will usually compensate a leg length
difference by excess
knee flexion on the long side and will have excess up and down excursion
of the center of gravity, so there is some loss of efficiency and
probably primarily a bit more stress on the knee. One school of thought
is also that at least some people with minor leg length differences have
some back pain and sacro-iliac pain due to uneven stance, and I think
this may be true from clinical experience. Some of my kids with
CNS/upper motor neuron problems will have equinus on the short side
noticeably aggravated when the leg length difference is not
compensated, and may have other really undesirable proximal deviations.
Of course some will hold the short side of the pelvis higher due to
increased tone in the low back muscles, and I don't often compensate
those. Pain does not seem to a predominant problem for these children.
I would tend to think that short distance indoor ambulation without the
lift is not terribly likely to cause this fellow any real problems- he
will probably let you know if he is tired or hurting, and ask you for a
lift on the slipper! If he does, good luck.
Vikki Stefans, pediatric physiatrist
Vikki A. Stefans < <Email Address Redacted> >
Dear Mrs.Franchini,
it will always depend on the amount of time he spends with slippers.A
two cms shortness is really significant and depending on the time not
compensated,he probably will develop strong lumbar back pain.I wouldn`t
recomend more than two hours of use of those slippers each day.Even that
amount could be sufficient to promote pain and depending on age and
clinical
conditions,a scoliosis.Try to compensate a slipper or another soft
shoe.It will be better.
Sincerely,
Mario Cesar Carvalho Biomedical engineer
Ortopedia Camponez Ltda < <Email Address Redacted> >
Without any more details from you, Daniele, I would be thinking about
lower back pain being a possible problem, scoliosis to a pathological
degree and a poor gait, which would use more energy, so making your man
fatigued. The development of a lot of the problems would depend on the
relative time that he spends on the shoes with a build-up and on the
un-built-up slippers. Why not built up the slippers?
Richard
ecat < <Email Address Redacted> >
--
Citation
Daniele Franchini, “lower limb shorter responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/211145.
