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Sunday, November 20, 2011

Lifts for Short Leg: Email Advice

This email was received several monthes ago. I apologize for the delay in responding.


Dr Blakes,
I've read through a lot of your information on foot lifts. Having researched this kind of information for a few years, I can tell you have a great knowledge on the subject.

Before I ask my questions I will give you a quick background on my situation.

I'm an avid runner and have been running competitively for 6 years. About 3-4 years ago I've noticed a glitch in my gait. To figure it out I've seen chriopracters, podiatrists and PTs. First it was thought as just a strength imbalance, particular in my G- Medius. Then it was diagnoised as a functional LLD. Next it was determined it was 11-12 mm ALLD by a plevic x-ray femur head height comparison. Lastly, I went on my own to get a full body x-ray. This confirmed that I have ALLD and that it's that my left femur is 11mm longer than my right.
Here a Standing AP Pelvic Xray with Hip Replacement shows short left side at the hip level. This is not the patient who emailed.



I've been using a 12mm clearly adjustable heel lift for about a year. It has helped by I still have too much asymmetry.
http://clearlyadjustable.com/
Dr Blake's comment: For most of my athletes, you have to try and get as much lift full length as possible to hold the lift correct into the push off part of the gait cycle.
I agree with you that a full foot lift should be used. I've made a full foot lift out of a clearly adjustable lift. It is quite heavy and inconvenient to use so I never stuck with it.

I want to try a full foot lift similar to the ones you make.
Dr Blake's comment: You can buy rubber cork at JMS plastics (link below) in 1/8th inch sheets that work just fine.
http://www.jmsplastics.com/posting_cork/rubbercork.php
So finally here are my questions that I would greatly appreciate that you answer.



What material do you make your lifts out of? I saw you referenced spenco. Is it the sepnco flat cushion inserts?
Dr Blake's comment: You can use the flat cushion inserts from Spenco that you see in many retail outlets or go to the rubber cork at JMS Plastics.
http://www.amazon.com/Spenco-Comfort-Insoles-Womens-9-10/dp/B000S6JTMQ/ref=sr_1_2?ie=UTF8&qid=1321838355&sr=8-2

Are you familiar with clearly adjustable lifts? If so, why do you recommend yours over them.
Dr Blake's comments: I just have found them too slippery, and too thin. Most things I do the 3mm cork or spenco works just fine. Clearly adjustable are 1mm or so and seemingly harder to keep in place (but I have only seen 3 patients using them). It is safer to say I am more use to the other material and try to in general avoid heel lifts.



How much thickness is lost due your lifts compressing?
Dr Blake's comment: Probably lose 1mm every 6mm, but my patients love the softness, and both are grindable on a sander to make a smooth transition. The spenco can be ground on the black side.



How much thickness do you recommend for me? I'm thinking 9mm-3/8in since that is about the max for shoes and is close to my discrepancy.
Dr Blake's comment: Yes, but an extra 1/8th in the heel alone may be eventually added based on how you are feeling symptom and stability wise.
Lastly, knowing that it is 100% that my LLD is 11 mm and all in my femur; do you have any other recommendations that would help me out?
Dr Blake's comments: Definitely there are different combinations of muscle tightness and weakness based on the length difference all in the femur, all in the tibia, or combos. And, it is actually rare to have a pure structural leg length difference without a functional component of unequal pronatation, unequal knee rotation, pelvic assymetry, etc. It is in these areas that a good PT can greatly help you. The patterns of weakness and tightness may make sense because of your short leg, or that fact that you are right or left handed, or you had an old hip or shoulder injury years ago with some permanent restrictions at those areas. It is a fun area to help patients with.



Thanks so much,



Jeff 
You are welcome.

1 comment:

  1. I barely have an idea on foot lifts but thanks to your post. I think I'll visit my podiatrist
    to check if I need this.

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.