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Sunday, January 15, 2012

Hip Function with Lifts for Short Leg Syndrome

Dr. Blake, 

When one has a lower leg length inequality, have you measured the effects it has on the hips when one goes into 


a heal lift verses a whole foot lift? I am curious to see what you observation is. 

Tim

Hey Tim, Thanks so very much for leaving a comment on the blog post entitled "Heel Lifts vs Full Length Lifts for Short Leg Syndrome". The schematic below is normal hip function in green and various motions or positions considered abnormal in purple. I see that there is a misprint which should read Hip Motion Asymmetry indicating different motion on the right and left. Over the years I have observed more Hip Hike with heel lifts vs full length lifts and more difficulty in general stablizing the hip height difference originally seen. For athletes who spend a lot or a bunch of time (just to irritate my high school English teacher) on the balls of their feet, the role of a heel lift is lessened in effecting change at the hip level and the base of the spine. 

Normal and Abnormal Motions/Positions of the Hip Area






     All this been said, experimentation with each patient is important. Every doctor/therapist that uses lifts goes off some general rules initially. There has to be a starting place. I like to start with full length lifts (normally stop just before the toes). As I watch a patient walk with lifts, I want to see easy, fluid hip motion, a lessening or elimination of limb dominance (lean of the body to one side), no hip hike (jerk upward), no knee instability which could be a sign of hip instability hiding under the clothes, and for the patient to tell me that they feel more stable and centered. Compromises have to be made when there are toe fit issues, or when stability is not being obtained.

     Another doctor/therapist may want to start with heel lifts. As they treat the patient, they should evaluate in every shoe that the patient uses the lifts whether there is hip stability, hip evenness, elimination of limb dominance and no hip hike at heel contact. There are so many shoe styles, that patients often find that the same lift in one shoe that was working well, has some issues with another shoe. In general, the nuances can be worked out, but most just do not wear the lift in those shoes it does not seem to work with.

    So, to answer your basic question, I normally see smoother, more equal, less jerky motion at the hip and knee with full length lifts than heel lifts. But, if I was starting with heel lifts in a non-athlete that was not on the ball of their foot a lot, I probably could find some shoes out there that worked well for the patient in terms of these issues. I hope I was able to answer your question.

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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.