September 30, 2016

Braces Can Create a Leg Length Discrepancy

I acquired a leg length discrepancy from a brace so I was not surprised that a study found shoe inserts improved stroke survivors' gait.  Here is what Mohapatra and his associates found (1).  Eleven stroke survivors were given two weeks of PT, but people in the experimental group were also given a shoe insert for the sound leg.  The insert added height to the sound leg just as the brace did for the affected leg..  After two weeks the group who had shoe inserts walked significantly faster.  Their weight bearing was also more symmetrical.  

Every PT is taught how to check for leg length discrepancy.         Yet my in-patient PT did not check my leg length after I got my brace.  A simple way to check is to put your thumbs on the         two hip bone that stick out in front (anterior superior iliac spine) and look to see if your two thumbs are level.  If one leg is longer, one thumb will be higher. 

Three years after my stroke I saw a PT who was trained in myofascial release which addresses good body alignment.  Tracy put her thumbs on my hip bones and told me to buy a shoe insert at the store where I buy orthopedic shoes.  I could feel a difference the moment I stood up with shoe insert under my sound foot. Stroke survivors should be evaluated for leg length discrepancy after they get a brace and taught about shoe inserts so we know what to do the next time we buy a new pair of shoes.

Spenco shoe inserts come in four different shoe sizes in full versus 3/4 length and thick versus thin.  A shoe insert can be a low tech, relatively cheap way (e.g. $30) to improve gait.

1.  Mohapatra, S., Eviota, A., Ringquist, K., Muthukrishnan, S., & Aruin, A. Compelled body weight shift technique to facilitate rehabilitation of individuals with acute stroke. International Scholarly Research Network. ISRN Rehabilitation Volume. 2012;  article ID 328018:7 pages.       

2 comments:

  1. I've been thinking of that since my Achilles tendon block was put in on my AFO. The block is one inch high and although I walk pain free for the most part, my balance is off. I've even considered wearing two different shoes, The insert sounds better. Thanks Rebecca.

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  2. I did this for myself with just a sprained ankle. I got fitted for the brace the morning after the injury, and within hours was having back spasms. An ordinary shoe-store heel pad solved the problem entirely. Amazing that the 'professionals' don't think about this when they put hardware under the patient's foot -- where do they think the extra thickness is going to go?

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