Assessing LLD And Whether Shoe Lifts Can Have An Impact

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Author(s): 
David Levine, DPM, CPed

Pertinent Pointers On Using Heel Lifts Effectively

Finally, probably the most effective way to assess for LLDs is to observe the patient and rely on the patient’s feedback as well. People can generally perceive 1/8-inch differences. Therefore, the difference will be 1/8 inch, ¼ inch, 3/8 inch and so on. Have these materials of different thicknesses in your exam rooms. Place a piece under one foot. Typically, you should start with a material that is at least ¼ inch. Ask the patient how it feels. Then switch feet. Try to confuse the patient with which foot and the thickness of material while you titrate the amount and the side it works best.

   It is truly amazing how quickly people can perceive balance, even when they have been functioning in an uneven manner for a long time. This can be a fun, rewarding and educational tool to use when discussing treatment with the patient. Within just a couple of minutes, in most cases, you will be able to determine easily and with a high degree of certainty whether there is a leg length discrepancy, which side is shorter and by approximately how much.

   How you interpret and use this information will directly impact your outcomes. The most important concept is to use shoes to your advantage. In general, as I mentioned previously, people perceive 1/8-inch differences. If the difference is only 1/8 inch or you are sure it is not as much as ¼ inch, simply placing a non-compressible heel lift in the shoe will suffice. The material needs to be firm and one should place it under the insole so it is as far from the foot as possible. This way, you don’t have to alter the feel of the shoes yet the shoe will be more comfortable and the patient will be more likely to be adherent.

   If the difference is greater than 1/8 inch, the lift needs to go on the shoe. Unfortunately, this is a concept that is foreign to too many practitioners. For the best outcomes, one needs to raise the entire short side, not just the heel.

   You can do an experiment to prove this yourself. Stand only on a ¼-inch heel lift. Then try standing on a ¼-inch platform of material. It is clearly a lot more efficient to raise the entire side than just the heel. In addition, if you only raise the heel, you are contributing to further asymmetry down the road. Doing this will also have a negative impact on the fit of the shoe. If you try to use more than a heel lift but put it inside of the shoe, then one shoe will be tight with the heel slipping out and the other loose. This is not a comfortable or efficient combination.

   Another common error is placing more than a 1/8-inch lift on an orthotic device. The function of orthotic devices and the purpose of a lift are different. Trying to combine them may negatively impact each. When adding an additional heel lift to the orthotic, it will alter the purpose of the heel post and change the pitch of the orthotic device. In addition, depending upon the material one selects, it might compress easily, making it difficult to determine how much of a difference really exists.

   The focus needs to be on the shoe. Not only can one add a lift to any shoe, it can happen in a cosmetically appealing way that is barely even noticeable. This way, one can sufficiently elevate the short side to the right level.

   Having the patient try the lift in the shoe for a couple of weeks will determine if you are right. The feedback you obtain after the patient tries it for a few weeks is always helpful. If you made patients worse, you can remove the lift. If you made them better, they will bring you more shoes. If it is not enough, you can modify the lift can be modified further. Just remember, it is always easier to operate on a shoe than it is to operate on a foot. The complications are much easier to deal with.

   The common question asked by patients is whether all shoes have to be modified. The answer is no. Patients should try the lift on just one shoe and wear it consistently for a couple of weeks. If it works, it will be more comfortable and patients will not only want to wear it, but they will recognize the need to wear it.

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