Keys To Recognizing And Treating Limb Length Discrepancy
- Volume 27 - Issue 5 - May 2014
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Lifts are not forever. What is appropriate at the onset of treatment may not be what is required six months later. Periodic evaluation is necessary. Once the patient has achieved symmetry, perform a computer-assisted gait analysis in two to three months to reassess. It has been my observation that functional LLDs in most individuals tend to reduce over time with treatment. This may be due to assimilation of the lift action into the musculoskeletal functional framework, thereby in some cases obviating the need for a lift at all. If the need for the lift is still apparent at the time of the first follow-up computer-assisted gait analysis, reassess it in six months and periodically thereafter.
The bottom line is when a patient states, “Fifteen years ago, my doctor told me my right leg is shorter so I have a lift built into all my shoes,” that lift is not doing the same thing now as it did at the initial prescription. Many times, I have found it is either too much, too little, not needed or on the wrong side.
Limb length discrepancy is a common musculoskeletal deficiency with widespread untoward effects. Historic methods to statically assess its presence do not address or take into consideration its dynamic requirements. Computer-assisted gait analysis is a non-invasive, objective, relevant, reliable clinical method to identify, quantify and manage functional asymmetry.
Dr. D’Amico is a Professor and Past Chairman in the Division of Orthopedics at the New York College of Podiatric Medicine. He is a Diplomate of the American Board of Podiatric Medicine, a Fellow of the American College of Foot and Ankle Orthopedics, and a Fellow of the American Academy of Podiatric Sports Medicine. Dr. D’Amico is in private practice in New York City.