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)#"/RTHOTICS"I -ONTHLY.EWSLETTER ICB Orthotics Bi-Monthly Newsletter

)SSUE Issue 11

$,4 DLT: 0845 230 4411

4REATING"ACK0AIN,,$ USING/RTHOTIC4HERAPY "Y!BBIE.AJJARINE "3C0OD 1-55+ $IP0OD .37 0ODIATRIST !USTRALIA "ACK PAIN IS ALWAYS INTERESTING AS THERE ARE SO MANY CAUSES OF THIS PROBLEM ) WANT TO KEEP IT SIMPLE ANDADDRESSBACKPAINANDSACROILIAC PAIN ASSOCIATED WITH LEG LENGTH ABNORMALITY AND HOW ) TREAT THE PROBLEM INCORPORATING ORTHOTICS AND OTHERMODALITIES &IRSTLYLEGLENGTHCANBECATEGORIZED INTO 3TRUCTURALnADIFFERENCEINTHELONG BONEMEASUREMENTOFTHELEGAND

&UNCTIONAL ARISINGFROMAVARIETYOF CAUSESWHICHAFFECTTHEBIOMECHANICS OFTHEBODY 7HEN A PATIENT PRESENTS WITH BACK PAIN ) ALWAYS START WITH THE BASICS AND COMPLETE A FULL BIOMECHANICAL ASSESSMENT WHICH INCLUDES LONG BONEMEASUREMENTANDACOMPARISON OF THE AMOUNT OF PRONATIONEVERSION AND SUPINATION EVERSION AT THE FOUNDATION4HElRSTTHINGTOLOOKFOR IS WHETHER THE PATIENT IS PRESENTING WITH BILATERAL OR UNILATERAL PRONATION )FITIS5.),!4%2!, )TRYTOESTABLISH IFTHEPATIENTHAS A SUFFERED A TRAUMA IN WHICH ONE PLANTAR FASCIA MAY HAVE RUPTURED OR ELONGATED MORE SO THAN THE OTHER CONSEQUENTLY CREATING A FUNCTIONAL SHORTLEG B TIBIAL TORSION WITH HIP COMPENSATION SUCH AS TIGHT PSOAS WHICHWILLROTATETHEPELVISANTERIORLY

20

ORTIGHTPIRIFORMIS)4"SAND'LUTEALS AS A COMPENSATION FOR INTERNAL TIBIAL TORSION TO CORRECT THE PIGEON TOED POSITION "OTH THESE COMPENSATIONS COULDEITHERROTATETHEPELVISFORWARD OR BACKWARD CREATING FUNCTIONAL LEG LENGTHPROBLEMSINTHEGAITCYCLE )F THE PATIENT HAS A LONG LEG COMPENSATION IN WHICH THE LONG LEG DROPS DOWN OR PRONATES TO LEVEL THE PELVIS )THENTRYTOESTABLISHTHETRUE STRUCTURAL LENGTH AND THIS CAN BE VERIlED USING A #4 SCANOGRAM SEE &IGURE FORLEGLENGTHORTHENORMAL

&IGURE#43CANOGRAM

X RAYlLMTOCHECKTHELEGLENGTH 4HE LONGER LEG WILL BE PREDISPOSED TO HIP JOINT WEAR AND TEAR AND MAY LEAD TO THE PATIENT REQUIRING A HIP REPLACEMENTINTHEFUTURE4HEREFORE IF A PATIENT IS ASYMMETRICAL INFORM THEM ABOUT THE CONSEQUENCES OF NOT TREATING THE CONDITION 3OME PRACTITIONERS SAY THE BODY WILL TAKE UPANDCOMPENSATEFORTHEDIFFERENCE AND WHY BOTHER WITH A HEEL RAISE TO LEVELTHEPELVIS(OWEVER SUGGESTTO THEMTHATIFTHEYWERESITTINGATATABLE THAT ROCKS SIDE TO SIDE WOULD THEY

PLACE A WEDGE TO STOP THE ROCKING -OSTWILLSAY9%33OIFTHEROCKING TABLEANNOYSYOU IMAGINEHOWALEG LENGTH DISCREPANCY OF  MM CAN UPSETTHEBIOMECHANICALSTRUCTURES )F THE PATIENT IS SUFFERING FROM HIP COMPENSATIONS THEY WILL NEED TO BE EITHER REFERRED TO THE APPROPRIATE !LLIED HEALTH PRACTITIONER TO @LOOSEN UP THE PELVIS AND USE STRETCHING AND STRENGTHENING EXERCISES TO CORRECT THE ANOMALY !T THE SAME TIME PRESCRIBE ORTHOTICS TO REALIGN AND CORRECT THE BIOMECHANICS ! COMBINATION OF ORTHOTIC THERAPY AND MUSCLE STRETCHING AND STRENGTHENING WILL IN MY EXPERIENCE GIVE THE BEST TREATMENTRESULTS )F THE PATIENT PRESENTS WITH A STRUCTURALDEFORMITYANDITISNOTDUE TOARECENTTRAUMARELATEDIMBALANCE THEN THE USE OF A HEEL RAISE ON THE STRUCTURAL SHORT LEG WILL BE REQUIRED ) RECOMMEND HALVING THE LEG LENGTH DISCREPANCY MEASUREMENT AND ADDING ONLY THAT AMOUNT IN THE HEEL RAISE 4HEN THIS AMOUNT CAN BE GRADUALLY INCREASED TO LIMIT INITIAL DISCOMFORT AND QUICKEN PATIENT COMPLIANCE#ONTRAINDICATIONINTHIS INSTANCE WOULD BE ANY FUSING OF THE SPINEASTHISMAYCAUSETHEPATIENTTO BEINMOREPAIN )FYOUPRESCRIBETHEPATIENTORTHOTICS AND HAVE ./4 -%!352%$ LEG LENGTH WHEN THE PATIENT DOES HAVE ALEGLENGTHDISCREPANCY THEORTHOTIC WILL INVARIABLY REMOVE THE NORMAL BODY COMPENSATION OF THE @LONG LEG PRONATION 4HIS JAMMING ACTION WILL CREATEPROBLEMSWITHTHE3)JOINTAND THE LONG LEG MAY ALSO CONTRIBUTE TO THE DEVELOPMENT OF A SCOLIOSIS AS STATEDIN"LAKE&ERGUSON 

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Podiatry Review November/December 2010  

Vol 67 No 6

Podiatry Review November/December 2010  

Vol 67 No 6

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