The effect of eliminating leg length difference on plantar foot pressure distribution in patients wearing forefoot offloading shoe. (December 2017)

• Record Type: Journal Article
• Authors: Palmanovich, Ezequiel; Ayalon, Moshe; Sira, David Ben; Nyska, Meir; Hetsroni, Iftach
• Is Part Of: Foot. Volume 33(2017)
• Page Start: 39
• Page End: 43
• Publication Date: 2017-12
• Subjects: Forefoot offloads -- Leg length -- Plantar foot pressure; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2017.10.003
• Languages: English
• ISSNs: 0958-2592

Abstract

Highlights: Shoes with an elevated heel are used to off-load the foot after forefoot osteotomies. The height difference between the shoes results in a leg length discrepancy and an abnormal gait pattern. Sole elevation of a standard contralateral shoe results in increase in the plantar pressures at the lateral forefoot in the foot wearing the forefoot offloading Darco shoe. Abstract: Background and purpose: Elevated heel construction offloads the forefoot after surgery. However, side-to-side height difference alters limb kinetics, whereas leg-length equalizing-sole at non-operated side may have beneficial effects on foot loading. The purpose of this study was to characterize leg-length equalizing sole effect on bilateral plantar pressures when using heel-lift forefoot-offloading shoe. Materials and methods: Twenty men were tested walking. Plantar peak pressures (PP) and pressure-time integrals (PTI) in the forefoot-offloading shoe and in contralateral running shoe were compared between two conditions: one with- and the other without leg-length equalizing sole elevation at the running shoe. Results: Adding leg-length equalizing sole to the running shoe resulted in the following changes in the forefoot-offloading shoe: increased lateral midfoot PP (8.7%, p = 0.03), increased lateral midfoot (11.3%, p = 0.05) and lateral metatarsals PTI (10.3%, p = 0.04), and decreased medial and lateral heel PTI (>5%, p = 0.02). These changes were non-significant when applying a Bonferroni correction. Changes in the running shoe were: increased medial midfoot (20.5%, p = 0.03) and decreased 2nd and lateral metatarsals PP (23%, p < 0.01). PTI increased in medial and lateral heel (>25%, p < 0.01), medial midfoot (63.2%, p < 0.01) and lateral midfoot (9.2%, p = 0.04) and decreased in 2nd and lateral metatarsals (>24.5%, p < 0.01). Conclusion: Leg-length equalizing sole at contralateral running shoe in subjects wearing forefoot-offloading shoe results in lateral load shift alongside heel pressure attenuation within the forefoot-offloading shoe, which is beneficial during first month after medial forefoot surgery. Reciprocal medial load-shift in the elevated running shoe itself should yet be considered when bilateral medial forefoot pathology is present.