Some clients come to us not long after a hip replacement feeling uneven as they walk. They have noticed they are uneven – the surgeon they tell us – has said it is nothing to worry about, even though the client can be quite bewildered.
Some clients walk in to Happy Feet Pedorthics with a limp and in the course of the assessment complain of back pain.
Some clients come in and tell us that the podiatrist has told them to use a heel raise in their shoe because one leg is shorter than the other – but then the client tells us they are walking out of their shoe, and / or they feel quite uneven. Sometimes the podiatrist is using the heel as a test to confirm their diagnosis and action plan with the client.
Some clients come in and we observe that they are walking on their forefoot and not heel striking at all due to an inability to fully extend the knee. At times this has always been, or become habitual. Other times there are underlying medical reasons for the situation such as cerebral palsy, polio, a workplace accident leading to surgery.
So what is the pedorthic response in the assessment / fitting process?
The key questions are around:
- What is the leg length difference? What should the raise amount be?
- How old is the client? Has the client ever had a LLD raise before?
- What is the diagnosis? Who do you see with respect to your foot health?
A LLD raise addresses leg length difference. A heel raise addresses an inability to fully extend the knee. At times there is need for both.
Sometimes, if there is sufficient depth in the shoe a very small LLD is addressed by a heel raise inside the shoe. This can prove satisfactory for some, but not others. The reasons for it not being satisfactory often relate to the feel of the foot in the shoe – ie due to insufficient depth the foot slips out of the back when walking. What we find at Happy Feet Pedorthics is that by having the LLD raise made on the outside of the shoe from the heel under the arch through to the mid foot area, the person feels more balanced and even in their gait as they walk.
Having established the leg length difference the next question is about the amount of the raise. This is when as pedorthists we work with a member of the allied health team – be it a GP, physio, podiatrist, chiropractor or osteopath. This discussion here is about whether the difference is structural or functional, the age of the person and their overall health, and whether there has been a raise before or not.
In the making of the leg length difference and / or heel raise for a new client we make the modification and then we tack the sole, and test the raise prior to bonding the sole. This makes it a little more time consuming for the first raise but results in a better outcome for the client for the first and subsequent raises.
The pictures in this blog are of a person who has been affected by polio and a work place accident. The person is wearing her current footwear and at Happy Feet Pedorthics our task was to make her a new pair with a leg length difference raise and a heel raise for the left.
Clare Nelson C Ped CM AU