I don't have any studies for you. The rule of thumb I have always gone by, and
heard, is that if the LLD is 1/2 inch, or less, it isn't necessary to treat it.
>From 1/2 to 1 inch I have heard differing opinons of the need for a heel lift
(personally I would try one). I doubt a 1/2 inch or less LLD would have a
significant impact on balance/falls absent other underlying pathology. However,
patients who fracture the femoral neck in a fall would be at risk for future
falls. The largest predictor of falls is a history of falls.
For a LLD greater than 1 inch I would wonder why it wasn't corrected surgically
with the ORIF or a THR. If your colleague sees a lot of patients with LLD s/p
ORIF femoral neck then it sounds like a great study for him/her to do. On a
case by case basis why not test a patient's balance with and without a lift? I
would be interested if your colleague finds any additional information on
this.
Douglas M. White, PT, OCS
Milton, MA USA
Jonathan Hutchins wrote:
> I am raising a query on behalf of a physiotherapist colleague, having
> failed to find anything of great relevance in the commercial bibliographic
> databases (EMBASE, AMED, MEDLINE).
>
> The question is: what is the effect of leg length difference (of 1" or
> less) on balance and risk of falls, espoecially in the elderly? Dynamic hip
> screw fixation for fractured neck of femur results in half-inch plus
> shortening, so my colleague is trying to make a case that a shoe or heel
> raise should be automatic.
>
> I hope this makes sense: any suggestions as to key references or current
> research would be welcomed.
>
> many thanks
>
> Jonathan Hutchins, Library Services Manager
> Royal Surrey County Hospital, Guildford
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