Gait improvement with the use of an orthotic insole in post-trauma lower limb-length inequality - case report

Abstract

Limb-length inequality (LLI) is commonly associated with compensatory gait abnormalities, resulting in secondarysyndromes. The correction of LLI with insoles is widely used, although there are few studies demonstratingobjective benefits. These where evaluated through Gait Analysis and Baropodography, in a patient with posttraumaticLLI.

The authors report the case of a male patient, aged 27, motorcycle accident survivor, with multi-level fractures inright lower limb (RLL), who was surgically treated. The RLL was radiographically 9 mm shorter. 3D gait analysisand computorized baropodography were performed in the gait laboratory with and without LLI compensation.In orthostatic position, the following were observed: relative rise of left pelvis; flexion of the hips and knees,ankle dorsiflexion (magnitudes on the left greater than on the right). The spacio-temporal gait parameters werewithin normal ranges.The static baropodography showed pressures concentrating at forefoot on RLL.The dynamic baropodography revealed abnormal progression of the center of pressure on the right, starting atthe head of the 5th metatarsal, backards to the mid-foot, then forward, towards the 1st toe.The vertical component of ground reaction forces analysis showed: absence of both peaks during right stance,normal on the left; flatter curve of ankle dorsiflexion moment on the RLL; ankle power comparatively reducedon RLL.The asymmetries were markedly reduced by wearing an 8 mm insole in the right shoe.The gait laboratory measured the positive immediate effects of an orthotic intervention with a more than likelyimportant role in preventing long-term complications.

Keywords: Leg Length Inequality; Insoles; Gait.