What is Leg Length Discrepancy?

The term refers to a difference in length between the left and right leg. It may be developmental, as the human body is rarely symmetrical, or can be as a result of trauma (usually resulting in a shortening of the affected leg) or joint replacement (sometimes resulting in a lengthening of the affected leg).

Symptoms

The most common symptom is low back pain which results from the postural adjustment which occurs in this area as a result of the discrepancy. Other symptoms include hip pain and knee pain.

Treatments

Treatment is based on equalising the leg lengths which reduces the postural adjustment and the unequal stresses on the limbs and is achieved by the use of either:

• A heel elevator which is fitted inside the shoe

• An externally fitted shoe raise

The type of raise (internal or external) is dependent on the amount of shortening identified.

What is Toe Deformities?

Muscular or biomechanical imbalance of the toes causing the specific joints to move from their normal alignment and become deformed and may be associated with over pronation. Toe deformities can also be a secondary (resulting) complication of other conditions such as Rheumatoid Arthritis.

Symptoms

Clawed, Hammered, Overlapping Toes.

Treatments

• Functional Foot orthotics to realign foot biomechanics.

• Metatarsal insoles to encourage extension of the Metatarso-phalangeal joints (at the base of the toes) and Inter-phalangeal joints (within the toes).

• Toe spacers to prevent or restrict overlapping.

What is Tibialis Posterior Tendon Dysfunction?

Over use or damage to the tibialis posterior tendon. Damage to the tendon can be caused by changes in the tendon which impair its ability to support the medial arch.

Symptoms

Initially there will be inflammation (pain, swelling, heat and redness) on the inner border of the foot along the line of the tendon. As the problem progresses there will be a flattening of the medial arch and the foot will roll in. With more progression the front of the foot may begin to drift outwards.

Treatments

Providing there is no indication for other medical intervention i.e. surgery, Orthotic treatment includes:

• A functional foot orthotic to realign foot biomechanics for early stage TPTD

• A UCBL type heel cup where the problem is more advanced and a higher degree of control is required to realign foot biomechanics

Symptoms

Symptoms include pain at the back of the heel at the insertion (attachment point) of the Achilles tendon; the pain will become more severe with increased activity. There may also be pain when squeezing the sides of the heel.

Treatments

• Cushioned heel pads to reduce shock through the heel and also lift the heel to reduce tension on the insertion of the Achilles tendon.

• Where over pronation is a contributory factor, the use of functional foot orthotics to re-align foot biomechanics.

Symptoms

Pain under the base of the big toe joint (1st MPJ) which is usually of gradual onset and becomes more severe as the aggravating activity continues.

Treatments

• An insole to reduce the pressure on the affected area and reduce loading on the joint can be beneficial.

What is Polio?

Polio is caused by an infectious virus which attacks the motor neurones (nerve cells which control muscle movement) causing damage or destruction of these cells. This can lead to muscle paralysis.

Symptoms

For those who have paralytic Polio, symptoms include muscle pain, muscle cramps, weakness and paralysis.

Treatments

Treatment will vary dependent upon the level of involvement of the disease. Options include:

• Fixed ankle AFO to align the foot and ankle to improve foot/ankle biomechanics

• Ground reaction AFO will additionally improve knee biomechanics without structurally stabilising the joint

• Knee ankle foot Orthosis will improve lower limb biomechanics and provide structural control to the foot, ankle and knee joints

What is Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis is a chronic (long term), progressive auto-immune disease (a disease whereby the body’s cells are attacked by its own immune system causing damage). It causes swelling and damage to cartilage and bone around joints. Over time this leads to deformities of the affected joints. The exact cause(s) of RA are not yet fully understood. Osteoarthritis may also be present in conjunction with RA.

Symptoms

The ankle joint is not as commonly affected by RA as other joints but when affected, symptoms may include: stiffness of the ankle, swelling, joint deformity and a feeling of instability in the joint.

Treatments

The effects of RA cannot be reversed but the aim of orthotic intervention is to reduce symptoms associated with joint deformity. This may be achieved using:

• Elasticated Ankle supports

• Boot style Stock Footwear

• Boot style Bespoke Footwear

• Fixed Ankle walker to allow temporary resting of the joint whilst performing daily activities

Symptoms

Spina bifida occulta normally rarely causes any problems. People may have hair growth or a dimple in the bottom of their back.
Spina bifida cystica has different levels of severity. A cyst like sac is evident on the spine. In the mildest form, the sac contains spinal fluid and the tissues that cover the spinal cord. The nerves can be intact or mildly damaged, normally by tethering. In the most severe type, the sac also contains nerves and part of the spinal cord. This can lead to paralysis, muscle wastage and loss of sensation. Hydrocephalus (an accumulation of fluid which causes a significant enlargement of the head) is almost always present in the most severe type, approximally 90% of cases.