Leg Length Discrepancy and Nonspecific Low Back Pain: 3-D Stereophotogrammetric Quantitative Posture Evaluation Confirms Positive Effects of Customized Heel-Lift Orthotics.

Moreno D’Amico,Edyta Kinel,Piero Roncoletta

doi:10.3389/fbioe.2021.743132

Abstract

Background: The literature reports evidence of leg length discrepancy (LLD) associated with musculoskeletal disorders, alterations in spinopelvic alignment, and body posture, leading to low back pain and lumbar scoliosis. The most common conservative treatment for LLD is the use of internal or external shoe lifts although no treatment guidelines have been established. Aim: The study aimed to contribute to low back pain–LLD relationship comprehension, highlighting the benefits of LLD correction in the nonspecific low back pain (NSLBP) population. Methods: A cross-sectional observational study recruited a cohort of 80 NSLBP patients (48 females, 32 males) with LLD, age (μ = 35 ± 17.2). Entire body posture, including 3-D spine shape reconstruction, was measured using a nonionizing 3-D optoelectronic stereophotogrammetric approach. After the first 3-D posture evaluation, patients were provided with customized orthotics, including 100% LLD heel lift correction. No other therapeutic interventions were considered. Pain level was assessed using the numerical pain rating scale (NPRS). The gender, age-related, and time-dependent effects of LLD equalization treatment in NSLBP patients was investigated during 2 years of follow-up. The statistical analysis was performed at the global level using multivariate methods by Hotelling T 2 tests and intrasubject-level using t-test. Results and Discussion: An initial average NPRS = 7.8 was determined. In the medium-term follow-up group (4 months), the NPRS dramatically decreased (NPRS = 1.1). The pain disappeared in the long-term (2 years) follow-up group (NPRS = 0). The study results highlight that LLD equalization treatment led to clear statistically significant improvements in all the postural parameters of the frontal plane, including the underfoot load asymmetry. No worsening has been detected. An adaptation period long enough is needed to obtain progressive pain relief improvements and structural posture changes. Younger NSLBP patients showed slightly better improvements than older ones. Minimal differences between healthy young adults’ and NSLBP patients’ postures were found either in natural erect standing posture or when LLD equalization is applied. Conclusion: Heel-lift customized orthotics with 100% LLD correction are an effective short- and long-term treatment in patients with nonspecific LBP, inducing pain symptom recession and stimulating the improvement of postural parameters without contraindications.

Highlights

Anisomelia, i.e., limb length discrepancy, is defined as a condition in which paired limbs are noticeably unequal
3.1.1 nonspecific low back pain (NSLBP) Patients’ Postural Characteristics and Reactions to leg length discrepancy (LLD) Equalization, Evaluated by Gender In group statistical analysis, we investigated gender differences in the IO1 representing the initial indifferent orthostasis and the WCO2 representing the erect corrected standing posture outcome after the adaptation period to the LLD equalization provided by the customized foot orthotics (Table 3)
LLD equalization needs some adaptation time to be effective on the entire body posture, and it must be maintained over time to prevent the body structure from returning to its original asymmetric unbalanced state

Summary

Introduction

Anisomelia, i.e., limb length discrepancy, is defined as a condition in which paired limbs are noticeably unequal. An extensive review by Sabharwal and Kumar (2008) shows no agreement on how the LLD has to be measured with either clinical or instrumental methods. Clinical methods, such as the use of a tape measure and standing blocks, (being the latter to be preferred in that they were found to be more reliable and complete giving the possibility to consider the LLD functional component) are noted as useful screening tools, but not as accurate as imaging modalities. The literature reports evidence of leg length discrepancy (LLD) associated with musculoskeletal disorders, alterations in spinopelvic alignment, and body posture, leading to low back pain and lumbar scoliosis. The most common conservative treatment for LLD is the use of internal or external shoe lifts no treatment guidelines have been established

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