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Hi all.

just wondering what all of you fellow podiatrists think the CONSERVATIVE management / treatment of FUNCTIONAL lld is... in a 11 year old child with <1cm

as far as i know, the best conservative treatment for STRUCTURAL lld would be adding heel raises in their shoes.

what about in FUNCTIONAL cases? im thinking a good pair of modified roots?

any help would be appreciated.

thanks

Where is the functional LLD coming from? Foot? knee? SI joint? Hip?

hmm, assessments show a left shoulder drop , right abducted foot, also (R) weak tib ant and peroneal longus, right leg appears longer then left, pronated (L) foot - pronounced medial malleoli. RCSP (L) is 11 deg everted and (R) is 9 deg inverted.
im thinking its coming from the foot...
any thoughts?

Related threads:
Leg Length differences
Hip replacement causing leg length difference
Shoe inserts for LLD and chronic low back pain
Leg Length Differences and Quality of Life
Measuring LLD
Functional propulsive phase limb length discrepancy

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ok, the reason why i dont agree with adding a heel lift is that everytime i add a heel lift, (keep in mind that this is a FUNCTIONAL) it just throws everything out of order, ie pelvic tilts the other way , and it doesnt get rid of the leg pain...
so im thinking a pair of mod root having the SAME heel raises?

I do not see how foot orthoses will help a functional LLD unless the foot is the source of the difference. Find the source and get it treated (eg sacroiliac manipulation).

well , manage, not treat, and also keep in mind that this is a 11 yr old child. from all the journal articles from google scholar that i pulled up , most seem to say orthotic intervention is the best.

It is, if the functional LLD is coming from the foot. How does a foot orthotic affect a functional LLD due to one knee being more flexed than the other? How does a foot orthotic affect a functional LLD due to a malposition/rotation at the SI joint? etc

it IS coming from the foot though....
"pronated (L) foot - pronounced medial malleoli. RCSP (L) is 11 deg everted and (R) is 9 deg inverted."
did that turn up ?
i thought i posted it :(

Podder123,
If you have eliminated any pathology proximal to the feet, why don't you try some temporary in-shoe padding (triplane heel pad and/or forefoot padding across the metatarsal heads)? Diagnosis in children sometimes takes time and careful observation. No offense to anyone, but pelvic manipulation in an 11 year old or anyone else, sounds hopeless.

Don't forget, the more material you put into the shoe to stop the "pronation", the more you might have to add to the short side.

How about a full through raise to the short side?. This might affect pelvic tilt less.

Also consider that the foot that pronates more "might" be a compensation technique.

I would examine the PSIS with the feet in talo-navicular congruency, or at least with the feet symmetrical, and legs abducted to the same degree.

Re-examine the PSIS sitting in case of pelvic obliquity.

Let us know how you get on.

PS is this child symptomatic, and how long has this LLD been monitored?