Orthotics to Treat Scoliosis?

[WYSIWYG]

I’m a pediatrician with a question that I think would be answered best by a podiatrist. Allopathic physicians are trained not to intervene in cases of scoliosis unless the deformity is considerable (i.e. greater than 10 degrees). Given that limb length inequality can cause scoliosis, I view this “laissez-faire” approach as being closer to a policy of somewhat-less-than-benign neglect—especially when correction of the patient’s biomechanics might alleviate the spinal deformity.

I currently have a (premenarchal) 12 y/o female patient with documented 1cm lower extremity length discrepancy (comparing respective direct measurements from ASIS to medial malleolus) and a 7-degree scoliosis contralateral to the longer limb. My question for all the pods is: Do you think that orthotic inserts could be used to correct (or at least prevent the progression of) the spinal deformity? Thanks in advance for any input you can provide.

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[krabmas]

I’m a pediatrician with a question that I think would be answered best by a podiatrist. Allopathic physicians are trained not to intervene in cases of scoliosis unless the deformity is considerable (i.e. greater than 10 degrees). Given that limb length inequality can cause scoliosis, I view this “laissez-faire” approach as being closer to a policy of somewhat-less-than-benign neglect—especially when correction of the patient’s biomechanics might alleviate the spinal deformity.

I currently have a (premenarchal) 12 y/o female patient with documented 1cm lower extremity length discrepancy (comparing respective direct measurements from ASIS to medial malleolus) and a 7-degree scoliosis contralateral to the longer limb. My question for all the pods is: Do you think that orthotic inserts could be used to correct (or at least prevent the progression of) the spinal deformity? Thanks in advance for any input you can provide.

This site is not supposed to be for soliciting or giving clinical/medical advice.

In short yes an orthotic with a built in lift could work. I'd recommend you send the patient to a podiatrist for an evaluation. Many pods will not correct for only 1cm though.

 

[diabeticfootdr]

I'm a pediatrician with a question that I think would be answered best by a podiatrist.

Doctor,

Accept my apologies for the above response, it seemed rather rude to me.

I understand you're seeking collegial interaction and direction.

I do not specialize in "podo-pediatrics", but Edwin Harris, DPM from Chicago is a well-known author and lecturer in this subspecialty. You can find his contact information on:
http://66.99.255.20/scpm/orthopedics/facultystaff.cfm
and
http://www.meddean.luc.edu/lumen/DeptWEbs/ortho/podiatry/harris.htm

Good luck to you and I applaud you for going to such lengths to find an appropriate answer to your patient's concern.

LCR

 

[Dr_Feelgood]

This site is not supposed to be for soliciting or giving clinical/medical advice.

In short yes an orthotic with a built in lift could work. I'd recommend you send the patient to a podiatrist for an evaluation. Many pods will not correct for only 1cm though.

I agree with both parties. An orthotic may help but the body will easily compensate for a 1cm difference. The short limb will supinate and the long limb will pronate; there by eliminating the difference. The length will not be compensated by the spine.

There maybe other problems that are leading to the deformity such as muscle imbalance, growth imbalance, or a union within the spine. I would think that back braces and a spinal consult would be the most appropriate course of action, especially if the patient may have a bar.

 

[SportPOD]

I’m a pediatrician with a question that I think would be answered best by a podiatrist. Allopathic physicians are trained not to intervene in cases of scoliosis unless the deformity is considerable (i.e. greater than 10 degrees). Given that limb length inequality can cause scoliosis, I view this “laissez-faire” approach as being closer to a policy of somewhat-less-than-benign neglect—especially when correction of the patient’s biomechanics might alleviate the spinal deformity.

I currently have a (premenarchal) 12 y/o female patient with documented 1cm lower extremity length discrepancy (comparing respective direct measurements from ASIS to medial malleolus) and a 7-degree scoliosis contralateral to the longer limb. My question for all the pods is: Do you think that orthotic inserts could be used to correct (or at least prevent the progression of) the spinal deformity? Thanks in advance for any input you can provide.

Unless your patient is having pain in the feet I wouldn't put in orthotics in this patient. What I usually try is getting flat insole (either Spenco or Dr. Scholl's insole) and placing one insole in the shorter side for one week, then put the other side in the same shoe but upside down. This will give about a 1/4" lift in the short limb helping compensate for the 1cm difference.

 

[krabmas]

Doctor,

Accept my apologies for the above response, it seemed rather rude to me.

I understand you're seeking collegial interaction and direction.

I do not specialize in "podo-pediatrics", but Edwin Harris, DPM from Chicago is a well-known author and lecturer in this subspecialty. You can find his contact information on:
http://66.99.255.20/scpm/orthopedics/facultystaff.cfm
and
http://www.meddean.luc.edu/lumen/DeptWEbs/ortho/podiatry/harris.htm

Good luck to you and I applaud you for going to such lengths to find an appropriate answer to your patient's concern.

LCR

Since my post was the only one before yours I assume you are appologizing for me.

No thanks.

I was not being rude. To bad you took it that way.

 

[Footmech]

I’m a pediatrician with a question that I think would be answered best by a podiatrist. Allopathic physicians are trained not to intervene in cases of scoliosis unless the deformity is considerable (i.e. greater than 10 degrees). Given that limb length inequality can cause scoliosis, I view this “laissez-faire” approach as being closer to a policy of somewhat-less-than-benign neglect—especially when correction of the patient’s biomechanics might alleviate the spinal deformity.

I currently have a (premenarchal) 12 y/o female patient with documented 1cm lower extremity length discrepancy (comparing respective direct measurements from ASIS to medial malleolus) and a 7-degree scoliosis contralateral to the longer limb. My question for all the pods is: Do you think that orthotic inserts could be used to correct (or at least prevent the progression of) the spinal deformity? Thanks in advance for any input you can provide.

hi, Im a Podiatrist practicing in Surrey, England.
I certainly agree, that some of these cases are not taken seriously enough when the 'deformity' is deemed mild.
I believe however that a holistic, multi-disciplinary approach to the problem of scoliosis would be beneficial. As a Podiatrist, appreciation of factors like LLD, and other biomechanical anomolies ie hypermobility, excess pronation etc. need to be dealt with. The question of LLD in a 12yr old, at 1cm, I may be reserved in intervening, as this may not be a permanent feature as the child grows.
I can assure you on examination other biomechanical priorities will present. In addition the focus on streching and strengthening, to assist spinal improvement should not be ruled out. So I would assess and provide the necessary in shoe corrections, and refer to a Biokinetisist for spinal appreciation and exersise regimes.

 

[jonwill]

hi, Im a Podiatrist practicing in Surrey, England.
I certainly agree, that some of these cases are not taken seriously enough when the 'deformity' is deemed mild.
I believe however that a holistic, multi-disciplinary approach to the problem of scoliosis would be beneficial. As a Podiatrist, appreciation of factors like LLD, and other biomechanical anomolies ie hypermobility, excess pronation etc. need to be dealt with. The question of LLD in a 12yr old, at 1cm, I may be reserved in intervening, as this may not be a permanent feature as the child grows.
I can assure you on examination other biomechanical priorities will present. In addition the focus on streching and strengthening, to assist spinal improvement should not be ruled out. So I would assess and provide the necessary in shoe corrections, and refer to a Biokinetisist for spinal appreciation and exersise regimes.

SWEET! A pod from "across the pond"!