Case Quiz: Part 2: The Questions
Here was our reply:
She has a cross over gait pattern Right > Left; assumedly due to the amount of tibial varum on the Left; is it that prominent unilaterally? The lateral shift is compromising the LCL (lateral collateral ligament on the Left, combined with poor gluteus medius control. She appears to have an uncompensated forefoot varus bilaterally as well. I would question if she has an LLD (let length discrepancy) on the Right, with more pelvic glide/drift occurring to that side during stance phase of gait. Her arm swing is also greater on the right. With the reconstruction, she has a greater stride length on the Right, as she tries to unload the Left side. Does she look any better in the orthotics ?
Our suspicions are:
- LLD (leg length discrepancy), short on the right
- moderate Forefoot varus, uncompensated
- LCL (lateral collateral ligament) laxity
- weak Gluteus medius complex bilaterally
- crossover gait
What could be done?
- continued acupuncture for muscle facilitation
- “waddle walks” with theraband around legs (to challenge the gluteus medius), keeping them in some degree of abduction
- Single leg standing exercises on foot tripod
- foot intrinsic strengthening (lift, spread, reach exercise; EHB; FDB, EDL)
- Sole lift if indicated to help with limb length challenge
prolotherapy may help but you need to know WHY the leg translates laterally; otherwise you are just band aiding it
Hope that helps. Let us know how it goes and if she has an LLD (short leg, anatomically).
Ivo and Shawn: asking the tough questions….