Shoe Lifts for Leg Length Discrepancy in Adults with Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature

Publication date: Available online 9 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): T Mark Campbell, Bahareh Bahram Ghaedi, Elizabeth Tanjong Ghogomu, Vivian Welch
ObjectiveTo determine whether shoe lifts effectively treat leg length discrepancy (LLD)-associated morbidities in adults with common painful musculoskeletal conditions.Data SourcesTRIP, CENTRAL, PubMed, PEDro and National Guideline Clearinghouse databases. The search was performed in September 2017, limited to English-only, and had no time constraints.Study SelectionTwo reviewers independently determined study eligibility. Inclusion criteria were: (1) participants ≥18 years-old with musculoskeletal-related complaints and LLD, (2) a shoe lift intervention was used, and (3) the study reported on pain, function, range of motion, patient satisfaction, quality of life, or adverse events. Randomized controlled trials (RCTs), controlled intervention, cohort, before-and-after, case-series and case report studies were included. Three-hundred-and-nineteen articles were screened and nine guidelines reviewed.Data ExtractionWe extracted data pertaining to participant demographic characteristics, study setting, recruitment, randomization, method of LLD measurement, shoe lift characteristics, treatment duration, and outcome measures. We included ten studies, including one RCT.Data SynthesisLLD was associated with low back pain, scoliosis, and osteoarthritis of the hip and knee. Description of LLD correction strategy was often inadequate. Study quality was very low or poor. In non-RCT studies reporting on the proportion of participants who improved with a shoe lift, 88±3% of 349 participants treated had partial or complete pain relief (effect size range 66.7-100%). All 22 RCT participants receiving treatment experienced pain relief (mean pain reduction 27±9mm on a 150mm visual analogue scale). Two of nine guidelines recommended shoe lift use based on consensus, and were of moderate-to-high quality.ConclusionsThere is low-quality evidence that shoe lifts reduce pain and improve function in patients with LLD and common painful musculoskeletal conditions. High quality research evaluating a threshold LLD to correct and a strategy to do so is necessary. Developing an appropriate comparison group to test clinically-relevant outcome measures would make a valuable contribution in this regard.



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