Management of Shortening

MANAGEMENT OF SHORTENING

Limb shortening is common in poliomyelitis. Occasionally limb lengthening can initially occur after paralysis, but after a few months gradually increasing shortening is the rule in the growing child. Shortening of an upper limb is of little importance. Shortening of the lower limb is very important, and may cause a patient to walk with a more severe limp than would otherwise be the case if he only had a weak leg. It is also of much greater importance in people who walk barefoot and who could neither tolerate nor afford a special boot or shoe with a compensatory raise. A small degree of flexion/abduction deformity (30°) of the hip or pelvic tilt, is often useful in these patients as it not only stabilises the hip, but also causes a degree of apparent lengthening which may compensate for true shortening. If the apparent lengthening is too great, however, the leg may be longer than the opposite one, especially if the opposite leg is also paralysed.

Treatment in leg shortening should be conservative in most cases. Apparent plus true shortening, should always be measured. The more important treatment for barefooted people and others can be summarised as follows:

a. Apparent shortening of less than 2 cm: No treatment.

b. Apparent shortening of 2-4 cm with the opposite leg not requiring a caliper: A clog on one leg only. No clog on the opposite side. Alternatively, a pair of boots with a raise on the heel 1/2 less than the shortening.

c. Apparent shortening of one leg of more than 4 cm with the opposite leg not requiring a caliper: A clog on one leg only with a raise so that the total height of the clog or boot is 1-2 cm less than the apparent shortening.

d. Shortening where calipers are required on both legs or where the patient wears boots: No raise for differences of less than 1 cm. For differences of more than 2 cm a raise on the boot or clog less than the actual degree of apparent shortening.

Treatment of Lower Limb Shortening