Cargando…

Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot

BACKGROUND: Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This di...

Descripción completa

Detalles Bibliográficos
Autores principales: Mehraban, Nasima, Idarraga, Alexander J., Wu, Kevin J., Patel, Milap S., Vora, Anand M., Kadakia, Anish R., Lee, Simon, Hamid, Kamran S., Bohl, Daniel D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697186/
https://www.ncbi.nlm.nih.gov/pubmed/35097386
http://dx.doi.org/10.1177/2473011420930236
_version_ 1784619992553095168
author Mehraban, Nasima
Idarraga, Alexander J.
Wu, Kevin J.
Patel, Milap S.
Vora, Anand M.
Kadakia, Anish R.
Lee, Simon
Hamid, Kamran S.
Bohl, Daniel D.
author_facet Mehraban, Nasima
Idarraga, Alexander J.
Wu, Kevin J.
Patel, Milap S.
Vora, Anand M.
Kadakia, Anish R.
Lee, Simon
Hamid, Kamran S.
Bohl, Daniel D.
author_sort Mehraban, Nasima
collection PubMed
description BACKGROUND: Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg length–evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. METHODS: Patients made WBAT in a CAM boot were randomized to either the leg length–evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for 2 weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (P > .05 for each). RESULTS: Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0±1.5 vs 3.2±1.8, P = .001; as-treated analysis: 2.1±1.7 vs 3.0±1.7, P = .009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (P > .05 for each). CONCLUSION: This multicenter randomized controlled trial found that adding a limb length–evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improved patient-reported self-assessment of balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain. LEVEL OF EVIDENCE: Level II, prospective comparative study.
format Online
Article
Text
id pubmed-8697186
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-86971862022-01-28 Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot Mehraban, Nasima Idarraga, Alexander J. Wu, Kevin J. Patel, Milap S. Vora, Anand M. Kadakia, Anish R. Lee, Simon Hamid, Kamran S. Bohl, Daniel D. Foot Ankle Orthop Article BACKGROUND: Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg length–evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. METHODS: Patients made WBAT in a CAM boot were randomized to either the leg length–evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for 2 weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (P > .05 for each). RESULTS: Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0±1.5 vs 3.2±1.8, P = .001; as-treated analysis: 2.1±1.7 vs 3.0±1.7, P = .009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (P > .05 for each). CONCLUSION: This multicenter randomized controlled trial found that adding a limb length–evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improved patient-reported self-assessment of balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain. LEVEL OF EVIDENCE: Level II, prospective comparative study. SAGE Publications 2020-07-28 /pmc/articles/PMC8697186/ /pubmed/35097386 http://dx.doi.org/10.1177/2473011420930236 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Mehraban, Nasima
Idarraga, Alexander J.
Wu, Kevin J.
Patel, Milap S.
Vora, Anand M.
Kadakia, Anish R.
Lee, Simon
Hamid, Kamran S.
Bohl, Daniel D.
Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
title Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
title_full Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
title_fullStr Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
title_full_unstemmed Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
title_short Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot
title_sort effect of leg length–evening device on perceived balance in patients wearing a controlled ankle motion boot
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697186/
https://www.ncbi.nlm.nih.gov/pubmed/35097386
http://dx.doi.org/10.1177/2473011420930236
work_keys_str_mv AT mehrabannasima effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT idarragaalexanderj effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT wukevinj effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT patelmilaps effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT voraanandm effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT kadakiaanishr effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT leesimon effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT hamidkamrans effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot
AT bohldanield effectofleglengtheveningdeviceonperceivedbalanceinpatientswearingacontrolledanklemotionboot