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Kim, Kim, Choi, Shon, Park, and Kim: The Effect of Shoe Lift on Lumbar Scoliosis Associated with Pelvic Obliquity
Original Article

Journal of Korean Spine Surg 2004;11(2):104-112.

Published online: 12 February 2004

DOI: https://doi.org/10.4184/jkss.2004.11.2.104

The Effect of Shoe Lift on Lumbar Scoliosis Associated with Pelvic Obliquity

Yong-Min Kim, M.D., Dong-Soo Kim, M.D., Eui-Sung Choi, M.D., Hyun-Chul Shon, M.D., Kyung-Jin Park, M.D., Yung-Sung Kim, M.D.

Department of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Korea

Address reprint requests to Yong-Min Kim, M.D. Chungbuk National University Hospital Department Of Orthopaedic Surgery Chungbuk Chong-Jusi Heungdukgoo Gaeshindong Tel: 82-43-269-6077, Fax: 82-43-274-8719, E-mail: ymkim@med.chungbuk.ac.kr

Copyright © 2004 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

A retrospective study designed to evaluate the effect of a shoe lift on the lumbar scoliosis associated with pelvic obliquity.

Objectives

To analyze the changes in pelvic height, Cobb angle and clinical manifestations after application of a shoe lift.

Summary of Literature Review

The most common form of scoliosis in adolescence is idiopathic (85% of scoliosis), which is a form of structural scoliosis. Some non- structural scoliosis may be assessed as an idiopathic form, which can result in an unnec-essary treatment, such as bracing. Pelvic obliquity may be a cause of non- structural scoliosis, and a shoe lift may be used for its correction.

Materials and Methods

Twelve cases of lumbar scoliosis associated with pelvic obliquity, between A pril, 1998 and October, 2002, were investigated for the changes in the pelvic height and Cobb angle. Standing T- L A P and standing pelvic A P for measuring the Cobb angle and pelvic obliquity, respectively, were checked before and after application of a shoe lift. The Bell-Thompson method was used for measuring the limb length discrepancy. The shoe lift was composed of a compact cork pad and soft sponge tissue. The extent of a shoe lift was determined with the use of the most comfortable wood block height on standing still. The radiological and clinical outcomes of the shoe lift were investigated.

Results

A fter the introduction of the shoe lift, 9 cases (75%) achieved a leveled pelvis (height difference less than 0.3cm) 1week post- shoe lift. The mean Cobb angle before treatment was 16°, ranging from 9 to 26°, which was reduced to 6.7°, ranging from 0 to 23°, due to the shoe lift 1 week post- shoe lift. The mean correction of the Cobb angle after the introduction of a shoe lift was 73.9%. Clinically, 2 cases with low back pain achieved an improvement in the pain, and most patients expressed that walking and standing had become more comfortable.

Conclusion

A shoe lift seems to be significantly effective in correcting the Cobb angle and pelvic height in lumbar scoliosis associated with pelvic obliquity.

Keywords: Lumbar spine, Lumbar scoliosis, Pelvic obliquity, Shoe lift

REFERENCES

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Fig. 1.
(A) Amount of shoe lift was determined by the most comfortable height of wood block on standstill.(B) Photograph of shoe lift made of compact cork pad enveloped in sponge tissue.
jkss-11-104f1.tif
Fig. 2.
Graph showing significant correlation between pelvic obliquity and LLD. But Cobb angle showed neither correlation with LLD nor pelvic obliquity.
jkss-11-104f2.tif
Fig. 3.
Follow-up of pelvic height and Cobb angle showed grossly two patterns. In first pattern(case 2), satisfactory maintenance of correction was observed, but pattern 2(case 3,9) showed gradual decrease of correction according to follow-up time.
jkss-11-104f3.tif
Fig. 4.
Pre-management radiograph of a 7 year-old girl. (A) showing 26° lumbar curve and 17° compensatory thoracic curve.(B) pelvic obliquity in standing pelvis AP view; left pelvis was 3.5cm lower than right side before application of shoe lift.
jkss-11-104f4.tif
Fig. 5.
Photograph showing a lateral ray deficiency of left foot.
jkss-11-104f5.tif
Fig. 6.
After shoe lift. (A) Lumbar and thoracic curves were straightened. (B) pelvic obliquity was decreased to 0.4 cm.
jkss-11-104f6.tif
Table 1.
Profiles of each patients with their respective results.
Case Sex /Age Extent of scoliosis Pre-management Amount of Shoe Lift After Shoe Lift(1week)
Cobb angle Pelvic obliquity B-T study Cobb angle Pelvic obliquity
1 F/21 L1-L4 9° Lt.-1.0cm Lt.-0.3cm 1.3cm 2° Lt.+0.3cm
2∗ F/8 T12-L5 15° Lt.-3.0cm Lt.-1.4cm 2.5cm 0° Same
3 M/13 T12-L4 14° Lt.-1.3cm Lt.-0.2cm 1.5cm 11° Same
4 M/29 T12-L4 12° Lt.-1.1cm Lt.-0.1cm 1.3cm 6° Lt.+ 0.1cm
5 F/9 L1-L4 13° Lt.-0.4cm Lt.-0.5cm 0.5cm 2° Lt.-0.2cm
6 F/13 T12-L4 26° Lt.-1.7cm Lt.-2.0cm 2.0cm 19° Lt.-0.1cm
7∗ F/7 T12-L5 26° Lt.-3.5cm Lt.-3.2cm 3.5cm 0° Lt.-0.4cm
8 F/11 T12-L4 8° Lt.-0.7cm Lt.-0.3cm 1.0cm 0° Lt.+0.5cm
9 F/13 T11-L4 18° Lt.-2.5cm Lt.-1.2cm 2.0cm 6° Lt.-0.3cm
10 F/12 T11-L3 26° Lt.-1.1cm Same 1.0cm 7° Lt.-0.5cm
11 F/13 L2-S1 16° Lt.-0.6cm Same 1.0cm 7° Same
12 F/41 T12-L5 10° Lt.-2.0cm (-)† 2.0cm 4° Lt.+0.1cm

Sex: M: male, F: female, B-T: Bell-Thompson.

∗ : known causes of limb length discrepancy.

† : B-T study not done.

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