Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRTI) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Shoe insoles and shoe lifts

Objective

To improve load distribution.

Theoretical base

The spinal column and back muscles contribute to the maintenance of postures and stability, transmitting the load from the upper part of the body onto legs and feet. In instances of alterations affecting load transmission to lower extremities, the spinal column could support an excessive amount of load, which would produce the adoption of incorrect postures and/or muscle contracture with subsequent back pain.

This mechanism could be present in patients with leg length difference -lower limb heterometry- alterations in feet shape, such as cave or flat feet, or in subjects who must stand during prolonged periods of time with inadequate shoes. In these instances, the convenience of placing shoe lifts on the side of a shorter leg length, or shoe insoles to correct support in cases of cave or flat feet was suggested.

However, epidemiological studies have shown that back pain is no more frequent in individuals with cave or flat feet, or in those with a leg length difference of 2 cm or less.

Shoe lift detractors argue that in adult patients who have had no previous history of back pain, muscles have adapted to their leg length difference and to load distribution asymmetry. Thus, placing a shoe lift may interfere with the compensated stability, triggering back pain.

Evidence of efficacy

Some of the existing recommendations based on scientific evidence establish that there is no evidence indicating the efficacy of shoe lifts, specially when the difference in leg length is less than 2 cm, but they recommend them for patients with low back symptoms who must stand for prolonged periods of time.

Other recommendations suggest that shoe insoles may decrease pain in some individuals with mild back complaints, and that there is no evidence that they provide any long-term benefit.

Risks and contraindications

Some patients have reported an increase in back pain after beginning the use of insoles or, more often, a lift.

Indications

Shoe insoles may be indicated in patients with low back pain who, due to their occupation, must stand for prolonged periods of time.

Shoe lifts may be indicated for those cases of leg length difference of 2 cm or more.

In either case, they should be removed if discomfort is not improved, and certainly, if symptoms worsen.