osteo support: SHORTENING AND COMPENSATION

Shortening may be either true or apparent shortening.Due to different pathological reasons shortening may happen as secondary deformity if particular diseases are not treated at the time e.g Polio, cerebral palsy,spina bifida,burn,osteomyelitis,fracture,myopathy etc.

True shortening or bony shortening is due to shortening of anatomical structure of the bone either shortening of femur or tibia. It may be due to congenital or pathological or accidental. Where as apparent shortening is false shortening or visible shortening. To find out the true shortening the patient will be kept on straight supine position. Measurement will be from ASIS to medial malleolus of both lower limbs. The different in the measurement will be the true shortening. For apparent shortening measurement will be from umbilicus to the medial malleolus of both lower limbs. The different in the measurement will be the apparent shortening. However most of the people have shortening up to 5 mm which is acceptable.

Anatomical structure of the body is affected by the shortening. The patient feel tired soon, energy will consume more, and gait will be ugly. Weight distribution of the body will unequal. Gradually shortening affect on spine which slowly develop scoliosis.If it become severe and chronic, internal organs like lungs and heart also affected.

Due to different pathological reasons shortening may happen. These shortening must manage to prevent from further complication. During assessment of the patient, it should be confirmed that shortening is correctable or not. For example fixed equines or fixed planter flexion may have more shortening and not correctable, which must accommodate in appliance (alignment in 90 degree).If the equines is correctable then it should be correct during casting and remaining shortening should accommodate in the appliance.sometime it may need to accommodate contra lateral shortening

Inside the appliance or inside the shoe shortening can be accommodate up to 4 cm, more than that shortening should be accommodate outside the shoe.

POP model of 3 cm shortening ( 1 cm heel height)

Foot orthosis( 3 mm tape foam) with 3cm padeline foam compensation (1 cm heel height)

Positive model with Foot orthosis ( 1cm heel height)

In case of fixed equines, shortening should be compensate accordingly and align the appliance on 90 degree.In those cases contra lateral compensation may needed.