Need your input on new diagnosis. - Cerebral Palsy Message Board

Flycatcher · 07-21-2004, 08:24 PM

I had an appointment today for orthotics evaluation. This was by a chiropractor recommended by my pain mgmt. doc (no chiropractic "adjustments" were planned, only the orthotics). He sent me in for a series of x-rays (standing position) and the results were amazing. One hip and pelvic arch are 8cm lower than the other side... but it's the right hip (I'm left hemiplegic)! At first I tried to argue that the film was backward because I know for a fact the left leg is shorter - and he agreed that it is but said the strong side offset is caused by the pelvis and hip rotating forward to compensate for the shorter leg on the other side.

I understand the hip joint can rotate but one half of my pelvis??? Okay, I'm willing to accept the possibility that the strong side has contorted itself to allow the shorter leg to reach the ground, but he wants to put the heel lift in my right shoe to raise the pelvis on that side. Now, I'm thinking that if he does that it may very well level out the pelvis and hip joints temporarily but could eventually cause the right hip to rotate further than it already has and make the whole problem worse. I already feel like I'm walking sideways on a hill and now he seems to want me rolling off it.

It seems to me like a no-brainer that the lift should go under the shorter leg in order to even out the leg length discrepancies, that's how my leg braces & raised shoe were set up when I wore them as a kid. Once that's accomplished I'd think the right side hip rotation would have a better chance at re-aligning itself to where it should be, provided the rotation hasn't become permanent over the years. The only good point is that the orthotics are custom moulded shoe insoles and the lift itself fits underneath, attached by velcro. By his own admission it would work in either shoe. Wanna guess what I'll be trying as soon as I get them home?!

If anyone has any thoughts or experience to share please, speak up. Am I way off base or is this guy going to turn me into something worse than I already am? Oh yeah... he also says I've got scoliosis in my cervical and thoracic vertebrae. I basically already knew, or at least suspected that but it still sucks to hear it from a medical professional.

Sorry, just bummed out tonight to have another doctor who isn't really listening, you know what that's like.

Jack

lastramy · 07-22-2004, 04:36 PM

Jack,

Keep that chin up, and know that you are not alone with having miserable doctors appointments. I have L hemiplegia with the left leg shorter and the lift they wanted me to try would go in the left shoe.
There is credibility on the rotation and compensation theories that were talked about but trying to fix something that is not broken concerns me too.
I was told in physical therapy that a lift in the shoe might create negativity in the right side (compensation issues). So, I go on without shoe lifts. My AFO has a plate that goes into my shoe and takes up space so an additional lift in the shoe would be just plain crowded. THey wanted to then put the lift on the outside (attached to bottom of shoe) and I told them no thanks!

All in all I think I agree with your thinking on this and would probably ask for another opinion before I would put them in the right shoe.
Interesting!

Lastramy

Flycatcher · 07-23-2004, 05:17 AM

Thanks Lastramy, it's good to have your input. My childhood leg braces were set up sort of like your AFO but with the elevated outer sole... on the left shoe.

I'd already set an appointment with the orthopedic surgeon that performed my lumbar fusion before all of this developed so my current plan is to keep that appointment, bring along copies of those x-rays and get his opinion on how to proceed.

I forgot to mention in the original post that the orthotics guy was looking at both the ball joints in the hips and the iliac crest positions of the pelvis. The problem is that my surgeon harvested part of the RT iliac crest for use in my fusion and he told me once it takes six years to fully return to normal. The hips ARE offset and a basic insole type orthotic seems like a reasonable thing to try but I really do want my ortho's advice before to far along with this.

I just noticed that I'd listed the offset as 8cm in my original post, I think that should probably be 8mm (roughly 3/8"). The actual leg length deficit has been measured at 2" several times since childhood, the last time being at my EMG after the 2002 surgery.

The reasoning behind all these attempts to get help is that I'm currently losing a lot of time off from work due to chronic pain. I've missed three weeks in the last two months, not including drs. appointments and now am only able to work half days. Being a State Government employee on AWOL time it's only slightly less serious than in the military and this will shortly cost me my job - they were talking that over yesterday. I just don't know what else I can do about it.
Jack

lastramy · 07-23-2004, 04:02 PM

Jack,

I think you are handling things just right. We need to keep on top of our healthcare as looking down the road doesn't look so good if we don't.
Don't worry about the job, things will work themselves out. Your health comes first.
A 2" difference is quite a bit! What was the back fushion for??

I don't have scoliosis or any major hip problems, but I did get an epidural at L5 for pain control. It worked very well.

Well keep us posted on how everything goes.
Take care and keep the positive vibes flowing!

Lastramy

Flycatcher · 07-23-2004, 09:58 PM

Lastramy:
I had a ruptured disc at L4-L5, a herniated disc at L5-S1, severe stenosis and a few other things going on that conservative treatments hadn't helped. It was primarily caused by an old work injury but two emergency trips to West Virginia around Christmas of 2000 pretty much did me in.

Found out from a coworker today that they do intend to fire me, that'll most likely happen next Friday. The real kicker is that my wife's having her second epidural steroid injection on that day (two herniated discs in her neck) so I'll be out taking care of her.

All in all I know I've done everything I can to overcome this back problem but with the CP causing its own complications there's no way I'll ever be completely over this. I've worked well beyond my limits and it's really doing more harm than good trying to work at all. I guess it's probably best for my health but the financial concerns are overwhelming at the moment.

Actually I'm much calmer than I thought I'd be right now. I know somehow things will work out in the end.
Jack