The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals.

OBJECTIVE

To determine the effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals.

DESIGN

Weight bearing on the paretic side was measured in patients with hemiparesis during quiet standing and in conditions of compelled weight shift.

SETTING

Free-standing acute inpatient rehabilitation hospital.

PARTICIPANTS

Nine individuals with hemiparesis as a result of unilateral stroke who were able to stand for 3 to 5 minutes without assistance or rest, and satisfied other inclusion criteria.

INTERVENTIONS: Compelled shift of the body weight was induced with different shoe wedges (5 degrees, 7.5 degrees, 12.5 degrees) or shoe lifts (0.6, 0.9, 1.2cm), which extended under the entire shoe of the unaffected limb. Weight-bearing symmetry scores were used to characterize the symmetry of stance.

MAIN OUTCOME MEASURES: Weight-bearing symmetry scores.

RESULTS

Without a shoe wedge or a shoe lift, weight-bearing symmetry was characterized by underloading of the paretic limb (39.90% +/-.80% of body weight). Weight shift induced by shoe wedges or shoe lifts applied to the unaffected limb promoted improved symmetry of weight bearing and stance. A shoe wedge of 5 degrees provided the most symmetrical weight distribution (51.44% +/- 1.88% of body weight).

CONCLUSION

Shoe wedges and shoe lifts under the unaffected limb induced compelled weight shift toward the paretic limb, resulting in improved symmetry of stance of individuals with mild hemiparesis. We suggest that improved symmetry of bipedal standing obtained with a shoe wedge or a shoe lift applied to the unaffected limb can help overcome the learned disuse of the affected limb. We further suggest that weight distribution induced by shoe wedges or shoe lifts may help in the treatment of ambulatory hemiparetic individuals with asymmetrical stance caused by unilateral stroke.