Orthotics to Improve Pain in a Patient With Multiple Internal Fixations and Multilevel Thoracic Fusion

Area of Science:

• Orthopedics
• Traumatology
• Physical Medicine and Rehabilitation

Background:

• A 24-year-old male sustained complex pelvic and spinal injuries from a parachute jump.
• Initial surgical management included sacroiliac joint fixation, pubic symphysis fixation, bilateral femur ORIF, and thoracic spine fusion.
• The patient reported persistent back, hip, and knee pain postoperatively, refractory to conservative treatments.

Purpose of the Study:

• To describe the successful management of chronic post-traumatic pain following extensive orthopedic surgery.
• To evaluate the efficacy of gait correction through custom orthotics in alleviating persistent pain.

Main Methods:

• A patient with chronic post-surgical pain underwent a comprehensive physical examination focusing on gait and biomechanics.
• Treatment involved the implementation of a left-sided heel lift integrated into custom molded orthotics.
• The primary outcome measure was the patient's self-reported pain score.

Main Results:

• The custom orthotic intervention with a heel lift effectively leveled the sacral base.
• A significant and simultaneous decrease in self-reported pain scores for back, hip, and knee was observed.
• This non-invasive approach provided substantial pain relief after multiple failed treatments.

Conclusions:

• Gait correction using custom orthotics and a heel lift can be an effective treatment for persistent post-traumatic pain after complex orthopedic injuries.
• Biomechanical alignment, specifically sacral base leveling, plays a crucial role in managing chronic pain syndromes.
• Physical Medicine and Rehabilitation offers valuable non-operative solutions for complex pain management post-orthopedic trauma and surgery.