Contralateral shoe-lift: Effect on oxygen cost of walking with an immobilized knee

Design: A prospective quantitative evaluation of oxygen cost of walking under varying conditions. Subjects walked (1) normally (N), (2) with one knee immobilized (I), (3) with one knee immobilized and with a one-half-inch shoe-lift applied to the contralateral shoe (I1/2 '' L), and (4) with one knee immobilized and with a one-inch shoe-lift (I1 '' L). Setting: Exercise: physiology laboratory. Subjects: Ten able-bodied subjects without known cardiopulmonary or musculoskeletal problems Main Outcome Measure: Breath-by-breath oxygen consumption measurements in mL/kg/m. Results: Oxygen cost on average was 20% more with the knee immobilized (I) compared to normal (N) (mean difference = .0298 +/- .0245 mL/kg/m, p = .002). Oxygen cost was significantly less (11% versus 20% above that of normal walking) with the half-inch shoe-lift (mean difference between I1/2 '' and I = .0167 +/- .0138 mL/kg/m, p = .002). Similarly, oxygen cost was significantly less (12% versus 20% above that of normal walking) with the one-inch shoe-lift (mean difference between I1 '' L and I = .0142 +/- .0116, p = .002). Conclusion: This study demonstrates that a subject with an immobilized knee requires less energy to walk with a contralateral shoe-lift and provides scientific evidence for prescribing a shoe-lift in patients with an immobilized knee as a result of knee joint fusion, knee immobilization as a result of casting or orthotics, or spastic paretic stiff-legged gait associated with upper motor neuron disease. (C) 1996 by the American congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation