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Tomasz Poboży

Kategoria: Patient Knowledge (EN)

Evidence-informed orthopaedic information for patients in English: symptoms, injuries, diagnostics, treatment, surgery and recovery.

  • Rotator Cuff Tears — When Is Surgery Needed?

    Rotator Cuff Tears — When Is Surgery Needed?

    PATIENT INFORMATION · SHOULDER

    We very often consider surgery for full-thickness tears, but it is not always necessary.

    The cause and size of the tear, tissue quality and shoulder function all matter. A recent, large traumatic tear with sudden weakness needs prompt assessment and may favour early repair.

    Shoulder weakness during clinical assessment of a rotator cuff tear. Medical content prepared by: Tomasz Poboży - orthopaedic surgeon.

    PODCAST · DOCTOR POBOŻY ON HEALTH

    Rotator Cuff Tears — When Is Surgery Needed?

    An English episode about early repair after injury, individual rehabilitation, imaging and the role of injections.

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    What does a rotator cuff tear mean?

    The rotator cuff consists of the tendons of four muscles surrounding the head of the upper arm bone. They stabilise the shoulder and help lift and rotate the arm. Tears most often affect the supraspinatus tendon, sometimes extending into part of the infraspinatus tendon.

    A tear can involve part or all of the tendon’s thickness. It may occur suddenly after a fall or a forceful pull, but often develops gradually with degenerative tendon changes. Pain when raising the arm, weakness and difficulty sleeping on the affected side are common symptoms.

    An abnormal scan does not establish the source of every symptom. Some tears cause little pain; symptoms may also arise from the subacromial bursa, the long head of the biceps tendon, stiffness or arthritis. Findings need to be matched to the examination.

    When is earlier surgery preferable?

    A recent, large traumatic tear, especially with sudden weakness or inability to lift the arm, usually favours early surgical repair. If the tendons are repairable and the patient’s health permits surgery, there is no need to complete months of rehabilitation first.

    Prompt orthopaedic assessment is important. Tendon retraction, muscle wasting and fatty changes can make later repair more difficult. The timing is planned individually after assessment; this does not mean that every tear needs emergency surgery on the day of injury.

    Other reasons to consider surgery include persistent pain, weakness and functional loss despite appropriate nonsurgical treatment, a repairable tear at risk of progression, and substantial work or sports demands. No single age or tear-size threshold settles the decision for every patient. [1, 2]

    When can treatment start without surgery?

    For many gradually developing tears, particularly smaller ones without major loss of function, individual rehabilitation is a reasonable starting point. This also applies to some symptomatic full-thickness tears. Both physiotherapy and surgery can improve outcomes in small and medium full-thickness tears. [1]

    Treatment involves adapting activities that worsen pain, restoring movement, improving rotator cuff and shoulder blade muscle strength and control, and gradually increasing loading. It is an active plan, not simply avoiding use of the arm. Pain medicines are selected individually, taking contraindications into account.

    Pain relief does not necessarily mean the tendon has healed. Tear size, muscle wasting and fatty changes may progress in some patients, so symptom improvement and tendon condition both need follow-up. [1, 3, 4]

    What do longer-term studies show?

    In the prospective MOON cohort of 452 patients with symptomatic, atraumatic full-thickness tears, more than 70% were managed successfully without surgery. Patient-reported outcomes improved in the first months and did not decline over ten years among those continuing nonsurgical care. These findings do not mean that every tendon healed or that surgery is unnecessary for every tear.

    Long-term comparative research also supports the importance of repair in selected patients and monitoring of tear progression. Conservative management means reviewing function, symptoms and tissue condition rather than leaving the problem unassessed for years. [3, 4]

    Ultrasound, MRI or X-ray?

    Assessment starts with the history and examination. Combining examination findings is more useful than relying on one provocative test. Imaging should answer a clinical question rather than replace the examination. [1]

    What can ultrasound show?

    Ultrasound assesses tendon continuity, the location and extent of many tears, the biceps tendon and bursa. Selected structures can be observed during movement. It is a useful examination when performed and interpreted by an experienced clinician.

    When is MRI useful, and what do X-rays add?

    MRI helps assess tendon retraction, muscle wasting and fatty changes, and deeper shoulder structures. It is particularly useful for surgical planning or when examination and ultrasound leave important questions unanswered. X-rays add information about bones, joint alignment and arthritis.

    Injections: different treatments, different aims

    Corticosteroid: an injection into the subacromial bursa may reduce inflammation and pain, but does not repair a torn tendon. Repeated injections require caution, particularly when tendon repair is planned. They should not be used to indefinitely postpone indicated surgery. [1]

    Platelet-rich plasma (PRP): in selected partial tears, including splits within the tendon, treatment may be considered with the aim of supporting repair processes. Results are mixed; routine PRP use for partial tears is not supported by the AAOS guideline. Improvement in symptoms should not be equated with proven structural healing. [1]

    Injectable platelet-rich fibrin (i-PRF): this is also being investigated, but evidence in these injuries remains limited. Published case reports involving liquid fibrin do not establish its superiority to PRP. Neither blood-derived treatment replaces surgery when surgery is needed. [5]

    How is the tendon repaired?

    Repair is most often arthroscopic, through small incisions. The tendon is secured to its attachment on the upper arm bone using anchors and sutures. The aim is to restore the attachment without excessive tension. The configuration, number of anchors and single- or double-row technique depend on tear size and shape, tendon quality and how far the tissue can be mobilised.

    Healing matters: healed repairs are associated with better functional outcomes than unhealed repairs and, in comparative studies, physiotherapy alone. Tissue quality, repair tension and biological healing potential therefore influence planning. [1, 2, 4]

    Rehabilitation after repair

    The repaired tendon needs protection and gradual rehabilitation following the orthopaedic surgeon’s instructions. Exercises used before surgery are not automatically suitable immediately afterwards.

    Postoperative protocol — for clinicians →

    The linked protocol concerns small and medium tears. Extensive or additional repairs require individual restrictions.

    What if the tear is extensive or irreparable?

    Not every extensive tear can be fully repaired. Marked retraction, advanced muscle wasting or fatty changes may make reattachment under acceptable tension impossible. Options depend on function, arthritis, health, age and goals, and may include nonsurgical care, partial repair, a biceps procedure, selected reconstructions, tendon transfers or a reverse shoulder replacement.

    A publication co-authored by Tomasz Poboży described ultrasound-guided implantation of a biodegradable subacromial spacer in one patient with a massive irreparable tear. This technical case report is not a basis for routinely recommending a spacer to everyone with an extensive tear. [6]

    How long should nonsurgical treatment continue?

    There is no compulsory rehabilitation period for everyone. Treatment may continue if it improves pain, movement and daily function and the tear’s characteristics allow ongoing nonsurgical care.

    A recent, large, repairable traumatic tear with major strength loss is different: early repair is usually preferred when health and tissue condition permit. Surgery should not be delayed merely to complete an arbitrary number of months of exercise. Progression of the tear or deterioration in muscle quality also calls for reassessment.

    When should you seek prompt help?

    • Sudden marked weakness or inability to lift the arm after an injury.
    • Deformity or suspected dislocation or fracture.
    • A hot, red shoulder with fever or feeling unwell.
    • New sensory changes or increasing arm weakness.
    • Unusually rapid deterioration or general symptoms such as unexplained weight loss.

    What should you remember?

    Full-thickness tears often lead us to consider surgery, but the decision is individual. Recent, large traumatic tears need prompt treatment planning, often with early repair. With gradually developing changes, nonsurgical care may provide lasting improvement. Symptoms, function, examination and tissue condition should guide the decision together.

    References
    1. American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries: Evidence-Based Clinical Practice Guideline. 2025. Guideline.
    2. American Academy of Orthopaedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. OrthoInfo. Patient information.
    3. Kuhn JE, Dunn WR, Sanders R, et al.; MOON Shoulder Group. 2024 Kappa Delta Ann Doner Vaughan Award: Nonsurgical Treatment of Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears—a Prospective Multicenter Cohort Study With 10-Year Follow-Up. J Am Acad Orthop Surg. 2024;32(23):1061–1073. doi:10.5435/JAAOS-D-24-00841.
    4. Moosmayer S, Lund G, Sire Seljom U, et al. Fifteen-Year Results of a Comparative Analysis of Tendon Repair Versus Physiotherapy for Small-to-Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am. 2024;106(19):1785–1796. doi:10.2106/JBJS.24.00065.
    5. Ogéus T. Treatment of a fractured humerus and partially torn supraspinatus tendon in a professional boxer with liquid platelet-rich fibrin and heat-coagulated albumin gel: a case report. J Med Case Rep. 2024;18:124. doi:10.1186/s13256-024-04458-7.
    6. Poboży T, Kielar M, Miąskiewicz J. Ultrasound-guided biodegradable subacromial spacer implantation in a patient with massive irreparable rotator cuff tears. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):145–148. doi:10.5114/wiitm.2018.77555.

    Tomasz Poboży - orthopaedic surgeon, MD, PhD — specialist in orthopaedics and musculoskeletal traumatology.

    Educational material; it does not replace an individual medical consultation, examination or treatment plan. Updated: 28 September 2026.

  • Starting Pain — Why Do the First Steps After Rest Matter?

    Pain that is strongest during the first steps after getting out of bed or after sitting for a while is sometimes described as “starting pain”. It is a useful symptom pattern because it shows how symptoms respond to rest and renewed loading. It does not, however, point automatically to a single diagnosis.

    How does an orthopaedic surgeon interpret “first-step pain”?

    The pattern matters. Some people notice that the first several steps after sleep or a longer period of sitting are the most painful, that symptoms then ease partly with movement, and that pain may increase again after prolonged walking or exercise. Constant pain that worsens with every step is a different pattern, as is sudden pain after an injury.

    These differences can help organise the diagnostic process, but they do not replace an examination. The exact location of pain, duration of stiffness, swelling, strength, range of motion and response to increasing load all matter.

    When the pain is under the heel

    Pain with the first steps after rest is a typical feature of plantar heel pain associated with plantar fasciitis. It is usually felt on the plantar-medial side of the heel. The 2023 clinical practice guideline includes first-step pain after rest among the characteristic clinical features, while also stressing that other causes of heel pain need to be considered.

    Not every episode of morning heel pain has the same cause. Recent trauma, burning or numbness, more diffuse pain in the heel bone, or symptoms associated with inflammatory disease require a different assessment. See also: Foot and Ankle Conditions.

    When the Achilles tendon feels stiff

    Morning stiffness and pain after inactivity can also occur with midportion Achilles tendinopathy. Symptoms may change during walking or training, so the beginning of activity is only part of the picture; the response during loading and afterwards is important as well.

    A sudden snap, a marked loss of push-off strength or difficulty rising onto the toes does not fit the usual gradual pattern of tendinopathy and should prompt earlier assessment for a possible tendon rupture.

    Why the symptom name is not enough

    Pain that “warms up” with movement is not necessarily trivial, and pain after rest does not automatically mean there is damage that needs a procedure. Similar descriptions can come from different tissues and conditions. Imaging does not settle every case either: ultrasound, X-ray or MRI findings need to be interpreted alongside the site of pain and functional examination.

    Before a consultation, it can be useful to note how long a period of rest triggers the pain, how many steps or minutes it takes to ease, whether symptoms return after longer walking or exercise, where the most painful point is, whether there is swelling, warmth, numbness or weakness, and how the area feels the next day after greater loading.

    When is earlier assessment important?

    “Starting pain” should not be used to explain away a sudden loss of function after injury, inability to bear weight, visible deformity, rapidly increasing swelling, a hot red joint with fever, or new loss of sensation or strength. Persistent pain at rest or at night also deserves earlier assessment when it is worsening or does not follow the usual relationship with movement.

    The whole symptom pattern matters

    When pain appears is only one part of the history. Combined with its location, response to load and examination findings, it can help distinguish several possible sources and decide whether imaging is needed. First-step pain alone should not be used to self-diagnose a condition or choose insoles, an injection or a procedure.

    References

    1. Koc TA Jr, Bise CG, Neville C, Carreira D, Martin RL, McDonough CM. Heel Pain — Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1–CPG39. DOI: 10.2519/jospt.2023.0303.
    2. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision — 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1–CPG32. DOI: 10.2519/jospt.2024.0302.

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    Polish version: Ból startowy — dlaczego pierwsze kroki po odpoczynku są ważne?

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Medical AI With a “Safety Brake”: Promising Results in Simulated Cases

    Researchers developed a locally deployed medical AI system that not only proposes a diagnosis but also checks how consistently it reaches the same answer across repeated runs. On two retrospective clinical-reasoning benchmarks derived from MIMIC-IV data, the agent achieved diagnostic accuracy of 90.04% and 83.8%. When a very high consistency threshold was used, 49.4% of cases were retained for potential autonomous handling, with 98.9% diagnostic accuracy in that selected subset; less stable cases were deferred for human review.

    For an orthopaedic surgeon assessing future clinical AI tools, this is an interesting approach to building a practical “safety brake” into such systems, but it is not evidence that such a system is ready to make independent decisions for real patients. All evaluations were retrospective simulations, the main benchmarks came from one data environment, and the threshold depended on the technical configuration. Prospective studies, independent validation and dedicated safety and bias assessments are still needed.

    Source: Zhang L, Wölflein G, Ferber D et al. On-premise medical AI agents for reliable clinical decision-making. Nature Medicine. Published online 15 September 2026. DOI: 10.1038/s41591-026-04609-x. Full open-access article reviewed; source checked 16 September 2026.

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    Polish version: Medyczne AI z „hamulcem bezpieczeństwa”: obiecujące wyniki w symulowanych przypadkach

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Worn Shoes Under the Microscope — A Clue, Not a Diagnosis

    Wear on a shoe sole can draw attention to asymmetry, the way the heel meets the ground or a difference between the right and left side. It can be a useful clue during a musculoskeletal examination, but it is not a diagnosis. The same wear pattern may result from several factors, including the design of the shoe, walking style, the surface used, mileage and repeated movement habits.

    What does an orthopaedic surgeon actually look at?

    The worn area of the outsole is only one part of the picture. It is useful to compare both shoes, see whether the upper leans or deforms, note where material is stretched and look for obvious pressure marks on the insole. The shoe itself also matters: sole height and stiffness, cushioning and fit can all influence how the limb is loaded.

    In a study that analysed 252 people, centro-lateral or lateral heel wear was far more common than medial wear. The investigators found associations between some gait features, knee alignment and shoe-wear patterns, but also identified effects of sex and body dimensions and limitations of visual assessment. These findings describe relationships within the study group; the appearance of a sole alone cannot diagnose valgus, varus or the cause of pain.

    Why can the same wear pattern have different causes?

    A shoe records the effect of thousands of steps, but it does not record the whole context. Running shoes used mainly on asphalt wear differently from work footwear or a pair worn mostly while driving. Sole materials also differ. Body weight, walking speed, surface, previous injuries and how long the shoes have been used can all contribute.

    Marked asymmetry is therefore the start of a question, not the answer. It should be considered together with symptoms, examination of the feet, knees and hips, limb alignment and gait observation. Sometimes pressure measurement, strength testing or movement recording adds useful information; sometimes the clinical examination is enough. Insoles or attempts to alter gait should not be prescribed from a photograph of the outsole alone.

    When is it worth bringing your shoes to an appointment?

    • when pain mainly appears during walking, running or work in particular footwear;
    • when one sole wears noticeably faster than the other;
    • when you use insoles, heel lifts or other shoe modifications;
    • when symptoms keep returning despite changing shoes;
    • when symptoms involve the foot, ankle, knee, hip or lower back.

    Bring the pair you use most often and, if symptoms are related to sport or work, the footwear used for that activity as well. An older pair may reveal more than a new one, but it helps to know how long it was worn and in what conditions. Bring any insoles you regularly use too.

    Shoes do not replace examination

    Outsole wear can help direct attention to a particular aspect of movement, but it cannot by itself explain the source of symptoms. A similar pattern may be present in someone without pain and in someone with a problem that requires treatment. The useful interpretation comes from combining the history, physical examination and observation of function, particularly when pain is worsening, limiting weight bearing or followed an injury.

    Explore patient information · Polish version

    References

    1. Soon J, Lee DW, Choi GR, Kim KJ, Bahn S. Identification of Gait and Personal Factors Associated with Shoe Abrasion Patterns. Int J Environ Res Public Health. 2022;19(19):12558. DOI: 10.3390/ijerph191912558.
    2. Finestone AS, Petrov K, Agar G, Honig A, Tamir E, Milgrom C. Pattern of outsole shoe heel wear in infantry recruits. J Foot Ankle Res. 2012;5:27. DOI: 10.1186/1757-1146-5-27.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • A First-Trimester Blood Protein May Signal Preeclampsia Risk

    Researchers measured 2,904 proteins in blood samples taken at about 12 weeks of pregnancy and found that low levels of isthmin-2 (ISM2) were the strongest protein signal associated with later preeclampsia or fetal growth restriction. The association was reproduced in two independent cohorts. Laboratory experiments with human trophoblast stem cells also showed that reducing ISM2 impaired the invasive behaviour needed for normal placental development, providing biological support for the clinical observation.

    An orthopaedic surgeon reading research from other specialties should note the study design: this was observational research in pregnant women supplemented by laboratory experiments, not a trial of a new treatment. ISM2 may eventually contribute to earlier risk assessment or become a research target for prevention, but it is not yet a diagnostic test or an available therapy. The cohorts were predominantly from northern Europe, so the findings need confirmation in larger and more diverse populations.

    Source: Miao R, Gong S, Sovio U, et al. Isthmin-2 is a first-trimester predictor of preeclampsia and fetal growth restriction. Nature Medicine. Published online 1 September 2026. DOI: 10.1038/s41591-026-04573-6. Verified 16 September 2026. Access: full open-access article and PubMed record; no correction or retraction was identified in the sources checked.

    Polish version · More General Medical Discoveries

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Old Injury, New Pain — Why Does Previous Treatment Matter?

    New pain does not always start from a blank slate. An old injury, previous operation or prolonged period of immobilisation can change joint structure, the way a limb is loaded and the appearance of imaging studies, so an accurate history of earlier treatment can be important when assessing a new problem.

    An old injury can leave important context

    An intra-articular fracture or an injury to a ligament, meniscus or cartilage can affect stability, alignment and load distribution long after the initial healing period. In a meta-analysis of 131 studies, previous knee injury was associated with a higher risk of later radiographic knee osteoarthritis. That is useful information about risk, but it does not prove that every new pain appearing years later is caused by the old injury.

    The name of an operation is often not enough

    Saying that someone had “knee arthroscopy” or “shoulder surgery” does not tell us exactly what was done. A procedure may have involved repairing or partially removing a meniscus, repairing a tendon, stabilising a ligament, removing a loose body or combining several procedures. Those differences can affect how scars, range of motion, strength, stability and later imaging are interpreted.

    The type of implant, the position of anchors or screws, associated procedures and any complications may also matter after surgery. A discharge summary, operative report and implant card can therefore be more useful than the remembered name of the procedure alone.

    Old images can show what has changed over time

    Comparing a current X-ray, MRI or CT scan with an earlier study may show whether bone alignment, joint-space width, implant position or another feature has genuinely changed. Without previous images, a normal residual finding after an old injury or operation may look concerning, while slow progression can be harder to recognise.

    Not every old finding explains current symptoms

    This is just as important. A screw seen on an X-ray, scar tissue on MRI or an old calcification may have nothing to do with the new pain. The clinician compares the history with the exact location of symptoms, when they began, movement and functional examination and, when needed, new imaging. The aim is not to blame everything on an old operation, but to separate background findings from the most likely cause of the current problem.

    What information helps an orthopaedic surgeon assess an old injury?

    • the approximate date and mechanism of the previous injury;
    • the name and side of the area that was operated on;
    • the discharge summary, operative report and implant card, if available;
    • previous X-rays, MRI or CT images together with their reports;
    • information about infection, wound-healing problems, reinjury or additional procedures;
    • a short timeline of when the current symptoms appeared after any period of improvement.

    Missing some of the documentation does not prevent a useful consultation. It is better to say clearly what is unknown than to guess the name of a procedure. Practical information about preparation and documents is also available in Patient Questions.

    When should you not wait?

    More urgent assessment is warranted after a new injury with inability to bear weight, rapidly increasing swelling, a hot red joint, fever, discharge from an old scar, sudden weakness or new sensory disturbance. In these situations, previous documentation can be valuable, but obtaining it should not delay medical assessment.

    References

    1. Duong V, Abdel Shaheed C, Ferreira ML, et al. Risk factors for the development of knee osteoarthritis across the lifespan: A systematic review and meta-analysis. Osteoarthritis and Cartilage. 2025;33(10):1162–1179.
    2. Dilley JE, Bello MA, Roman N, McKinley T, Sankar U. Post-traumatic osteoarthritis: A review of pathogenic mechanisms and novel targets for mitigation. Bone Reports. 2023;18:101658.
    3. Washington University Orthopedics. Introduction to Orthopaedic Surgery: History, Physical Examination/Imaging.

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    Polish version

    This material is educational and does not replace an individual medical consultation or examination.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • A Pig Kidney Provided 271 Dialysis-Free Days — Then Bridged to a Human Transplant

    Researchers have reported a patient with end-stage kidney disease who received a gene-edited pig kidney and remained independent of dialysis for 271 days. After months of initially stable function, microvascular injury developed and the xenograft eventually failed and was removed. Eighty-two days later the patient received a human kidney, which functioned immediately; during 231 days of follow-up, the investigators found no evidence that the pig kidney had caused clinically significant sensitisation that would hinder the human transplant. The case suggests that a gene-edited pig kidney might one day serve as a temporary bridge for selected patients facing a long wait for a human organ. An orthopaedic surgeon following advances in transplantation should distinguish a case report from established care: this was the first recipient in a planned three-patient study under an FDA expanded-access programme, not an established treatment, so durability, safety and rejection mechanisms still need to be studied in more people.

    Source: Riella LV, Borges TJ, Rosales IA, et al. Porcine kidney xenotransplantation as a bridge to allotransplantation: a first-in-human study. The Lancet. First published online 3 September 2026. DOI: 10.1016/S0140-6736(26)01295-X; checked 16 September 2026; access: full abstract and bibliographic record via PubMed and the publisher link; the publisher’s full text was not available in the access used.

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    Polish version

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • New Tick-Borne ALTNV Virus Identified in People in China

    General Medical Discoveries · Human observations plus laboratory and animal studies

    Researchers have described a newly identified tick-borne virus, Asian longhorned tick nairovirus (ALTNV), in people with fever after tick exposure in China. Among 3,163 such patients, ALTNV RNA or IgM antibodies were detected in 10.4%; 56 patients had ALTNV infection without concurrent Dabie bandavirus infection, and all of them recovered without sequelae. The virus was isolated from patient samples, detected in Haemaphysalis longicornis ticks, and experimental work showed that these ticks could transmit it to mice. Among 38 people coinfected with ALTNV and Dabie bandavirus, respiratory symptoms and renal impairment were more frequent and 7 patients died, but an orthopaedic surgeon or any other clinician interpreting these findings should note that this observational comparison cannot establish that ALTNV itself caused the greater severity. This is not a new treatment or a ready-to-use screening test; the main significance is recognition of another potential tick-borne human pathogen that now requires further epidemiological surveillance.

    Source: Zhang X-A, Liu B, Wu S-Q, et al. A Zoonotic Orthonairovirus from Febrile Patients in China. New England Journal of Medicine. Published online 2 September 2026;395:929–931. DOI: 10.1056/NEJMc2602496. Checked 16 September 2026; access: full article, supplementary material and PubMed record. No correction or retraction was found in the records checked.

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    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • One Leg Feels Shorter — What Should Actually Be Measured?

    Feeling that one leg is shorter does not always mean that the bones are actually different in length. Pelvic position, a hip or knee contracture, scoliosis, foot deformity or the way a painful limb is loaded can produce a similar impression. Before using a shoe lift, it is therefore important to establish what is actually being measured.

    Two different situations: anatomical and functional discrepancy

    An anatomical leg-length discrepancy means that the bony segments of one limb are genuinely different in length. It may be developmental or follow a fracture, bone deformity or surgery. A functional discrepancy occurs when bone lengths are similar, but the position of the pelvis, spine or joints makes one leg behave as though it were shorter or longer.

    For example, a knee that cannot fully straighten effectively shortens the limb in standing. A hip contracture, pelvic tilt or collapse of the foot can also change functional limb height. This is why assessment should not begin and end with a tape measure between two points on the skin.

    What does the orthopaedic examination look for?

    The examination starts with standing and walking, pelvic and spinal alignment, and the position of the feet. Hip and knee extension are checked because a contracture can mimic shortening. It also matters whether both legs are loaded equally and whether the perceived asymmetry changes when the pelvis is levelled.

    One useful screening method is the block test: blocks of known height are placed progressively under the apparently shorter side until the pelvis is approximately level. A systematic review found this to be the most useful clinical method among those assessed, but it does not replace imaging when an exact measurement is needed for an important treatment decision.

    Gait adds another layer of information by showing whether the asymmetry actually affects function. More: Why Does an Orthopaedic Surgeon Watch How You Walk?

    Why can home measurements be misleading?

    Bony landmarks are covered by soft tissue, and even a small change in pelvic position or tape direction can alter the result. Measuring from the waistband, navel or floor does not show which segment of the limb is responsible for the asymmetry. Hip rotation, knee flexion and foot position can also change the measurement.

    A home observation can be a good reason to seek assessment, but it is not enough to justify a permanent lift. If the apparent discrepancy is caused by a contracture or pelvic tilt, mechanically “levelling” the height may not address the real problem.

    When is a standing full-length X-ray useful?

    If the exact size of the discrepancy could change treatment, a standing radiograph that includes the entire lower limbs may be useful. It allows the femur and tibia to be measured separately and shows alignment and joint position under load. In the systematic review by Alfuth and colleagues, full-length standing anteroposterior radiography appeared to be the most valid and reliable imaging method among those assessed for anatomical leg-length discrepancy.

    Not everyone needs this test. If a small asymmetry causes no symptoms and would not change management, additional imaging may add little. After a recent injury, standing should not be forced simply to obtain a measurement. More about imaging under body weight: Why Do Weight-Bearing X-Rays Show More?

    Does every discrepancy need to be corrected?

    No. The number of millimetres is only one part of the decision. The cause, symptoms, age, ability to compensate and effect on walking also matter. Reviews of treatment indications emphasise that evidence for rigid thresholds is limited and that management should not be based on a single measurement alone.

    A shoe lift can be helpful in a properly selected situation, but it is not a neutral experiment for everyone. Rapidly correcting the full measured difference in someone who has adapted to an asymmetry for years can itself provoke symptoms. The amount of correction should therefore follow the examination and the aim of treatment, not a home tape measurement.

    What if the sensation started after hip surgery?

    After hip replacement, a perceived leg-length difference has to be distinguished from an actual change in bony length. Previous contractures, pelvic position, gait and soft-tissue tension can influence the sensation, although a true anatomical difference is also possible. There is no single interpretation based only on the name of the operation: the actual procedure, the examination and, when relevant, appropriately performed imaging all matter.

    A sudden sense of shortening after an injury or operation together with severe pain, deformity or inability to bear weight requires urgent assessment. In other situations, the first step is to establish whether the problem is anatomical, functional or mixed before trying to correct it.

    The key point

    “One leg is shorter” is a description of a sensation or observation, not a diagnosis. The pelvis, spine, joint range of motion, feet and gait should be assessed before deciding whether precise imaging measurements are needed. Treatment makes sense when it addresses the real cause and a meaningful functional problem.

    References

    1. Alfuth M, Fichter P, Knicker A. Leg length discrepancy: A systematic review on the validity and reliability of clinical assessments and imaging diagnostics used in clinical practice. PLoS One. 2021;16(12):e0261457.
    2. Vogt B, Gosheger G, Wirth T, Horn J, Rödl R. Leg Length Discrepancy—Treatment Indications and Strategies. Deutsches Ärzteblatt International. 2020;117(24):405–411.

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    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Loberamisal After Ischaemic Stroke: Promising Phase 3 Results

    General Medical Discoveries · Large randomised phase 3 trial

    The LAIS trial tested intravenous loberamisal, a drug being studied to protect nerve cells and support recovery after an ischaemic stroke. Among 997 patients treated within 48 hours of symptom onset, full or near-full functional recovery at 90 days was achieved by 69.7% of patients receiving loberamisal and 56.3% receiving placebo. For an orthopaedic surgeon following research on recovery of function, the result is encouraging, but the trial was conducted entirely in China, excluded patients treated with endovascular thrombectomy, and several secondary outcomes did not differ between groups. The findings therefore need confirmation in other populations and care settings before broader clinical use can be established.

    Source: Li S, Feng B, He D, et al. Loberamisal for Acute Ischemic Stroke: The LAIS Randomized Clinical Trial. JAMA. Published online 10 September 2026. DOI: 10.1001/jama.2026.16557. Checked 16 September 2026; access: full text on the JAMA website and PubMed record. No correction or retraction was found in the records checked.

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    Content prepared by: Tomasz Poboży - orthopaedic surgeon.