Short Leg Syndrome
When one leg is shorter then the other, it is medically referred to as Limb Length Discrepancy or Short Leg Syndrome. Having a shorter leg does indeed produce a variety of bodily symptoms, and the term “syndrome” is very accurate. Syndrome implies a multitude of symptoms.
In discussing limb length discrepancy we must consider that there are two distinct basic types of limb length shortages. There are those that are considered to be actually a structural shortage, whereby the limb is actually shorter than the opposite limb for a variety of reasons. The other type of limb shortage is considered to be a postural shortage, the limbs are actually the same length, but due to postural changes there is a shortage present. The symptoms may present identical but there could be a variation in the treatment based on whether the shortage is structural or postural.
Before discussing symptoms, let us look at the most common causes of a short leg:
- Congenital causes can include the position of the developing fetus.
- Birth injuries such as a dislocated hip sustained during delivery.
- Infections of or injuries to the growth plates in the leg during childhood.
- Injuries in adults, involving fractures or dislocations of the lower limb, even if properly treated.
- Surgery on the hip or knee may cause the leg to shrink.
- Poor posture, where the pelvis is tilted so that one side is higher then the other, thus making the leg on the high side of the pelvis work as if it was shorter than the other leg.
Symptoms may affect our entire body; from our feet to the way our teeth come together when we chew. People with a short leg usually compensate for this problem, and thus may cause other problems to occur. An example would be leaning towards the side with the short leg, trying to make its foot touch the ground while standing still. This puts pressure on the back and the pelvis, causing lower back and hip pain. Other symptoms may include the following:
- Knee pain in both the short and long legs.
- Sciatica, or inflammation of the nerves in the leg and lower back.
- Poor balance when walking and running.
- Foot and ankle pain.
Compensation: Our bodies are wonderful! When we have a problem the body tries to fix it; and, if it can’t, it tries to get around the problem by compensating for it. There are two common methods that our bodies use to equalize the length or our legs:
- Leaning towards the short leg, thereby trying to extend it and make the leg longer.
- Bending the short leg’s foot down and out, trying to make it longer. This is called pronation.
These methods of compensation may help our gait, or the way we walk, but they produce abnormal stress in lower back, hips, knees, ankles, and feet. This causes pain in these structures, especially when we are on our feet.
Diagnosis: There are two diagnostic methods you can try yourselves. These are not full-proof methods of diagnosing a short leg, but they can help. If you are not comfortable with these methods, then the next time you are at your doctor’s office, ask him or her to measure you for a limb length discrepancy. Here are the two methods of diagnosis I recommend:
- Stand with your back against the wall. Assume your normal posture; do not try to stand up straight. Have someone place the end of a tape measure on your belly button. Now measure each leg, from the navel to the bottom of your foot, and compare the measurements to see if they are equal, or within 1/8 of an inch. If they are equal, you probably do not have a leg shortage of any significance. If there is a difference greater than 1/8 inch, you should try the following diagnostic method to make sure your measurements were accurate.
- If the above method shows a shortage greater than 1/8 inch, or it did not and you still think you may have a short leg, then try this:
- Place a 1/4-inch thick foam heel pad in the heel of the short leg’s shoe.
- Walk at least 2 days with this pad in your shoe, unless it is causing increased pain. If increased pain is present, than you probably do not have a short leg.
- If you feel better after 2 days, but the pain is not completely gone, add another 1/4-inch pad to the heel, for a total height of 1/2 inch.
- Walk at least 2 days with this pad in your shoe, unless it is causing increased pain. If increased pain is present, remove about 1/8 inch of felt from the pad, and try it again for 2 days.
- In this manner you will not only learn if you have a shortage, but you will determine how short your leg is.
If self-measurement attempts have failed to relieve symptoms, your doctor can make an accurate assessment. Limb length measurements performed by the doctor should include postural as well as structural measurements. Due to a patient’s compensatory factor, there could be both types of shortages present. For instance, a patient has a shortened leg perhaps from knee surgery and he has learned to compensate for the shortage by tilting his pelvis when walking.
To relieve the pain of a short leg — whether the pain is in the feet, ankles, knees, hips, or lower back — you need to make both legs equal in length when walking and standing. Building up the sole and heel of your shoes does not help. These structures wear down rapidly and unevenly, causing the symptoms of the shortage to return. The only treatment that will permanently add height to the short leg involves the use of a custom-made orthotic. These comfortable medical devices, made from molds of your feet, will not wear down for years, thus saving you money and pain! They will also alleviate pains in the short foot caused by walking abnormally for years, such as calluses.
Our custom-made orthotics are made of comfortable, semi-flexible thermoplastic materials that have a “memory.” This memory allows the orthotic to comfortably compress with each step you take, and then return to its original height, providing comfort to the heels, arches, and balls of the feet. To compensate for the shortage, we add material to the orthotic for the short leg in the amount to overcome the shortage. We use long-lasting, semi-flexible materials that will last for years before wearing down.
An orthotic can also be designed to accommodate and relieve the pain of calluses, neuromas, chronic metatarsalgia, and other biomechanical defects that are causing pain in the short leg. If you have a shortage of 1/4 inch or less, you will be able to wear our orthotic in most dress shoes. If the shortage is greater than 1/4 inch, then you may need to wear walking shoes, gym shoes, or dress orthopedic shoes. An orthotic can also be modified so that if there is a shortage greater than 1/4 inch, the maximum can be added to the short side orthotic and the longer side orthotic device can be slimmed down in the heel area for an additional 1/8 to 1/4 inch correction.
In a younger patient that still maintains greater flexibility, if it is determined that the shortage is postural, consideration is sometimes given to increase the height at the heel on the longer limb in order to apply pressure to tilt the pelvis to normal symmetrical position. This often will relieve symptoms of low back pain. This process requires a doctor’s evaluation and a gradual application of lifts to the shoe or orthotic.