Leg Length Discrepancy at Whole Family Chiropractors
What is a Short Leg / Leg Length Discrepancy?
Do you feel like one leg is shorter than the other or one leg is longer than the other leading to hip, knee, ankle or back pain? Has someone said you have a scoliosis? The field of leg length inequalities or leg length discrepancy, often abbreviated as LLD, is well documented and understood. There are two types of short legs: functional (functional LLD) and structural (true LLD). A functional short leg occurs as a result of muscle imbalances, pelvic torsion or other mechanical reasons. The millimeters of ‘appearing’ short are typically very few, and do not appear on X-ray. This article is about structural or anatomical short legs which we can objectively measure using X-ray.
An anatomical short leg is due to several orthopedic or medical condition mechanisms. Often, one leg simply stops growing before the other one does and is called ‘congenital’. We often see mother-daughters or father-sons who exhibit virtually the same degree of shortness on the same side. Often it is not known why this occurs, but it seems to account for approximately 25% of the population demonstrating a true LLD.
Other causes of a true Leg Length Discrepancy include trauma or broken bones, surgical repair, joint replacement, radiation exposure, tumors or Legg-Calves-Perthes disease.
What are the effects of Leg Length Discrepancy (LLD)?
The effects of a short leg depend upon the individual, the extent of discrepancy, their activity level and their age. The most common manifestation if a lateral deviation of the lumbar spine toward the short side with compensatory curves up the spine that can extend into the neck and even impacts the TMJ. Studies have shown that anterior and posterior curve abnormalities also can result.
The Relation to Scoliosis
Idiopathic is a word that means, “we don’t know why”. Idiopathic scoliosis is the thing they screen kids for and the prevalence is less than 4% of the population. However, a recent study reported that 70% of idiopathic scoliosis cases have a short leg! That means that only 30% are really idiopathic! Most scoliosis doctors evaluate kids with crooked spines and perform surgery or fittings for spinal braces and NEVER evaluate leg length!
Frequently Asked Questions
What are the symptoms I may notice if I have a short leg?
How could I screen at home for this?
- Look in the mirror: Are your shoulders and collarbone even or is one higher than the other?
- Does your head tilt to one side? (look at your earlobes!)
- Does one hip or kneecap (patella) appear higher than the other?
- Do you find that you need to have dress pants hemmed different amounts on each side?
- Do skirts seem to fall unevenly?
- Has a podiatrist told you that you should get orthotics?
- Has a massage therapist commented that the muscles on one side are much tighter than the other and you don’t engage in asymmetrical one side dominant activities regularly? (i.e. golf, pole dancing, softball throwing)
- If you turn a well-worn pair of hard soled shoes upside-down, is one shoe more worn than the other? (it’s probably the LONG leg that is worn down!)
Could I have both a functional LLD and a structural LLD?
I’ve been told I pronate, wouldn’t orthotics be the best solution?
Can this condition correct itself?
If the patient is a child, the answer is different. Bones grow from the ends, at a place called the growth plate, not from the middle. When we have an adolescent where we suspect a significant short leg, we take an x-ray and evaluate how short it is and how close to skeletal maturity the person is. When they are within a year or two of skeletal maturity (typically 15-16 years of age), we refer them to a pediatric orthopedist who then monitors and at the right moment, injects a solution to stop the long leg from growing any more and allow the short leg to catch up.
What type of treatment is there?
When we get close to balancing a patient by lifting a leg with heel inserts, then we perform another gait analysis and follow up xray. At that point, we can typically write them a final prescription to have their shoe modified.
A heel lift is typically fine up to 7 mm. When it gets higher than that, the entire shoe must be modified. There are two reasons for this:
- The back of the shoe is generally too short to accommodate more than 7-8 mm inserted inside the shoes, and;
- A heel lift greater than 7 mm will lead to Achilles tendon shortening, which then creates it’s own panoply of problems.
Who modifies a shoe, how is it done and what does it cost?
There are some podiatrists who can modify shoes, but typically it is a pedorthist who does this. These people are highly skilled modern cobblers, who have facilities to custom alter shoes. The lift is often incorporated into the sole of the shoe, in the same color, and between the bottom of the shoe material and the surface sole of the shoe. A prescription is required and each pair is custom modified.
In our market in Austin, there are only two pedorthists who do this work. A full shoe modification runs between $60-$70 and many insurance companies will reimburse the patient for this service if it’s deemed medically necessary. A permanent lift that his just a heel lift, cost significantly less—around $25-$30.
But I have 65 pairs of shoes, how can I modify all of them?
The tremendous upside is that an anatomical leg length discrepancy is not only easily managed, but the correction of it often has significant positive effects on quality of life and an individuals ability to fully participate in the activities they love.
The doctors at WFC are full spine adjustors interested in restoring proper biomechanics, structure and function in a body. A working body, in the absence of nervous system compromise, tends to not only heal itself, but to also go far in maintaining optimal homeostasis. Our goal is to ultimately provide wellness care, similar to a dental cleaning, rather than merely pain relief and late intervention strategies. Early intervention can help prevent or minimize ongoing degeneration, especially when combined with soft tissue therapies and home stretching and strengthening techniques.
Though we work with many athletes and many children, our particular brand of biomechanistic evaluation works well for any population. We have created a network of carefully selected medical specialists to whom we feel confident in referring our patients.
The critical sub-specialty that sets us apart from other offices and doctors is the evaluation and management of structural leg length inequalities.
Highly trained and experienced doctor, massage therapy and staff make the office not only run smoothly and with great efficiency, but also allows us to genuinely focus on patient’s needs rather than our own. The state of the art clinic is outfitted with the best that technology has to offer. From EHR software that allows the office to easily transfer notes, files, reports and X-rays to other health providers to touchscreen check-in, online forms, in office iPad patient and doctor notes and the latest digital X-ray equipment. Our three clinical massage therapists have multiple and ongoing advanced trainings and a combined experience working in spinal clinics of over 40 years.
Learn More About Leg Length Discrepancy in Mueller
To find out whether you might have a short leg, contact Whole Family Chiropractors today!
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Jan 16, 2017 at 3:31 AM
My left hip is higher than the right hip. My right pant leg has to be hemmed shorter than the left pant leg because my right leg is shorter than the left. I have right hip pain and low back pain at times and gait change.....scoliosis in the thoracic area of the backbone....also have muscle and nerve pain in both legs accompanied by weakness. Any advise will be appreciated Thanks
Feb 02, 2017 at 10:50 AM
We'd be happy to evaluate you for the pain you're experiencing. Dr. Paris can certainly help with all those and save you a bit on hemming those pants! Call us today! 512-505-8500