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Leg Length Discrepancy in Mueller

What is a Short Leg / Leg Length Discrepancy?

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 Mueller 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!

Mueller Leg Length Discrepancy Frequently Asked Questions

What are the symptoms I may notice if I have a short leg?

Often there are few or no symptoms prior to the age of 25-35. The most common symptom is chronic lower back pain, but also is frequently middle and upper back pain. Same-sided and repeated injury or pain to the hip, knee and/or ankle is also a hallmark of a long-standing untreated LLD. It is not uncommon to have buttock or radiating hip pain that is non-dermatomal (not from a disc) and tends to go away when lying down.

How could I screen at home for this?

It’s actually quite easy to evaluate at home whether you may have a short leg.
1. Look in the mirror: Are your shoulders and collarbone even or is one higher than the other?
2. Does your head tilt to one side? (look at your earlobes!)
3. Does one hip or kneecap (patella) appear higher than the other?
4. Do you find that you need to have dress pants hemmed different amounts on each side?
5. Do skirts seem to fall unevenly?
6. Has a podiatrist told you that you should get orthotics?
7. 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)
8. 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?

Yes. Absolutely. Empirical evidence though suggests that the functional component is typically less than 4 mm in cases of a true LLD; and this can work in your favor or against it. In other words, if your doctor says you have an 18 mm short leg. With treatment including progressive lifts and manual therapy or adjustments, the final prescription could wind up being 18 mm, or it could be as little as 14 or as much as 22.

I’ve been told I pronate, wouldn’t orthotics be the best solution?

Maybe. And here is where I alienate some of my podiatrist friends… Our bodies tend to work well and make necessary compensations to accommodate minor asymmetries. There are cases where a very unstable foot with a highly abnormal gait requires a rigid orthotic. However, whenever we minimize the foot’s contact with ground surface, whether it’s with an orthotic or a scientifically designed padded running shoe, we lose proprioception. Proprioceptors are sensory receptors found in joints and tendons and muscles, that tell your body it’s position in space. Nike actually conducted an excellent study years ago trying to determine the best running shoe. The results were published, but not used as marketing material. The best shoe is actually something with the least amount of support to allow the joints to perceive the ground. As you might suspect, the incidence of ankle sprains, due to padding, is increased exponentially with the padding and support of a ‘good’ running shoe. If you don’t feel a stick that you step on, your foot and body don’t make necessary accommodations, and you sprain your ankle. That said, running also really shouldn’t be done on asphalt. Running barefoot or in Keds might be great on crushed granite or dirt or grass, but the compromise we make to run on streets requires some padding to protect the foot from the increased compressive loading due to the surface hardness.

Can this condition correct itself?

No. if you have reached skeletal maturity, short of a Frankensteinian contraption to re-break and stretch out bone, you won’t be able to ‘cure’ this. However, the good news is that it’s easily managed and ‘fixed’.

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?

In an adult, we find that we can add a non compressive silicone heel lift to a shoe in increments of 3-4 mm maximum per week. Were we to give a patient with a 20 mm short leg, 20 mm of lift all at once, their entire body would rebel. The various compensations that the body has made, such as curvatures and shortening of muscles on the convex side of the curve, would make such a dramatic change not just noticeable, but painful.

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:
1. The back of the shoe is generally too short to accommodate more than 7-8 mm inserted inside the shoes, and;
2. 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?

You probably can’t. What we suggest is that you modify three new pairs that you use frequently; perhaps a pair of exercise shoes, daily work shoes, and dress shoes. Then you can purchase some movable or permanent heel only lifts for occasional shoes. Let’s say your final Rx is for 18 mm. The shoes you wear most frequently, will be modified to the full amount. However, you can get some 7 or 8 mm lifts to use for special occasions when you are wearing other shoes for an event. That way, instead of going from 18 mm correction to zero (which would lead to pain and discomfort), you are going from 18 down to 8 . Yes, it’s not ideal, but it’s just fine for an evening.

What about going barefoot?

Yeah, this is a problem. I have many patients who have had to purchase Yoga shoes instead of going barefoot. I also have several people who don’t wear shoes in the house. They have purchased ‘house shoes’. I wear glasses. When I wake up in the morning, I put on my glasses or I simply can’t see. You have to learn to look at a shoe lift the same way. Is is a hassle? No, not really anymore—except for when I lose my glasses and can’t see to find them! It’s just how it is.

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.

Information About the Author

Dr. Michelle Paris is an expert in Leg Length Discrepancy, teaches continuing education courses for chiropractors, has served as a Qualified Medical Examiner, Independent Medical Examiner and as an expert witness in court. She is active politically, helping raise awareness of critical issues impacting the chiropractic profession and been profiled in several magazines as well as asked to speak at many corporate events.

Dr. Paris has been practicing since she graduated from Life West as the Valedictorian, in 1994. Most of those years were spent in San Francisco until she moved to Austin in 2008. With a background in performing arts (she was an opera singer) that had her working on staging and ergonomics for several theatrical productions and a passion for physical biomechanics (the integration of structure and function), as well as being a primary care physician in California, she is more than well-versed in most all aspects of physical medicine. However, Dr. Paris has become the leading authority on Leg Length Inequalities; an under-evaluated and under-managed aspect impacting structural integrity of the spine that without appropriate treatment, not only prevents long-term stability, but also may lead to permanent curvatures, degeneration, and contribute to scoliosis.

Because of Dr. Paris’s performing background and ongoing interest in the unique stresses performers and musicians place upon the body, WFC has partnered with HAAM (Health Alliance for Austin Musicians) to offer lower cost services to the uninsured and under-insured musicians working in Austin.

Additionally, the clinic supports many charitable organizations and typically selects one specific organization each quarter to profile and to focus fundraising efforts.
The clinic, Whole Family Chiropractors, located in the Mueller Development near Dell Children’s Hospital, serves the local community, and as the name suggests, numerous children.

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 us today!
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Mueller Leg Length Discrepancy| (512) 505-8500

2 Join the Conversation

  1. Dorothy says
    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

    • reception@wholefamilychiropractors.com says
      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

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