Most patients have a short leg, either structurally or functionally. A structural short leg is true length difference of the bones, where a functional short leg may be caused by many factors including one arch lower than the other side. As long as one arch collapses more than the other side, the short leg syndrome exists.
Most people have one foot longer than the other, but the long foot may or may not be on the long leg. Remember you are taught to buy shoes always for the longer side (longer foot). If you wear out one shoe more than the other, either by observing the heel of the outersole or the footbed within the shoe, you can tell that one leg may be shorter. Orthopedists normally do not recommend treatment unless over 1/2". Podiatrists have observed that as little as 1/8" difference in leg lengths can cause symptoms. By treating these small differences, and having patients report positive outcomes, leg length discrepancies are a vital part of care.
Treatment of leg length discrepancies is with various types of lifts under the short leg. The photo above shows a shoe with a full length external or outersole lift of 3/8". Due to the swelling in his foot, this patient could not tolerate any lifts within the shoe. Full length lifts, whether within the shoe or on the outer sole, are normally so much more stable than just heel lifts. Heel lifts alone can create a high heel effect with more instability. Also, a heel lift alone can be compensated for with mere bending of the knee negating the desired lift height. So, I love full length lifts and try to always start with these in my treatment. A future post will explore this treatment in detail.
Most athletic shoes can accommodate up to 3/8" lifts. All patients should have a trial of lift therapy with shoe inserts with positive results before external shoe lifts are utilized. Most shoe repair shops can put on external lifts, but there may be one in your area that specializes. Ask around for referrals from local orthopedic or podiatry offices. The external lift must be tapered at the toes, and somewhat flexible at the ball of the foot, to allow the patient to walk smoothly from heel to toe.
The Golden Rule of Foot with lift therapy: Start Low, Go Slow. Normally, if the difference is 3/8" total, 1/8" lift is given for 2weeks, then another 1/8" lift for 2 more weeks, then finally the full 3/8". As you go up in lift therapy, blame any new symptoms on the added lift, take out the additional lift until the new symptoms subside, then try again. Some patients are stuck for one reason or another at one level of lift. Their bodies will reject the higher amounts.
There seems to be more stress on the body when the exact same lift is placed on the outersole as was originally used as an insert. It probably weighs slightly more, or effects the motion around heel strike more. To lessen this change, which may cause symptoms itself, place 1/2 of the overall lift in the opposite shoe as an insert initially. Two weeks later, take 1/2 of that away, then finally 2 weeks later take it all away so you are left with just the desired outersole lift. This eases the process dramatically, allowing the body to relax more in making this big change. Good luck!!
Do you know of a good place to get shoes lifted in the bay area?
ReplyDeleteLizard, I like Anthony's in downtown San Francisco, or Fonda's on Church St in San Francisco. There is Tony's in San Rafael also. Good Luck.
ReplyDeleteHello Dr Blake. I was diagnosed with different leg lengths of 8mm in Nov 2011, after suffering neck pains for over 25 years and not knowing why. Adding orthopaedic insoles to all my shoes - including my running shoes - immediately worked wonders.
ReplyDeleteHowever, since then I have found that for some strange reason, I now seem to be wearing down the soles of my left shoes, the side with the insoles, quicker than the right ones. Over time the neck pains gradually keep reappearing. This is despite the insoles - which are very well made and will probably last for many years yet - keeping their proscribed height perfectly. In some instances I am seeing 2mm of shoe wear in just a few months, quite a lot in relation to the overall 8mm difference between one leg and the other.
The wear happens not just in running shoes but in harder shoes such as one pair I wear for work in the office.
This is driving me nuts! I thought my neck troubles were cured once and for all. What is going on, and what can I do about it? Each time we measure and find more wear, I keep adding the correct extra height to the insole using gaffa tape, but the shoe wear just keeps taking place. It's as if the shorter leg side is heavier or something - which I really doubt as the discrepancy isn't enough to make my left-right body balance that off from the expected norm.
Do you have any ideas about this, and/or suggestions?
Many thanks,
Nelson
Thanks for the email. This is actually a quite common problem if it makes you feel much better. Lift may balance your hips and neck, but it pushs the shoe 8 mm away from your foot. This means as your foot travels through the air in what is called swing phase it lands slightly earlier than it has during the rest of your life and your body has not figured out how to even that out yet. The earlier you land, normally the more inverted your heel strike is, which typically means you land on the lateral or outside of the heel. I have patients who monthly are in the neighborhood shoe repair with one or several shoes for outersole wedging. Some patients see a physical therapist to change to a less heel strike gait. This definitely helps. Look up Chi Walking on You Tube. I will try to do a post on that. Hope this makes some sense. Dr Rich Blake
DeleteAt times, adding some wedging to the shoe insert can help, but some good experimentation would be needed.
i prefer not disclosing my short leg discrepency by wearing shoe lifts that hide the fact ... do you recommend https://step-ups.com ?
ReplyDeleteI am really interested in hiding the fact that my leg is shorter than the other..
Like any internal shoe lift on the market, it depends on the depth of the shoe and the amount of lift you need. The more lift the less ability to do it all internally. Rich
DeleteI lived my whole life with a huge leg length discrepancy completely compensated without lifts - some of it functional due to the pelvic tilt and some of it structural. This is a result of the congenital bilateral hip displasia. This resulted in significant damage to my knee and back but it appears that I was always using that leg discrepancy to accommodate the extremely limited hip flexibility and simply could not function with even minor lifts. I am now 56 and after the second hip replacement few months ago, it is now possible - and necessary - to use an external shoe lift of about 1 inch. I am finding extremely difficult to get used to outdoor shoes with the lift however, and I think my biggest issue is inflexibility of the sole of the shoe with the lift which makes the heel slip out of the shoe with every step I make. I work with the certified orthotist and she is trying to adjust the "rocker" at the top of the shoe to minimize this, but even after dozen attempts with 6 different models of shoes the feeling of instability and "losing" the shoe is not going away. Do you have any suggestions?
ReplyDeleteIrena, thanks for your comment. First of all, do you have 1 inch full length, or 1 inch in heel and 1/2" at the ball of the foot? This usually helps. Also, does the ball of the foot have any flexibility (cut grooves cut into the outer sole)? Rich
DeleteMany people feel totally comfortable wearing a combination of taller heels and insoles, and so can you. shoe lifts
ReplyDeleteI recently found out I have a 2 inch structural leg length difference. The rub is I also have plantar fasciitis in both feet and wear a size 9 W ladies shoe. I tried 2 X 3/8' heel lifts in the shorter leg but with the arch support of the plantar fasciitis shoe (i.e. Vionic- Orthoheel) or even with a deep box orthodic shoe (i.e. Drew), I was either slipping out of the shoe with it coming off my heel when I walked OR I was pronating outward. Is there anywhere to accommodate both plantar and leg length discrepancy. Will to pay for custom shoes even if I have to travel to London.
ReplyDeleteThe lift is put on the outside of the shoe, and the orthotics for PF are inside the shoe. Did you have a Standing AP Pelvic Xray in Normal Stance Barefoot to document the length? Rich
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ReplyDelete