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Sunday, February 27, 2011

Help with Short Leg Syndrome: Email Advice

Hello Dr Blake

I have a LLD structural of 9mm on the left leg as per a CT scan. This was found after I strained the hip rotators while squatting. The hip would not heal and I suffered at least 1.5 years of pain for a minor strain! I have also had pain when running to the joint of the big toe on the left foot foot. This was corrected with orthotics. I have a 6mm lift in my flip flops and work boots and this stops the issues with my hip (had the soles adjusted on my american heelers).

The problem I have is running when I put the 6mm lift in my running shoes ( hard plastic adjustable type ) this takes away the cushioning proved by the shoes that stop the pain in my joint of the big toe of the left foot. After 1/2 mile of running my joint of the big toe starts hurting. I have 2 pairs of orthotics from different podiatrists the first pair has no lift as this is what I asked for . I wanted to experiment with different lift heights. With a 6mm heel lift I can run without pain, but I get a over worked peroneus longus in the left lower leg.

I recently went to a new podiatrist in Hawaii as I just moved here . I don't have much faith in the new podiatrist as there was a lot of delays and excuses in delivery of the inserts . Once delivered I asked how much lift there was as they look the same left and right . The reply was there is 2mm lift as the standard is 1mm per 5mm of LLD . I have measured with caliper there looks to be 1mm max. I do think the lift was forgotten.
Dr Blake's comment: Never heard of this rule.

I'm in the Military and I have to be able to run . Can you provide some advice on how to modify running shoes ? If I just get a pair of running shoes with a lift I suspect they will lose the forefoot cushioning that I need . How much lift do I need for 9mm LLD ?

Alot doctors keep telling me that LLD doesn't matter at all. Everyone has some and I just need to run more . I also have had alot of shoulder problems because my posture was terrible . I have spent alot of time trying to correct it and my left mid back gets irritated all the time. Since starting to use the lifts, alot of these issues have started to clear up (especially my shoulders).

Regards

Dave

Dear Dave, Thank you so very much for your email. I am assuming that the left side is short the way you describe it, but let me know if this is wrong. Many doctors ignore the role of LLD (limb length discrepancy or leg length difference). It sounds like you have already found out it can be a valuable factor in balancing your body. I try never to put the lift on the orthotic device so that it can be somewhat adjustable. In sports, but normally when prescribing lifts, I try to keep them full length, with the toe area cut off. As long as you build up under the heel and metatarsals you are doing it correctly. Most athletic shoes take 3/8 inch lifts, and I use spenco/neopreme to accomplish that. Buy 3 1/8th full length spencos your size, use just the side of the short leg, stand on them and mark between your toes. Then cut out the area of the toes. Use all 3 under the orthotic device on your short side. Since it is soft material, and will compress some on impact and pushoff, you are probably only getting 8-9 mm total which should be enough. If this is the side of your sore big toe joint, cut out that area on one or two of the 3 layers to off weight it. Try to tapper the leading edge of the inserts to smooth the transition somewhat.

 Here is the lift I imagine for you made off a Spenco knockoff called neolon. It is easy to purchase spenco insoles of your size and use the side only of the short leg. Since you need 3, buy 2 pairs and turn one of the right ones over to make it another left. Cut out 1 to 3 of the layers at the toes and at the ball of the foot for off weighting of the sore big toe joint.
Here is the insole cut appropriately and placed under the shoe insert or orthotic device in your case. If you read all my posts on Short Leg Syndrome you can see that I do not like heel lifts since they can make the ankle unstable (probably why you get peroneal problems) and shift weight forward (not great for big toe problems).

Dave, please correspond (if needed) in the comment section of this post. Thanks and I hope this helps. Rich

4 comments:

  1. DR Blake

    I bought some Spenco and made the adaptions.

    I found that when i used a couple of the cut outs under the orthotics, there was to much pressure in the arch of my left foot. the orthotics was hurting my arch in the first mile of a run,I had to stop. I tried with the cut out in the orthotic only and 2 full spenco under it . this wasn't as much of a problem for the arch . But my left big toe joint became irritated and the big toe was fatiguing on a run. It doesnt hurt enough to stop me running but i'm don't want to cause any damage.


    I'm going to try a couple more combination to see if it make any difference.

    Thanks for you help

    Dave

    ReplyDelete
  2. Dave, Thanks for the comment. Please try spica taping of the big toe joint (see video section)to limit the motion of the joint. The joint will always move more with the cutouts, even if the cutouts are designed to off weight. See the section on shoe modifications to skip the laces above the sore arch to decompress the area. Lifts do increase the pressure in the arch and the orthotic may have to be altered in the exact area (last alternative). Please let me know about the taping and lace skipping ideas. Rich

    ReplyDelete
  3. Dr Blake,

    I have LLD. 6mm short on the right side.

    I purchased custom orthodics 3 months ago with a 3mm heal lift (1mm hard material and 2mm compressable material).

    I am uncertain whether my pelvis is in alignment and whether the 3mm lift is the correct height.

    I have been experimenting with adding another 2mm lift but my right hip is beginning to hurt.

    I don't know whether I need a 6 mm lift or if the 3mm lift is sufficent.

    Amy general recommendations with lift height vs LLD discrepancy?

    Please help!

    Thanks,


    Josh

    ReplyDelete
  4. Josh, Thanks for the email. I answered by blog post on 3/25/11. Hope it helps you.

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.