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Monday, August 1, 2011

Short Leg Syndrome: Email Advice

Dr. Blake,


I see from your many blogs that you actually know what you are talking about and I am very relieved. I have been dealing with this for a long time and after many mis diagnosis and thousands of dollars wasted I finally got the verdict.. 2cm short on left side with onset of scoliosis.

I also have a very pronated right foot.


Dr Blake's Note: A short left side with a more pronated longer right side is fairly typical. The longer right side pronates to collapse the arch and drop the hip some of that side. If limb dominance is seen in gait, it will be seen on the longer right side (see posts and videos on limb dominance). Here is where the crucial initial decision in treatment comes. The physician/therapist must correlate symptoms to mechanics and decide if you correct the pronation first, or the leg length difference. If you correct the pronation, since the longer leg pronates more, it will actually have a net greater lift in the arch, further raising the right leg. The long leg will become longer, but the biomechanics of pronation will be much more stable. Typically, I tend to correct the short leg syndrome first with lifts, and you can see a marked decrease in the pronation of the long leg (it does not need to pronate as much).


I went to an orthapedic and was given the plastic inserts to correct the pronation and the short leg. I still had problems and went to a back doctor who took xrays and determined that after looking at my orthodics that they were not sufficient as the one made for the short leg had no lift.


Dr Blake's Note: This is probably a mistake by the lab, but the doctor and patient should easily be able to see if the shorter leg has been lifted more than the opposite side.

He sent me to another person who made me a "cheap" heel lift. I have a very hard time with movement on my right leg, I kinda "shuffle" I don't have full hip motion.. Is this because of the pronation???

Dr Blake's Note: It is rare that pronation causes this type of restricted hip motion. It is probably related to the compression forces on the longer right leg jamming up the hip joint. It could also be related to early degenerative changes in the right hip (wear and tear). The hip xrays should have caught that. Predictably there are more wear and tear on the longer side at the hip joint, than on the shorter side.

It is very annoying and bothers me when I run. It is also very tight in the front "hip flexor?". I need your help. Willing to fly out if needed to get the proper orthodics and treatment. I live in Texas. If you know of any one here that you can recommend who actually knows what they are doing that would be o.k. too.

http://www.aapsm.org/members.html


Dr Blake's Note: The link above to our website at the American Academy of Podiatric Sports Medicine is a good starting point. Any podiatrist interested in biomechanics utilizes lift for short legs. You need to call the 2 podiatrists in San Antonio in the academy directory and see if they use lifts at least up to 1 cm or 3/8th inch. Once you can get the 3/8 inch full length correction in the right shoe, and see how this 1/2 correction changes your symptoms, let me know. Rich

Please let me know.

P.S. one of my main problems is I wear cowboy boots alot and the orthodics don't fit….. I can only wear the heel lift in them.



Dr Blake's Note: It is normally quite easy for a shoe repair store to add 3/8 inch lifts to the heel and forefoot of a cowboy boot outersole after the patient is used to the lift in an athletic type shoe.

Any suggestions would Be Greatly Appreciated.


Thank you again.

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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.