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Tuesday, September 25, 2012

Functional Short Leg Syndrome: Email Advice

Dr. Blake,

Sorry to bother you - I was reading your blog and have a question:

I think I have been suffering from short leg syndrome. Hip hike, shoulder hike, irregular arm swing, ONE flat foot and weird walking gait.

My legs are anatomically even.

This has resulted in bulging disks in my lower back and a lot of lower back and lateral knee pain.

Your blog seemed to touch upon my symptoms better than any doctors here (Israel). I was hoping you could guide me as to how I can FIX the problem? Perhaps techniques I can show to a practitioner here?


Dr Blake's response:

     Thank you so very much for your email. I had the pleasure of visiting your incredible country in 1989 and was moved deeply spiritually. 

     What you are describing is called "Functional Short Leg Syndrome" where there is asymmetry of motion between the 2 sides, but the legs are structurally the same length. There are a hundred and one reasons for this to occur (like back tightness from bulging discs), and the art of this medicine is to discover ways to make the unevenness go away. Golden Rule of Foot: The body seeks symmetry of motion. The following is my order of events, but you and your medical team go look at this in another sequence. 

     First of all, take the Standing AP Pelvic Xray in normal stance to make one hundred percent sure there is no structural component. If some structural component is found, even as small as 1-2 mm, treat it. 

Note the long right side at the hip level with the marker noting Upright.

     The next thing to do is correct the unilateral (one foot) pronation or flat foot. You want to design 2 unique orthotics to correct for this asymmetry. The flatter foot should actually have more correction, but however it is done, the end result is that both feet are functionally even with the weight at push off through the 2nd toe.
     The next step is to re-eval the limb dominance. The dominant leg is the leg you are putting more weight on. Has your possible lift and orthotic corrections evened this out? Is the unequal arm swing better?  If no to either of these 2 questions, look for muscle imbalances (tight or weak muscle differences between the two sides), and begin slowly correcting. The tightnesses from the calf, hamstring, hips, and low back should be the easiest. The weakness differences between the two sides is slower and more difficult and can take months and months. But, you should see the progress. 

      The end result is that you have corrected any structural component, you have corrected unequal foot positioning and motion, you have then corrected all muscle tightness and weakness imbalances. It is logical, albeit slow and time consumming. I sure hope this points you in a good direction. Rich

Patient's response:

Thanks alot!
I had custom orthotics made - I'm curious what you mean by them fixing the pronation? I thought if anything they would simply make my body used to it?
What about simply strengthening the calf muscles on the pronating foot could that help the pronation?

Dr Blake's response: 

     There are fast and slow ways to help reduce pronation if that is part of a pain syndrome. Orthotic devices, stability shoes, taping, power lacing, and wedging are all fairly quick and dramatic methods.Muscle strengthening  normally coupled with body work and gait training are slower methods, but can achieve good results.  Gait Evaluation is done noting the over pronation, and in your case asymmetrical. Then, the practitioner uses various methods on each side to create foot motion that is more centered, eliminating any excessive pronation or supination tendencies. Orthotics can be designed to control motion or just balance the various archs, probably the type you are describing. Discuss with your health care provider orthotic options to make you more symmetrical and more centered. I hope this helps. Dr Rich Blake


  1. Hello Dr Blake,
    My left calf is very tight(does not hurt) but is continously tight. My left shoulder is higher than than the right one I know that one of my feedt is longer than the other(functional). However I am not sure which one !

    My left arm is more compact /shorter than the right one.. but I am a right hander... My left Quad and hamstring are significantly weaker and thinner than the right leg.

    Also the errector spine muscle on the right side is way more developed than the one on the left side.

    How can I correct this imbalance ?

    Thank You,
    Armin Ray

  2. Armin, there are so many possibilities. What is the most obvious? The typical biomechanical picture you present is a long right leg, with a right sided shoulder drop, more stress in the longer lower back area and more stress in the longer right leg. This means the muscles in the right back and thigh would be more developed. Treatment is beginning lift therapy for a short left side, but you really would have to go slow and see how your body feels. It you gradually add 1/8th inch (3 mm) to the left side per month, and make sure you feel more centered as you go. Good luck. Rich

  3. Your blog on Short Leg Syndrome was very informative. However, your discussion on the link between a hyperpronated foot and short leg syndrome was not complete.

    I encourage you to look at the published research (including my own) at Your comments would be most welcomed.

    Professor Rothbart


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.