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Friday, March 16, 2018

Short Leg Treatment: Email Advice

Dear Dr. Blake,

     I came across your blog online and am hoping that you will have a moment to read and respond to my question- I would REALLY appreciate it.  I am a 38-year-old woman.  When I was born apparently there was a glitch with the movement of my right leg that the doctor noticed and said might just go away on its own.  My parents never pursued it any further so I have no idea what was noticed when I was born or whether it is at all related to the current issue I'm trying to address.

     For many years I've noticed that my right hip and shoulder sit slightly higher than my left side.  I would typically walk with my right foot toes pointing out about 40 degrees.  My right knee has always turned in toward my left leg when I'm in a standing position.  A couple years ago I started wearing some Powerstep insoles on both sides, which helped turn my right knee out a bit straighter.  Growing up I was told I had slight scoliosis.
Dr. Blake's comment: You are describing a long right leg with more pronation or internal rotation on that side. When you stand is your right knee in and right foot out as mentioned above, or is it only in walking. You can turn your right foot due to the long leg and excessive pronation that collapses the arch and drives the right knee in with it in attempt to shorten that leg. 

     So, I've been to a couple chiropractors for adjustments and they said that my left leg was about 1/2" shorter and that my right hip was tilted forward, which they adjusted.  They didn't seem to really look at my legs or hips much but said that the leg length difference was because I needed regular adjustments. 
Dr. Blake's comment: The chiropractic world is to adjust out these imbalances that can start as leg length differences when you finish growing, and end up with pelvic tilts and scoliotic curves in the spine. Podiatrists, not skilled in these adjustments, tend to want to lift and support the short leg. It is an art though since there are many variables to consider and many ways patients adjust to lift therapy. 

     I felt that perhaps they didn't have much experience addressing these issues.  I think maybe I do have a structural leg length difference that has contributed to these other issues.  I tried a small heel lift on the left side but that seemed to make me feel more imbalanced on the right side.  Now I'm wondering if I should try a full length (as opposed to just heel lift) maybe 1/8" lift on the left side (in addition to the Powerstep insoles on both sides) and gradually work my way up to 1/2"?  If you think that's a good idea can you recommend a brand of full-length insole and over what period of time could I work up to 1/2"?
Dr. Blake's comment: I prefer full length lifts to balance the foot out throughout the gait from heel contact to push off. You can cut out the toes to give yourself room. You can go with simple Spenco Insoles without any arch, just flat. You can use the left as the first lever, if it feels okay in two weeks, try the right turned upside down as the second layer on the left side. The second layer you may or may not need to cut out the toe area, but keep the lift under the metatarsals or ball of the foot. For the third layer and possibly fourth layer, you will have to get another pair. You should feel better and more stable with lifts. If not, you should consider getting an AP Standing Pelvic Xray in normal stance barefoot to document the true structural leg length. 

Thank you very much!

Dr. Blake’s comment: Yes that sounds right. I tell my patients to get Spenco flat 1/8th inch insoles, you just flip the right one over to make a second left. If you are crowding the toes too much, you can stand on the insert, and mark between each toe. Cut out the area of the insert in the area of the toes. Typically you go 1/8th inch every 2 weeks.

My remaining questions after spending additional time on your blog-

Should I try switching from Powerstep to Sole insoles since those are what you recommend?  I have not tried the Sole brand before.
Dr. Blake's comment: Yes, you should try both to see what is more stable and fits you better. From my standpoint, they are both easy to adjust and customize for the patient. 

Just to make sure- would the full length lifts be placed under the Powerstep/Sole insole in the shoe?
Dr. Blake's comment: Yes, they go under the arch support. Hope this helps Rich

Thanks a million!

Here are some of my videos on short leg syndrome.

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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.