The Short - Leg Syndrome: How To Correct This Common Ailment

Many individuals develop imbalance and pain as a result of a leg-length discrepancy. If one leg is longer, it is similar to driving around with one car tire bigger than the others. The center of gravity changes as weight is transferred to one side of the body. One shoe heel will usually wear away more than the other. One foot, ankle, knee and hip will be under more stress, and there will eventually be compensatory changes that take place above the pelvis as the balance of the spine is altered. Scoliosis develops with eventual premature joint degeneration on one side of the spine. The short-leg syndrome has been an enemy to both runners and doctors for many years. Questions such as the following are asked daily: (1) Can it be an aggravation to, or cause of, low back pain in lower extremity problems? (2) Should a lift or orthotic be put in the shoe of the long leg or the short leg? (3) Will I always have to run on beveled road shoulder to have even lengths? The first thing that should be considered is that there are two types of short-leg syndrome:

1. Anatomical Short Leg. The measurement from the bony protuberance (the greater trochanter) of the hip joint to the lateral ankle measures shorter on one side than the other. This is seen in approximately three percent of all short-leg syndromes.
2. Functional Short Leg. The measurement from the same two points is equal on both sides, but there is still an apparent short leg. With this type, there is usually a rotation or displacement of the pelvis on one or both sides. This causes abnormal stress on all muscles, nerves and joints that are involved. The longer a person has this type of short-leg syndrome, the greater the chance for a secondary compensatory problem somewhere else in the body, usually in the upper back, shoulders or neck. Common symptoms here are muscular pains in the involved areas, headaches, numbness and/or tingling in the arms or hands.

There is an easy way to determine which short-leg syndrome you may have. It is known as the Deerfield Test. With the person lying face down, check the length by correcting any pronation or supination of the feet so that the heels are parallel and perpendicular to the plane of the legs. This is easier to visualize with shoes on than with bare feet because the shoe has a flat heel as opposed to the foot's rounded heel. After noticing which leg is short, flex both knees to 90°. If it is anatomical shortness, the difference in leg length will be identical in positions 1 and 2. If it is a functional shortness, the short leg will either become longer as the other leg or longer when in the flex position. If it is functional shortness, the short leg will be either become as long as the other leg or longer when in the flex position. This is called cross-over. Whichever syndrome one is suffering from, the weight distribution through each leg will be uneven. As a result of the increase in poundage and stress on the body and legs during running, the symptoms will be more pronounced in a runner than a non-runner. What symptoms should make a person think of short-leg syndrome? First, any symptom that is exaggerated by running, such as low back pain, hip, knee, ankle or foot pain. A tendency to pull repeatedly the same muscle even though you have given it sufficient time to heal is a symptom commonly seen. Also, shin splints and sciatic neuralgia (inflammation of the sciatic nerve that produces pain in the buttocks and down the back of the leg) are very common symptoms. How does a functional leg-length difference develop? Over a number of years, one side of the spine may develop stronger than the other. Sleeping on one side; carrying items on one side; running clockwise on a track; using the phone on one side; facing traffic when you run; lifting suitcases; carrying kids; acquiring injuries when as a child, or even forceps delivery at birth, for example, can result in a functional imbalance. A person with a large difference in leg length often first notices something peculiar in photographs of himself or herself. One shoulder is a bit higher, and the head is always tilted a tiny bit to the side of the high shoulder. Sometimes the person that hems pants is the first one to notice the leg-length discrepancy. Many runners with leg-length discrepancy tell us that when they run, they feel one foot impact the pavement more than the other. Some runners state that they feel a bit “lopsided” when running, and as noted earlier, one heel usually wears away faster than the other. Further, sometimes runners notice the difference when they receive photographs in the mail from the "finish-line" photographers. At the end of a race, fatigue has set in and the true raw structural imbalance can be viewed in its entirety. After it has been determined which syndrome is evident, a correction can be considered. With an anatomical shortness, correction is made simply by placing a heel lift in the shoe of the short leg. The lift can either be inserted in the shoe itself or constructed onto the inside shoe (or of your orthotic). This can be done by any qualified chiropractor, orthopedist, or podiatrist. When it comes to a functional shortness, which is more complex, the first thing to consider is the underlying cause of the short leg. A functional leg-length discrepancy is present in three out of five people. The difference may be minimal or very great. If the difference is minimal, there are usually no symptoms from it. Over time, however, a minimal difference always becomes greater. In the runner, there is usually a more rapid change in leg length, as running involves tremendous vertical impact. Gravity eventually wins if nothing is done to combat the imbalance. Some common causes are: (1) Arches are not the same in both feet. (correction can be aided with the arch supports or orthotics). (2) An abnormal range of motion, in the joints. Each joint, including ankle, knee, hip, and low back, should be put through a full range of motion to ensure normal equal motion. (3) A weakness of one or more lower extremity muscles, which allows the pelvis to rotate either anteriorly (forward) or posteriorly (backward) in relationship to the other side. (4) Bad habits, such as poor posture, slouching in chairs, crossing legs while sitting, standing with all your weight on one leg, always running on the same side of a beveled roads or insufficient stretching. (5) Poor quality running shoes. Correction of functional shortness involves a number of factors. First, correction of any structural faults has to be made to allow for normal weight distribution and normal functioning of the joints and muscle involved. This is done by correcting any muscular imbalances (right vs. left and front vs. back) that become apparent after a through kinesiological examination by a qualified chiropractor. After correction of the muscular imbalances, manipulation of the involved joints is performed to correct any structural imbalances. This allows all joints to functional under a proportionate weight distribution. Second, a visual observation of the patient running is a must to determine if there are any abnormalities in the gait or stride, such as one arm held close to the body in its correct motion. All muscles being balanced and working equally on both sides of the body allows for maximum efficiency of oxygen usage. Third, correction of the short-leg syndrome must be made in order to prevent any undue stress. The body is the most amazing piece of machinery imaginable. With a little care and understanding of its normal function, and with proper balance and alignment, it will give you many more quality miles on the road, with much less chance of injury. In my clinic, during the patient's first visit, we examine and determine the amount of leg-length difference, then treat it and develop specific exercises to correct the condition. Withinin four weeks, we re-examine to determine what changes have occurred.  The best time to check for a leg-length difference is when a child is in elementary school. Examination by a sports injury chiropractor is recommended. We have had many children referred to us by parents after they have performed a basic scoliosis check on a child and found that a problem existed.

To set up an appointment with Dr. Serne please contact reception@vitalityclinic.ca or call the office at 604.687.7678.