You've been told by your doctor, or you suspect, that you have a leg length difference. What should you do about it? Should you really care?
Yes, you should care. A leg length difference can often be a major cause of not only lower back pain but a host of other ailments, as well. The abnormal alignment that results from a leg length discrepancy can cause hip, knee, ankle, and neck pain. It is even associated with headaches and TMJ problems.
Evaluation and identification can be as simple as a visual inspection or x-ray. That is the easy part. The difficult part is when should it be corrected and how to correct it.
What needs to be done first is discover if you truly have a leg length difference. Short leg analysis and correction for a short leg is a controversial subject within the healthcare profession. It is also a confusing matter for the general public.
The best way to identify and measure a short leg is with x-ray analysis.
To believe a short leg is rare, or doesn't need to be corrected, is foolish and naive. If your healthcare provider and you choose to ignore a short leg you are risking a lifetime of spinal damage, pain, and disability.
If you have a short leg, or think you do, and cannot find a doctor that is willing to correct for it, lacks the knowledge or ability to correct it, then you are left to figure it out on your own.
You may be able to clearly see that you have a short leg by looking in the mirror. Observe the level of your pelvis noting any tilting to one side. With a short leg there will most likely be a pelvic tilt to the short leg side. However, just because you have a pelvic tilt does not necessarily mean you have a true short leg.
For example, if you have flat feet and one foot is flatter than the other, or over-pronation is more significant in one foot compared to the other, that may explain for the “appearance” of a short leg.
When in fact, the leg lengths may be equal but the pelvis will tilt to the side with the most dropped arch or over-pronation.
Once a proper orthotic is used, to correct for the excess pronation and dropped arch, the leg lengths may then become equal and that is all the correction that may be needed.
Another example to consider is that you may have a short leg which should drop the pelvis the short side; but perhaps your opposite foot has more of a dropped arch and over-pronation causing the pelvis to drop on that side (the long leg side). Therefore, this may cause the pelvis to appear level even-though you have a left short leg.
If you then correct for the flat foot and excess pronation on the long leg side, by the use of orthotics, the short leg should become more obvious.
Other factors that may cause confusion or a wrong analysis would be:
As already stated, the best way to analyze for pelvic tilt and true short leg is with x-ray analysis. Most chiropractors should be able to perform this procedure for you.
You must first determine if that short leg is causing a pelvic tilt (which it usually will) and any spinal scoliosis, or abnormal curvature (misalignment in the low back).
There are three possible scenarios:
Considering the three possible scenarios above, the first one is the only case where a heel lift may be helpful.
Remember, in scenario two a heel lift would aggravate your posture and in scenario three it would have no effect. Therefore, a heel lift should not be used in either scenario two or three.
Now, before you decide to use a heel lift, you must first support and correct for flat feet (fallen arches) and any existing over-pronation. The best way to do this would be to have custom made orthotics inserted in your shoes. This will support and correct these problems, or prevent them from getting worse, or perhaps developing in the future.
One study found a leg length difference of 90% in lower back pain sufferers.
Other studies show that by age twenty 80% of the population has significant pes planus (flat feet) and over-pronation that needs to be corrected and by age 40 it is nearly 100%.
Is it any wonder that there exists so much back pain, or hip and knee arthritis, when this many people have clinically significant pes planus and over-pronation?
We all know the importance of ensuring the tires on our cars have proper tread, balance, and alignment. Doesn't your body need the same care and attention? How much pain, suffering, disability, and medical costs could be prevented with the use of proper shoes, orthotics, and heel lifts?
You have analyzed your leg lengths (either with x-ray or visual inspection) and determined whether a heel lift is needed. Once you are fairly sure that a lift may be needed and could be helpful you must then figure out how much you will need.
“Well,” you say. “That is easy. If I have a half inch difference, all I need to do is add a half inch lift in my shoe on the short side.”
Whoa! Not so fast. That may be true, or it may not be.
Depending on how long you have been walking around with a short leg, your age, and the overall condition of your spine you may actually make matters worse if you start using a lift.
Are your spinal joints so far degenerated that correcting for a short leg may not be possible? In this case it may cause more harm and pain to use a lift. If so, you will need to manage your lower back pain in other ways and forget about using a heel lift.
As already stated, the best approach would be to have a knowledgeable chiropractor monitor your progress and take before and after x-rays to help determine the best heel lift thickness to use.
The best approach to managing a short leg is a systematic 6 step approach.
A lift and orthotics will perform best in quality footwear. Poor footwear will result in less than ideal results. The best shoe are athletic, walking, and oxford type shoes. Avoid sandals, loafers, flip-flops, and high-heels. (You can purchase quality shoes, sandals, and flip-flops here.)
Once you have achieved the proper lift, are using custom-made orthotics, and wearing quality shoes remember to continue to do so throughout your life. Don't allow your shoes to become excessively worn, fail to replace your orthotics as needed, or forget to use your heel lift all of the time.
Find your balance, support your foundation, and maintain proper function and you will be doing far more for your lower back and the rest of your body than any drug, surgery, adjustment, massage, or herbal supplement.