Video: How to Diagnose and Treat Problems Caused by a Short Leg

Having one leg that is shorter than the other (called “limb length discrepancy” or “short leg syndrome”) can lead to a number of problems. These include pain in the back, hip, knee and foot. In fact, we have seen many patients who have spent years and thousands of dollars trying to figure out why they have back, knee and hip pain – only to be told that nothing is wrong with their joints. With simple measurements of their legs these people could have avoid years of pain and unnecessary medical expenses.

Dr. Hale and Dr. Huppin are experts at diagnosing short leg syndrome and treating the problems associated with it. For an evaluation, contact us today for an appointment in our Seattle foot and ankle clinic

Causes of Short Leg Syndrome

The most common causes include:

  • Congenital problems which include issues with the position of the fetus in the womb
  • Injuries that occur at the time of birth. For example a dislocated hip.
  • Trauma that affects the growth plate during childhood.
  • Fractures or dislocations affecting the leg bones and joints
  • Surgery on the hip or knee – for example a hip or knee replacement
  • Poor posture so that the pelvis is tiled leaving one side higher than the other.

Symptoms of Short Leg Syndrome

Symptoms can occur almost anywhere in the body – from the feet to the jaw. If one leg is short, some sort of compensation usually takes place – this compensation can lead to other problems. For example, if you have a short leg you may lean toward the short side. This can put excessive pressure on one hip and knee. Other symptoms may include the following:

  • Knee pain in either the short or the long leg
  • Nerve pain in the lower back and legs (sciatica),
  • Poor coordination or balance
  • Pain in the feet and ankles
  • Jaw pain (TMJ)
  • Tiredness and fatigue

Compensation for a short leg

When one leg is short, your body works hard trying to correct the problem and equalize the two legs. This is called compensation. Compensation can be very complicated and vary from person to person, but two common methods of compensation include:

  1. Leaning towards the short leg, in order to extend it and make the leg longer.
  2. Flattening the foot on the long side in order to make the leg act shorter. This is called pronation.

In fact, these types of compensation may help us walk more normally. Unfortunately they also place abnormal force on our feet, ankles, knees, hips and lower back – even the neck. This can, of course, lead to pain.

Diagnosis of Limb Length Discrepancy

We diagnose a short leg in three different ways

  • We have you lie down and/or sit in our treatment chair and directly compare your right and left leg length. Although this can be a good initial screening test, most studies show that it is not a very accurate method of obtaining the correct limb length measurement.
  • We perform gait analysis. There are some distinctive traits seen in the gait of persons who have a short leg
  • We order a special diagnostic x-ray test called a scanogram x-ray limb length study. There are a couple radiology clinics in the Seattle are where the radiologists are expert at performing this study. The scanogram is the most effective and reliable method of measuring a limb length difference.

Treatment of Short Leg Syndrome

To relieve the pain of a short leg — whether the pain is in the feet, ankles, knees, hips, or lower back — our goal is to equalize the length of both legs. We can accomplish this in several ways.

Building up the sole and heel of your shoes. This technique is especially helpful for those people with large differences (greater than 1″) in their limb length. The problem with this treatment is that it can be a hassle to add a lift to all of your shoes.

Add Lift Inside Shoe: This is the quickest and simplest method of adjusting for a short leg. The downside is that these lifts can wear out quickly and raise only the heel rather than the entire foot. In addition, they do not compensate for the abnormal pronation that often occurs when a short leg is present. At the very least, we will often start with in-shoe lifts and then move onto more definitive treatments later.

Custom Orthotics: Custom orthotics for short leg offer the advantage of treating both the short leg AND the abnormal pronation that usually occurs when a limb length discrepancy is present. These comfortable medical devices, made from molds of your feet, will not wear down for years, thus saving you money and pain. Read here why orthotics from the Foot and Ankle Center are likely to be more effective than those from other clinics.

Your orthotics will be designed to also relieve the pain of calluses, neuromas, bunions, ball of foot pain, and other biomechanical defects which are caused by having a short leg. If your leg is short by 1/4 inch or less, you will be able to wear our orthotic in most dress shoes. If the shortage is greater than 1/4 inch, then you may need to wear walking shoes, gym shoes, or extra deep dress shoes.

References – Short Leg Syndrome

  1. Friberg, Ora. “Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality” Spine 1983
  2. Giles, L.G.F. Leg Length Inequality Spine 1981: Sept. 6 (5): 510-518
  3. Nachemson AL; Low Back Pain -its Etiology and Treatment Clin Med 78:18-24, 1971 Sept. 8(6):643-651
  4. Barton CJ, Coyle JA, Tinley P. The effect of heel lifts on trunk muscle activation during gait: a study of young healthy females. J Electromyogr Kinesiol. 2009 Aug;19(4):598-606. Epub 2008 May 9.
  5. Beal MC. A review of the short-leg problem. J Am Osteopath Assoc 1950;50:109-121.
  6. Giles LGF, Taylor JR. Low back pain associated with leg length inequality. Spine 1981;6(5):510-521.
  7. Rush WA, Steiner, HA. A study of lower extremity length inequality. Am J Roentgenol 1946;56:616-623.
  8. Fann AV. Pelvic obliquity in patients with and without chronic low back pain. Arch Phys Med Rehabil 2000;81.
  9. Gofton JP. Persistent low back pain and leg length disparity. J Rheumatol 1985;12(4):747-750.
  10. Blake RL, Ferguson H. Limb length discrepancies. J Am Podiatry Assoc 1992;82(1):33-38.
  11. Okun SJ, Morgan JW, Burns MJ. Limb length discrepancy: a new method of measurement and its clinical significance. J Am Podiatry Assoc 1982;72(12):595-599.
  12. Giles LGF, Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine 1982;7(2):159-162.
  13. Fann AV, Lee R, Verbois GM. The reliability of postural x-rays: a new study. Arch Phys Med Rehabil 1999;80(4):458-61
  14. Woerman AL, Binder-MacLeod SA. Leg length discrepancy assessment: Accuracy and precision in five clinical methods of evaluation. J Orthop Sports Phys Ther 1984;5:230-239.
  15. Christmas, C. How common is hip pain among older adults. J Family Practice. 2002

Healthy feet allow you to enjoy regular exercise and a happy healthy life. If you have any pain at all that is not relieved by the suggestions above, make an appointment to see us in our Seattle office. We can provide you with conservative treatment options that will relieve your pain.