Leg length inequality is a condition where one leg is slightly shorter than the other. Imagine if you were walking around with one shoe on and one shoe off. The difference would probably be uncomfortable, especially while engaging in physical activity.
As a result of having a leg length inequality, patients may experience other conditions such as low back pain and hip pain (it’s possible that knee and ankle pain can occur as well). Newly released research demonstrates how strenuous activity (such as running) with leg length inequality results in overcompensation by the ankles, knees, and hips.
There are two different types of leg length inequality: anatomical and functional. Depending on the underlying problem, there are a few different treatments to consider.
Anatomical Leg Length Inequality
Anatomical leg length inequality could be a congenital issue (something you were born with). In some rare instances, it could be caused by trauma. For example, some patients have had a broken fibula or tibia in the lower leg, or a broken femur in the upper leg. Surgery and repair can shorten the length of a leg as well.
Starting from the ground up, we will likely recommend a heel lift for the shorter limb. It’s simply an insert that goes in the heel of the shoe that levels out leg lengths, getting patients into a more neutral position. Research has shown that a length difference of as little as 5 millimeters (or 3/16”) can contribute significantly to low back pain.
Of course, the heel inserts must be introduced in a gradual fashion. First, we will figure out how much the limbs differ. Since the body has likely become accustomed to the discrepancy over time, we will start with a small insert and gradually work up to the full height so the result is not jarring and uncomfortable. If there is a 1/4” difference, we will probably start off with 1/8” heel insert and build up to 1/4” over time.
Heel lifts are a very simple, conservative treatment for anatomical discrepancies. Patients can put them in dress shoes, sneakers, workout shoes, etc.
Functional Leg Length Inequality
In cases of functional discrepancy, leg lengths can differ because of posture, pelvis shift, or with daily activities that cause the extremities to tighten. This is usually a bit easier to manage than anatomical issues. The majority of the population has some form of functional leg length discrepancy. Activity levels, types of footwear (high heels, for example), or occupation can contribute to functional leg length discrepancies.
Additionally, functional discrepancies are often contributing factors to other conditions such as low back pain, hip pain, or core instability. It is a puzzle piece that we look for when evaluating a patient with low back pain or hip pain to see if it could be an underlying factor.
To treat functional discrepancies, rehabilitation, physical therapy, or chiropractic therapy can be used to level things throughout the pelvic region. In many cases, heel lifts may be unnecessary or even obsolete.
If you have any questions about how we can help treat leg length inequalities, about aches or pains, or if something just doesn’t seem right, contact us at Tulsa Spine and Rehab.