Addressing Leg Length Discrepancy In A Patient With Low Back Pain and Right Anterior Hip Pain

A patient contacted me after suffering from low back pain and right anterior hip pain for three or four years. He has received contradictory advice from a variety of medical professionals (physiotherapists, chiropractors, orthopedists, etc.) with limited success. 

A year ago, a physiotherapist told the patient he had a true limb length discrepancy of approximately 1 cm, which the physiotherapist measured by looking at the ankle bones with the patient lying down. The patient got an orthotic made with a 0.5-cm heel lift to wear with the short right leg. This didn't really help with the symptoms after the patient wore it for about half a year. Six months ago, a chiropractor told the patient that based on X-rays, he had a 1.6-cm true leg length discrepancy and advised him to wear a heel lift of 1.5 cm. The patient notes the extra lift hasn't really helped with the symptoms after wearing it for four or five months. He found the heel lift caused some foot pain as it was a very high heel lift.

Recently, the patient has been working with another physiotherapist who believes a lot of leg length discrepancies are functional. This physiotherapist has been providing an exercise program aimed at addressing this. 

The patient is “very confused” about whether he has a true or a functional leg length discrepancy. The chiropractor took X-rays as the patient stood barefoot so the patient thought this proved it is a true leg length discrepancy as the tops of the femurs were off by 1.6 cm.

It is so hard to know all the causes of this patient’s problem. When he started wearing the heel lifts, the spine looked so much better on the X-ray with the hip and sacral base still low. It also looked like some of the compression of the spine without the lift is around L1 and L2. This can easily lead to both anterior hip and low back pain. This patient should have a nerve conduction study with an electromyogram to see what is involved in the leg length discrepancy. Also, this patient should have magnetic resonance imaging (MRI) of the low back and see if L1 and L2 are injured. Then a physician can decide on treatment. 

From my viewpoint, I would use heel lifts of around 15 mm for three months under the left foot as close to full length as possible and see what symptoms change. Of course, if there is increasing pain, blame the lifts and remove them. If there are no untoward effects, I hope after three months that this patient can go up to 20 mm lifts. He has some scoliosis, as I can see on the X-ray, and should be on a program of back strengthening and stretching that is appropriate for the curves of his spine. Typically, the concave side of the curve gets tighter and the convex side gets looser so he should stretch the concave side and strengthen the convex side.      

When you put permanent lifts on the outer sole of a shoe, no matter how careful you are, there are times the lift feels like too much. You cannot easily lower the permanent lift, but you can lessen or offset the lift by placing a lift into the other shoe for a while.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2018/06/short-leg-syndrome-email-advice.html . It is reprinted with permission from the author.