Short Leg Syndrome

• Short leg syndrome involves either an anatomic or functional leg length discrepancy.
• This leads to sacral base unleveling, vertebral side bending and rotation, and/or innominate rotations.
• Patients typically complain of low back pain rather than directly mentioning a short leg.
• A structural evaluation is necessary if short leg syndrome is suspected.

Types of Leg Length Discrepancies

• Anatomic and functional discrepancies are the two types.

Anatomic Short Leg

• This involves a femur that is shorter on one side or a congenital deformity that makes one leg anatomically shorter.
• Anterior innominate rotation causes the leg to function as if it is shorter or longer.

Treatment for Anatomic Short Leg

• Heel lifts are the primary treatment.
• Most anatomic short legs are under 2 cm and treated with heel lifts.
• Leg-shortening surgery is considered for discrepancies of 2–5 cm.
• Leg-lengthening surgery is considered for discrepancies greater than 5 cm.
• Amputation and prosthesis may be needed for discrepancies over 20 cm.

Potential Causes of Anatomic Short Leg

• Short femur on one side
• Short tibia on one side
• Deformity of the foot and ankle such as valgus or overpronation
• Unilateral varus or valgus deformity of the knee
• Heel lifts can address low back pain caused by these deformities that lead to a short leg

Heel Lift Application - Acute Onset

• This includes hip fractures, or hip replacements.
• Correct the full discrepancy immediately
• For example, use a ½ inch heel lift for a ½ inch shorter leg

Heel Lift Application - Long-Standing

• Correct only ½ to ¾ of the full discrepancy, gradually.

Heel Lift Application Process

• A maximum of ¼ inch heel lift can be placed inside the shoe.
• Lift is applied externally if more than ¼ inch is needed.
• Specialized shoes with modified soles are needed if correction exceeds ½ inch.

Heel Lift Guidelines - Elderly or Frail Patients

• Start with 1/16 inch and increase by 1/16 inch every two weeks.

Heel Lift Guidelines - Healthy Patients

• Start with ⅛ inch and increase by ⅛ inch every two weeks.

Effects of Heel Lift Therapy

• The pelvis, spine, and shoulders adjust to the heel lift.
• Patients may experience aches, pains, and musculoskeletal discomfort during the adjustment period.
• OMT can aid adaptation to the heel lift.
• Proper correction leads to reduced pelvic and lower extremity somatic dysfunction.
• Improves standing flexion test results.

Functional Short Leg

• The anatomy is symmetrical, but somatic dysfunction causes one leg to function as if it is shorter.
• Just as disruptive as an anatomic short leg.

Causes of Functional Short Leg

• Posteriorly rotated innominate causes the leg to function shorter
• Anteriorly rotated innominate causes leg to function longer
• Lumbar spine group curve draws the pelvis up on one side making the leg function shorter
• Overpronation makes the leg function shorter.
• Supination (underpronation) makes the leg function longer.

Treatment for Functional Short Leg

• OMT is the primary treatment since the core issue is somatic dysfunction
• Correct innominate dysfunction (anterior/posterior rotation)
• Adjust lumbar spine group curves
• Address foot and ankle dysfunctions.
• OMT techniques include still techniques, strain-counterstrain, and muscle energy techniques.
• Functional short leg can be normalized by correcting these dysfunctions.

Summary

• Treat anatomic short leg through Heel lifts
• OMT treats functional short leg
• Introduce heel lift therapy gradually in chronic cases
• OMT can help patients adapt to heel lift therapy and improve overall function
• Understanding the difference between anatomic and functional short leg is crucial for providing the correct treatment and improving patient outcomes.