Short Leg Syndrome

Has your osteopath, chiropractor, physical therapist, or school nurse told you that one of your legs is short? Has this been a repetitive finding during examination or manipulation?

Causes of a short leg

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The presence of a shortened leg is usually associated with pelvic joint or lumbar spine misalignment and a syndrome of physical symptoms and signs. Leg shortening, or leg length discrepancy, is usually functional, but it may, also, be anatomical.

Although there are a number of musculoskeletal conditions that may aggravate the functional shortening of a leg—usually, it is due to either:

  • A misalignment of one of the sacroiliac (SI) joints causing the sacral base to drop to one side—or
  • A rotation (flexion or extension) of one of the hip bones (iliac bones) out of normal position.

These types of joint misalignment cause a functionally short leg (FSL). FSL is a common finding in patients with low back pain due to SI joint or iliac dysfunction. Ordinarily, this form of shortening may range from 1 to 5 millimeters in leg length discrepancy, though it could be more.

On more rare occasions, leg shortening may actually be due to some degree of anatomical shortening, which is most often caused by:

  • A developmental arrest in the growth of one leg versus the other.
  • The aftermath of a severe fracture with loss of original bone architecture during the healing—or
  • The aftermath of a prosthetic joint replacement, e.g., hip or knee replacement.

Anatomical shortening may range from 1 to 10 millimeters in leg length discrepancy, and sometimes more, depending on the actual cause. An anatomically short leg (ASL) is often accompanied by a coexisting FSL.

Symptoms and Signs

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Radiological examiniation can confirm the presence and determine the exact extent of leg length discrepancy. This is especially helpful in the case of prosthetic joint surgery causing a leg shortening.

Short leg syndrome: Whatever the cause, a shortened leg is usually accompanied by recognizable physical symptoms, signs, and long-term effects. These symptoms and signs usually fit into a clinical “syndrome,” and may include:

On the short leg side:

  • Leg aBductor muscle (e.g., Gluteus medius) weakness, which subsides immediately after pelvic realignment
  • Very slight, but perceptible, abnormal reaching out (supination) of the ankle and foot
  • External rotation of the ankle and lower leg—and
  • Knee cap (patella) misalignment and abnormal tracking.

On the long leg side:

  • Hesitation limp (“vaulting“ over the long leg’s hip joint) with very slight external rotation of the lower leg and ankle-foot
  • Very slight abnormal pronation (rolling inward) of the ankle and foot—and
  • Knee cap (patella) misalignment and abnormal tracking.
  • If the above abnormal compensatory changes exist for too long—even in the case of a functionally short leg—the abnormal stresses and strains can produce significant sprain injuries.

Whether purely functional, purely anatomical, or a combination of the two conditions, short leg syndrome is usually accompanied by other compensatory changes due to the dropping of the sacral base, including:

  • Thoraco-lumbar side-bending and consequent scoliosis—and
  • Lumbar vertebral rotation.

NOTE: Such purely musculoskeletal compensatory changes may rarely coincide with significant degenerative intervertebral disc compression of a nerve root causing a clinically vicious “Perfect Storm”.  The result may be acute, severe debilitating pain, neurological deficit (e.g., dropped foot) leading to an requirement for an emergency decompression of the nerve root either medically or surgically.

All of the above physical changes can ultimately result in disastrous, very painful results for the patient. The end-result postural deterioration and musculoskeletal decompensation can be very painful and disabling. They need to be adequately diagnosed through an complete functional musculoskeletal examination. Once diagnosed, further deterioration is preventable and treatable.

Treatment

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Typically, a functionally shortened leg does not require extensive treatment, AS LONG AS—

  • The shortening is only functional, as proven by Osteopathic Manual Therapy (OMT), reexamination, testing off
  • IF the primary cause of the functionally shortened leg is quickly treated to permanently resolve the leg length discrepancy—usually with Prolotherapy.
  • Platelet-Rich Plasma (PRP) Therapy would be more appropriate if the sprain injury and dysfunction are due to significant ligament or tendon tearing.
  • However, for an anatomically shortened leg (ASL), even minor leg length discrepancies may require prosthetic correction, in order to avoid long-term compensatory injuries. Treatment for ASL typically includes:
  • Orthotic Therapy: A properly fitting pair of orthotics that helps assure the best plantar arch support—often with a heel lift.
  • Heel lift: Using the orthotic on the short leg side as a base, apply a leg-length-restorative heel lift. If the leg length discrepancy is minimal in severity (e.g., one to three millimeters), using a heel lift may be all that is needed to achieve leg length equality and resolve symptoms. A heel lift may cause compensatory shortening of the leg’s posterior muscular column
  • Full-length sole elevation: If the length discrepancy is more severe and a heel lift is not sufficient, an addition or elevation to the full shoe sole length may be required on the short leg side. This should be obtained from a reputable shoe repair shop.  A full-length sole-elevation is less likely to cause compensatory shortening of the leg’s posterior muscular column.

Gary B. Clark, MD, MPA | 1790 30th Street, Suite 230, Boulder, CO | (303) 444-5131