I tend to class the results as follows:

I will never class a leg length difference as a primary complaint. Pain may develop because of differences, but length alone will not be painful.

The causes of a SLEX are either developmental (born with it) or traumatic (e.g. following a fracture of a thighbone which sets as a shorter length).

"Traumatic" onsets can possibly cause more problems as the whole postural compensation mechanism changes immediately, whereas "developmental" can be less of an issue as the body has adapted through life.

If, however, a SLEX is suspected in either case, how might the symptoms manifest?

Well, the leg itself will not feel painful just because of its length, but the way it integrates within the whole posture can lead to pain in joint or soft-tissue. Typically, pain will be felt on the same side as the LONGER leg, but this is not guaranteed.

The reasons for the longer leg being more of an issue are reasonably simple to picture: a short-leg cannot be lengthened, but a longer leg can "shorten" by compressing or twisting at the foot, knee, hip, sacro-iliac or spinal areas.

If some of these compensations reach their limit, pain and dysfunction ensue.

Treatment

Each osteopath (and other professionals) have their own opinions. This is mine.

My approach is somewhat "global" to the whole problem, as I do not wish to force the body to adapt to postures that it is finding difficult to deal with. I also believe that if the body has been adapting "neurologically" for some time to deal with the problem, it is unlikely that a quick fix is going to appear with treatment to just one area. It is far more likely that many small changes at different sites will be more effective.

Starting from the bottom and working up, here are some of my approaches:

Management

Minor differences (see table above) are relatively simple to deal with and I have found that differences over 2.0cm are less difficult than between 1.0 and 2.0cm. I have wondered if perhaps a gross leg length difference causes more widespread adaptability.

Presuming treatment is underway and a working plan is in place, I need to look at "cause and effect" as any symptoms due to leg lengths differences tend to come on slowly rather than immediately.

Runners could perhaps see if the road camber on one side is more helpful than the other and there is always an option of a heel lift to artificially balance the difference to those who spend a lot of time on their feet. However, if you spend most of your day sitting, a heel lift is less likely to help.

With heel lifts, I rarely recommend permanent use. My reasoning is that one cannot always keep a heel lift in place permanently and perhaps "neurologically" the body may tend to go back to its old ways and not adapt well enough.

I do tend to recommend heel lifts for short-term use as required, but even then, I will use an arbitrary size (e.g. 1.0cm), so as to reduce the strain on the affected tissues until the treatment starts to have its effect.

If there are minor recurrences of pain in the future, wearing the heel lift for as little as one week can often help the body settle down.

Within footwear, I am perhaps more likely to recommended simple (reasonably flexible) arch supports. Once again, I am not looking for a specific "orthotic" fit, as the body rarely responds specifically. Sometimes arch supports will give a moderately stable base for the feet to work from, so as not to fatigue as easily, and to give a reasonably consistent presentation of the foot to the ground. I tend to recommend basic Scholl products, as these are relatively inexpensive and can be replaced as required.

Combining an arch support with a temporary heel lift is also possible.

Flexibility exercises are very important to supplement the treatment over the longer term. Strengthening exercises can also be useful, but I find these less so. These strength exercises can range from core-stability to leg stability.

Summary

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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards