Functional Leg Length Disparities: Are Shoe Lifts Really Needed?

I had a truly amazing experience happen to me the other day. I had a client come in with one of the worst cases of leg length disparities I have ever come across. Roger had called me prior to give me a brief history of his condition. He explained that he was born with club feet. He had eleven surgeries, one back surgery and two shoulder surgeries. His most current symptom was right hip pain. He was diagnosed with bursitis. I thought wow this guy is going to be a challenge. Roger said to me "If you could help me it would be literally a miracle."

Before I began my evaluation on him he showed me his shoes, his lifts and his brace for his foot and ankle. His right shoe had a two inch lift! Roger was almost pulling out of his shoe because the lift took up so much space. The lift was designed to hold his right foot in plantar flexion and level his pelvis out. The problem I saw was the right side his pelvis was about three inches higher than his left side. That is not an exaggeration. When Roger walked he was basically pegging off his right leg because of the leg length disparity. I explained that any times people have what I call a functional leg length disparity versus a congenital leg length disparity. I knew Roger was thinking to himself that his case was congenital. I then explained that people with congenital disparities generally worsen as the years progress. I designed a program to try to correct his leg length or at the very least slightly improve it. When we got done with the routine I checked the leg lengths and was blown away by the improvements. His pelvis leveled out.

Now at this point I was thinking that I would be able to improve it slightly but did not think it would improve that much. Remember Roger was born with clubfeet, had 11 ankle and foot surgeries and wore lifts in his shoes and a brace. I had him walk and he felt an instant change in his gait. He was not pegging off his right leg. This was an interesting situation because what were we going to do with his lifts? As I am writing this article I am still not sure because he needs the lift to stabilize his right foot but it is throwing off his pelvis.

It is the following week and I decided to have Roger decrease the height in his shoe. By doing this he has actually felt more stable and his gait feels more even. I do not like to challenge other health care professionals but I also want to help my clients. If I feel that someone has prescribed the wrong protocol I will question it but will always tell my client to have the other health care professional call me if they have questions or comments. All health care professionals should share a common goal, which is to help you.

If you got to a podiatrist they will probably tell you that you need orthotics or heel lift to address your pain. What if the actual problem was located in your pelvis? In my experience I have found that almost all of my clients that have leg length discrepancies actually have functional leg length disparities. The muscles are pulling the pelvis up which is causing the leg length versus a true leg length discrepancy. My point is if you could correct the muscles that are pulling the pelvis up you will not need the shoe lift or orthotics. I know if there are podiatrists reading this they are saying I am incorrect. I guess my response would have to be I fix it every week. Am I wrong? I always tell my clients that the proof is in the pudding. Let me prove it. It is ok to be skeptical. I welcome the challenge.

Rachel Jenkins