The short-leg syndrome has been an enemy to both runners and doctors for many years. Questions such as the following are asked daily: (1) Can it be an aggravation too, or cause of, low back pain in lower extremity problems? (2) Should a lift be put in the shoe of the long leg or the short leg? (3) Will I always have to run on the beveled road shoulder to have even lengths?
The first thing that should be considered is that there are two types of the short-leg syndrome:
- Anatomical Short Leg. The measurement from the bony protuberance (the greater trochanter) of the hip joint to the lateral ankle measures shorter on one side than the other. This is seen in approximately three percent of all short-leg syndromes.
- Functional Short Leg. The measurement from the same two points is equal on both sides, but there is still an apparent short leg. With this type an apparent short leg. With this type, there is usually a rotation or displacement of the pelvis on one or both sides. This causes abnormal stress on all muscles, nerves, and joints that are involved. The longer a person has this type of short-leg syndrome, the greater the chance for a secondary compensatory problem somewhere else in the body, usually in the upper back, shoulders or neck. Common symptoms here are muscular pains in the involved areas, headaches, numbness, and/or tingling in the arms or hands.
There is an easy way to determine which short-leg syndrome you may have. It is known as the Deerfield Test. With the person lying face down, check the length by correcting any pronation or supination of the feet so that the heels are parallel and perpendicular to the plane of the legs. This is easier to visualize with shoes on than with bare feet because the shoe has a flat heel as opposed to the foot’s rounded heel.
After noticing which leg is short, flex both knees to 90°. If it is anatomical shortness, the difference in leg length will be identical in positions 1 and 2. If it is functional shortness, the short leg will either become longer than the other leg or longer when in the flex position. If it is functional shortness, the short leg will either become as long as the other leg or longer when in the flex position. This is called cross-over. Whichever syndrome one is suffering from, the weight distribution through each leg will be uneven. Because of the increase in poundage and stress on the body and legs during running, the symptoms will be more pronounced in a runner than in a non-runner.
What symptoms should make a person think of short-leg syndrome? First, any symptom that is exaggerated by running, such as low back pain, hip, knee, ankle, or foot pain. A tendency to pull repeatedly the same muscle even though you have given it sufficient time to heal is a symptom commonly seen. Also, shin splints and sciatic neuralgia (inflammation of the sciatic nerve that produces pain in the buttocks and down the back of the leg) are very common symptoms.
After it has been determined which syndrome is evident, a correction can be considered. With anatomical shortness, correction is made simply by placing a heel left in the shoe of the short leg. The lift can either be inserted in the shoe itself or constructed onto the inside shoe (or of your orthotic). This can be done by any qualified orthopedist, podiatrist, or chiropractor.
When it comes to functional shortness, which is more complex, the first thing to consider is the underlying cause of the short leg. Some common causes are: (1) Arches are not the same on both feet. (correction can be aided with the arch supports or orthotics). (2) An abnormal range of motion, in the joints. Each joint, including the ankle, knee, hip, and low back, should be put through a full range of motion to ensure normal equal motion. (3) A weakness of one or lower extremity muscles, which allows the pelvis to rotate either anteriorly (forward) or posteriorly (backward) in relationship to the other side. (4) Bad habits, such as poor posture, slouching in chairs, crossing legs while sitting, standing with all your weight on one leg, always running on the same side of beveled roads, or insufficient stretching. (5) Poor quality running shoes.
Correction of functional shortness involves several factors. First, correction of any structural faults has to be made to allow for normal weight distribution and normal functioning of the joints and muscles involved. This is done by correcting any muscular imbalances (right vs. left and front vs. back) that become apparent after a thorough kinesiological examination by a qualified physician. After correction of the muscular imbalances, manipulation of the involved joints is performed to correct any structural imbalances. This allows all joints to function under a proportionate weight distribution. Second, visual observation of the patient running is a must to determine if there are any abnormalities in the gait or stride, such as one arm held close to the body in its correct motion. All muscles being balanced and working equally on both sides of the body allows for maximum efficiency of oxygen usage. Third, correction of the short-leg syndrome must be made to prevent any undue stress.
The body is the most amazing piece of machinery imaginable. With a little care and understanding of its normal function, and with proper balance and alignment, it will give you many more quality miles on the road, with much less chance of injury.