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Some patients have one leg (or “lower limb” as osteopaths call it) a lttle shorter than the other.There can be a “real short leg”, or an “apparent short legs”.
Real short leg is when there is an actual shortening of one of the bones in the leg. Apparent short leg is when there is no actual bone length difference, but because of the angle one of the joints in the leg is held, the leg appears shorter.
Real short legs can arise from alterations of growth rate, as infractures or polio. Slight differences in bone growth can also occur naturally – as our bones grow, the left and right legs do not grow at equal rates, so when they stop growing in our late teens one can be a bit ahead of the other. An example of an apparent short leg would be when the knee is held slightly bent (as in osteoarthritis), effectively shortening the limb on that side.
Depending on the leg length difference and its flexibility,the body can adapt (“compensate”) to the difference, usually with a sideways curve in the spine that brings the body back to the midline. Problems arise ifthe leg length difference is too great (some people can cope well with up to half an inch difference), if the compensation is poor, as the patient gets older and maybe less likely to be able to adapt, or if there are other loads on the body that need other compensations.
Osteopaths routinely exam for leg length differences, their cause and effects. They look at levels of the pelvis and the spinal curves and how they change when the patient stands, sits and lies.
Sometimes, it is necessary to consider putting a small heel lift inside the show to make up a bit of the difference. This is usually a pad of chirody felt that sits unobtrusively under the heel. This is done if the osteopath thinks the patient’s body is not coping well with the leg length difference. In acute patients it may be done as a temporary measure to decrease one of the loads on the patient’s body while they are recovering
Case Study. Anne had a hip replacement operation for an
osteoarthrotic hip whens he was 65. It went well and she
was pleased with the result. A few weeks after the
operation however she started getting pain on one side
of her back on standing or walking.
She went to see her daughter’s osteopath, who. among
other things,, looked at the level of the pelvis, curves
of her spine, and leg lengths. The osteopath explained
that in hip replacements the length of the leg sometimes
got altered and that in Anne’s case there was about a
quarter inch difference on one side. The osteopath got
Anne to stand with a little riser under the heel of the
shorter leg and saw that her spine was straight away
a lot straighter and the muscles of the spine working
less hard to keep her upright. The osteopath thought
a permanent lift in the shoe would help a lot. She sent
Anne off with a heel lift a phoned her four weeks later
to see how she was. Anne was pleased to say that her
low back pain had gone completely.
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