There are many causes for short (anatomical) legs, ranging from early injury to the epiphysis, prolapse of the arch of the foot, inversion of the ankle, congenital anomalies, fracture and the most uncompensated long-bone growth pattern. [1]

The end result or the bottom line is, nevertheless, an anatomical short leg and it must be dealt with as such. Any attempt to correct it through adjustment or manipulation will usually succeed in removing the vertebral fixation caused by the deficiency thereby relieving symptoms, the re-check x-ray, however, will remain the same.

Let's take a further look at the x-ray we have marked. On the low leg (deficient) side the spine will be curved, further up there will be present a secondary or compensatory curve, this time in the opposite direction, this is to prevent your entire body from falling over to the deficient side. Is all of this really true or are my eyes deceiving me?

To prove it, place your parallel ruler once again on the film, this time the edge of the ruler is parallel to the right or left margin of the film. Roll the ruler across the film stopping when the edge just bisects the symphysis pubis, a light line is now drawn up to above the level of the third or second lumbar vertebra. Yes, our suspicions have been confirmed, the center of the pelvis has moved away from the normal center of gravity and has moved to the high side of the pelvis in an attempt to maintain balance.

This heroic attempt of the body's mechanics is almost never complete as witnessed by the 5-to-50 lbs. of extra weight on this deficient side in almost all cases. A closer look at the lower concavity of the resultant scoliosis will show weight bearing degeneration and, of course, another picture taken a few years down the track will show still more changes. But, the argument continues, "the "PI" is certainly there and this is what is causing all of the trouble. I've found it, let's adjust it and everything will be OK."

The facts are: there was never a "PI" that caused a short leg, however a short leg almost always causes a "PI." [3]

Looking at the mechanics logically, we see the deficiency causing a sacral tilt with the spine curving towards the lower side. The bodies of the vertebrae, since they must carry the mainframe weight MUST rotate towards the low side to do this (the center of gravity). As the vertebra is a whole unit and not segmented, the resultant rotation towards this deficient side must carry the articulating processes with it (them) posteriorly: enter the ubiquitous "PI."

When the mechanics of the situation computes, we have to ask ourselves "What can I do to help this person in a more permanent way?" If we were ambulating around on all fours, there would be little problem but since our unfortunate biped stance has evolved the only things to do is correct the leg length.

Going back to the reasons for the deficiency, the foot and ankle problems can be resolved usually with proper orthotics but growth anomalies and "real" short legs must be compensated for with a heel lift. There! That dreaded word has come out, "It's not natural, it's not chiropractic, they won't follow through, the whole sole must be lifted." All of these are incorrect.

There is nothing more natural than showing an obviously recovering patient the real-life, tangible proof of successful treatment in the form of a self-explanatory straight or straightening spine as soon on x-ray. Pressure is taken off endplates, compensatory pressure thickening (degeneration) is slowed and the tendency towards vertebral fixation and subluxation is lessened. Isn't that what we and chiropractic are all about?

There are certain "rules" that must be followed, however, before we blindly rush off placing heel lifts under every short leg. To do so, is to invite therapeutic disaster. The rules are fairly simple, however, and follow the dictates of common sense. Some of them are as follows:

1. The entire sole should not have to be raised, and to raise it inside with the use of pads will compromise the toes and arch. Anything to 1/2" (12mm) is tolerated in the heel which is where the height adjustment for the body takes place.

2. Do not tell the patient to have the shoes raised by the shoemaker. The height is never accurate. It's expensive, it wears more and the patient compliance is low.

3. Do not give the patient one heel lift. Start with six or one for every shoe. Do not allow changing from shoe to shoe, after all this is a permanent adjustment to the length of the leg, over the age of 21, the leg will not grow longer.

4. If a low hip is offset by an opposite tilt to the sacral base (an early life compensation), take this into consideration when assessing the height of the lift. Prescribing more height than needed for a short time to accomplish specific corrections or to force correction can be a viable therapy.

5. When assessing the leg length visually, as in a spinal screening, do not rely on palpation alone. Assess the: a) horizontal and vertical alignment; b) the amount of body mass to one side of the centerline; c) height of the hips; d) obvious scoliosis; e) head tilt; and f) weight balance.

A machine such as S.A.M. (Spinal Analysis Machine) will allow all of the above, as well as afford the ability to assess the effects of change instantly. The entire body should be viewed and assessed as a unit, to be confirmed with the x-ray examination.

6. In the approximate 10% that display a low hip and/or sacral base and a spinal curve to the opposite or high side, you must look for sacral base anomalies or atypical causes for this.

7. A general rule is that it matters little how short the leg is. The only reason for correcting it is to render the spine more anatomically correct, lessen degeneration, promote re-generation, and, most importantly, enhance the adjustment an enormous amount. All heel lifts are to be used with these objectives in mind.

I hope that readers will benefit from this look into another therapeutic effort that is chiropractic from the ground up and designed to enhance any technique used today. After all, if you can start with a straighter, more anatomically correct and comfortable spine, you are half way there.

1. Giles, Taylor: "Leg Length Inequality," JACA (Aust.), December 1985.

2. Jerome, John: "Measurable Mysteries," Outside, August 1984.

3. Dulhunty: "Sacroiliac Subluxation," JACA (Aust.), September 1985.

4. Silverman: "A Calcaneal Orthosis in the Treatment of Postural or Functional Scoliosis in Children," ACA Journal, December 1987.

5. Dishman: "Pedal Mechanics Affecting 'Short Leg' Measurements," M.P.I.'s Dynamic Chiropractic, February 1988.

6. Slosberg: "Activator Methods, An Update and Review," Today's Chiropractic, July/August 1988.

7. Pennell: "Diagnosis & Treatment of Leg Length Inequality," 1989.