November 2007

The short leg syndrome ‑‑ Part 2

by Dr. Howard Loomis

Since January of 2007, this column has been reviewing an easy‑to‑learn‑and‑apply system of examination that I refer to as the 2nd Factor in Chiropractic. The purpose of the exam has been to identify visceral dysfunctions that perpetuate musculoskeletal problems and prevent their permanent correction and healing. Last month, I began to focus specifically on the side of structural weakness and the role it plays in causing a functional short leg and perpetuation of chronic symptoms.

This month, I want to describe, in‑depth, how to accurately determine functional short leg and its many clinical faces. I believe it is important to recognize that the short leg is only an effect and not the underlying cause of the symptoms.

Our search for the true cause(s) begins, naturally enough, in the legs. I will make no attempt here to indicate correction since all techniques deal effectively with these issues.

Testing leg rotation

With the patient lying supine, stand at his or her feet and grasp both feet by the heels. Raise the legs off the table slightly to fully extend the knees. Attempt to rotate the legs first internally and then externally. Compare the rotation of one side to the other. Restriction indicates muscle contraction that may involve the tissues from the sacro‑iliac joints, hip joints, the knees, the tibia and fibula, and the ankles.

***  Limited internal rotation = Ilium has rotated internally. Begin palpating for stress points and soreness/pain at the medial surface of the calcaneus. Move up the medial tibia and through the medial thigh recording your findings.

***  Limited external rotation = Ilium has rotated externally. Begin palpating for stress points and soreness/pain at the lateral surface of the calcaneus and systematically search headward up the lateral tibia and through the lateral thigh recording your findings.

The astute clinician will recognize that any leg restriction described above is a function of the sacral base angle and side of weakness described last month. This test is used to ascertain chronicity and involvement of the hip joints. The knee is not being tested specifically here because there is no rotation in the knee joint when the knee is locked in extension, as it is when we perform this test.

Nevertheless, this test is useful in determining a prognosis for knee and hip degeneration. Prolonged fixation in internal rotation leads to knee degeneration due to compression stress on the knee. In external rotation, prolonged fixation leads to hip degeneration due to shearing stress on the hip.

Determine pelvic instability due to a functional short leg

Next, have the patent bend his or her legs and place the soles of the feet on the table. Ascertain the feet are symmetrical to each other, not one caudad or cephalad in relation to the other.

***  Problems above the knee. Place your hands on front of the knees, over the patella and compare. The hand closest to the pelvis indicates a problem above the knee.

***  Problems below the knee. Next, place your hands on top of the knees and compare height. Low knee indicates a problem below the knee.

Morton's syndrome ‑‑ long second toe

Morton's toe is the presence of a second toe being longer than the first toe. This may occur in one or both feet and is not an unusual finding since it is estimated that 40% of the population has a second toe longer than the big toe. This condition causes the weight‑bearing surface of the foot to shift laterally from the first metatarsal to the second metatarsal. This creates a knife‑edge rolling effect and allows the foot to roll and can be seen as the lateral heel and medial sole wear out on shoes. This creates instability in weight bearing, since the big toe is designed to bear weight when walking. The only possible answer is to support the first toe. The patient should be fitted with orthotics to correct this mechanical problem. Failure to do so will result in a continued major mechanical stress for the patient.

Orthotics can also be a useful resource when dealing with the short leg syndrome. Inequality in the length of the legs is a continual stress to the body and undermines virtually any other condition the patient may have.

It should not be assumed that any leg deficiency is permanent. Unless there is a past history of surgery or fracture in the lower extremities, these inequalities should be considered as functional and can be corrected with chiropractic care once they are identified. Once the cause is known, the treatment is obvious.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1‑800‑662‑2630. Visit his website at http://www.loomisenzymes.com .)