"I love my shoe lift. I can walk straighter without a wobble. I spent years with a wobble walk because of hip surgeries. You have made a very positive change in my life. I tell everyone about you. Thanks again." -Susan
Those words are the sound of relief after years of ignoring leg problems and coping with ailing pain. "Susan" is not the only one to benefit from shoe lift modifications for a leg length discrepancy. In this article, a podiatrist and a provider of shoe lift modifications will offer their observations on the various options, temporary and permanent, available to people with leg length differences.
The two types of lower leg discrepancies are structural LLD and functional LLD. Structural leg length differences are more often treated with a shoe lift because they are the result of an actual anatomic shortening of the bone. Leg length differences of 3/8" or more are best suited for external shoe lift modifications while LLDs of less than 3/8" may be accommodated with internal heel lifts.
Diagnosing Leg Length Differences
The cause of leg length discrepancy may be injury to a bone in the leg. Fractures that result in a LLD are usually fractures in multiple places where the bone is exposed to skin and muscle during the injury. While recovering, the bone may heal to a shortened position.
Bone infection in developing children is also a cause of LLD, as is juvenile arthritis. Other causes include bone diseases such as neurofibromatosis, and there is a hereditary component as well.
The diagnosis of leg length difference comes during a physical examination or an X-ray. Most adults are aware there is something amiss before they seek help, but may be surprised at the diagnosis during a routine check-up. Many patients complain of back and hip pain, which are common symptoms.
A checklist of conditions a physician looks for that may indicate short leg syndrome include:
• Degenerative disk disease;
• Muscular injuries;
• Total joint anthroplasty (hips and knees);
• Post polio syndrome;
• Temporary cam/boot usage;
• Osteogenia imperfecta;
• Brittle bone disease.
When treating leg length differences it is important to initially try to avoid invasive surgical procedures and try conservative options first. Failing conservatively is not too damaging and after the fact, the invasive options are still on the table. Relatively cheap conservative treatment options are shoe lift modifications and inserts.
Weighing the Options
A shoe lift modification is an adjustment to any footwear to accommodate for leg length discrepancy. Shoe lift modifications can be a good treatment for a specific group of patients. For those who are candidates, the relief they bring is a real life changer.
Almost immediately, patients who had their shoes modified to compensate for a leg length difference have reported alleviated foot pain, alleviated back pain and alleviated hip pain. Once the compensation is made in the shoe the body does not have to work as hard anymore. The body is not burdened by having its equilibrium thrown out of balance.
Upon a doctor or physical therapist's recommendation, a professional shoe doctor splits the sole of the shoe with a precise and exact cut. This partition makes room for custom-sized soft rubber that is outfitted to the shoe. Through skilled craftsmanship and experience, it is now feasible to systematically take apart a running shoe, work boot, stiletto pump, or even a golf or cycling shoe.
With great precision, the cobbler makes a mold of a shoe lift that confines to the curvatures and intricacies of the subject's shoe. Industrial glue ensures a strong bond. A McKay machine fires an industrial strength needle and stitches the material in place.
This process reuses the original sole that was sliced off in one of the initial steps. There may be some trial and error involved in finding the appropriate height to have a shoe modified. An X-ray and examination by a doctor may reveal a leg length difference of "X" but functionally the difference may be more or less than that.
Many doctors and physical therapists recommend starting with a shoe lift modification of 50 percent of the diagnosed leg length difference, then adjusting the shoe to add more gradually over time, usually in 3-4 month increments. This allows for the body to get used to wearing a shoe lift and the results are more likely to be positive.
By reattaching the sole to the rubber now in place, the wearer of the shoe feels no discrepancy while walking. This also prevents degrading of the shoe lift material because it is not hitting pavement or road when walking. Shoe lift modification allows for the lift to be easily adjusted when needed. When the patient needs greater lift, the shoe doctor simply adds on the appropriate amount to what is already there.
It is important to listen to the patient to see how they are adjusting to the new shoe. If there is indication that they are not safely walking in the new shoe height, designers should scale back and more slowly build up to full leg length difference. Too much or too little tapering could do more damage than good. A professional will finish the job by smoothing, finishing and dying the outside of the shoe so that it looks original.
External shoe lift modification is a relatively cheap option to deal with leg length differences when compared to more aggressive and invasive procedures such as leg lengthening operations. A patient may have a shoe modified for as little as $50 and the lift of a modified shoe is as long as any unmodified shoe. It is not uncommon for patients to wear the same shoe lift for 2-3 years before modifying other shoes.
Internal heel lifts, used as an insert under the heel inside the cavity of the shoe, may become obtrusive and bothersome to the wearer because they move around and crowd the inside of the shoe. External shoe lift modifications avoid these types of problems but are more expensive because they are semi-permanent and need to be applied to many pairs of shoes.
When Surgery is Needed
In addition to shoe lift modifications, a more severe yet permanent option is surgery. In children, a relatively simple surgical procedure involves stopping or slowing down growth in certain sites on the leg.
However, this method is slow and not immediate. Timing is critical because everyone stops growing at their own pace. Therefore, over- or under-correction is a risk.
Surgical lengthening of the shorter leg involves an external fixation device affixed to the leg. A family member or the patient turns a dial, which creates tension in the wires and pins that have been surgically attached to the bone. It is possible to lengthen approximately one millimeter per day.
Leg length difference is something that has to be tolerated, but it should not be a source of despair. It should not be ignored, but rather helped or treated. And this treatment should be convenient and easy to do.
Both surgical and non-surgical options to correct structural and functional leg length differences should be considered. Patients should consult with both professionals working in groundbreaking medical practices and innovators and craftsman of durable medical equipment such as shoe lifts.
It is important for patients to weigh the options that are on the table, which can include heel inserts or external shoe lift modifications. For clinicians, the goal is for all patients to have "Susan's" positive outcome and lead a full life.
Marc Berkowitz graduated from the Ohio College of Podiatric Medicine in 2004 and completed a three-year surgical residency at Richmond Heights/University Hospitals in Cleveland, OH. Ilya Romanov, who also contributed to this article, earned a degree in business from The Ohio State University. In 2006 he founded American Heelers Inc. with a focus on orthopedic shoe lift modification for people with leg length differences.