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1305 Views 5 Replies Latest reply: Jan 22, 2012 8:10 AM by MouseRN
MouseRN Pro 135 posts since
Feb 15, 2009
Currently Being Moderated

Nov 2, 2011 12:54 AM

Anyone else with leg length discrepancy?

I've been dealing with ITBS for almost 2 months now...at first I thought it was just from overdoing it on a run on the Vegas Strip where I was running up and down stairs (something I don't normally do), then I thought it was due to overcorrection of my pronation issue by my shoes. After resting basically for almost a month I was feeling 95% better and decided to try to do my full short runs 3-4 miles, but also decided to try to run on some small hills once (where I train normally is totally flat). Well, apparently that triggered the ITBS again in my left hip and right knee. The knee I can deal with, but the hip is almost constantly tender. I was able to run a 10K on the 22nd with the pain just starting to act up, but this past Sunday I was just barely able to finish another 10K becuase the pain kicked in a little over a mile into the race...and today I couldn't even get 3/4 of a mile before I had to give up and walk the rest of was was supposed to be a 3.3 mile run and ended up being maybe...a 2.5 mile walk. Anyway, Monday night I had remembered that a massage therapist had mentioned to me a few years ago that my hips were uneven. I then realized that a leg length difference maybe the underlying cause of the hip ITB symptoms. Went and saw my family doc today and a visual inspection did show up to a ½" difference in my legs with the left leg being shorter...the same side as the hip pain. So I went for hip/leg xrays today, have a referral to PT for strengthening exercises and an accurate measurement of my legs to see if it's a functional or congenital. I've gone and bought a ¼" heel lift and tried walking with it today, but now it feels as if my left heel is higher than the right! I'm just wondering what has  (or hasn't) worked for others who have this problem or if there are any recommendations for heel lifts. Thanks in advance!

  • JamesJohnsonLMT Legend 1,162 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Nov 4, 2011 10:28 AM (in response to MouseRN)
    Anyone else with leg length discrepancy?

    Yes, but mine is mild compared to yours. Depending on the mileage though, LLDs of 1/8" or less have been known to cause chronic pain. I compensate for mine with a relatively thin flat gel pad in my left shoe only. The arch support I had been using caused me problems during high mileage, including ITBS.

     

    1/2" is major. I suppose it's within the range of possibility for a functional, but not likely. If it were a functional LLD, you probably would have been experiencing issues in your back and/or hips before the ITBS. It's also not unusual to have an asymmetrical pelvis and leg bones of equal length. The pelvis can even be flared on one side, skewing the hip angle for an apparent LLD. A slight congenital can also lead to compensations resulting in a functional LLD, so therapy can get complicated, and still require orthotic support.

     

    Since you experience severe hip pain in the leg that is apparently shorter, there is a good chance your minor glutes are drawing up the hip for a functional LLD. Not sure what you are going to exercise to make that go away, since more exercise has apparently made it worse. This kind of Glute Medius/Minimus tightness does pull on the ITB, but also produces false Sciatica pain down into the legs, sometimes as far as the foot. In many cases, it can actually be solved by deep massage to the minor glutes, including self-massage with a tennis ball. If the glutes release, the functional LLD can many times be reversed, and the ITB and Sciatica pains along with it.

     

    I still use a thin pad in my left shoe because both lower leg bones were fractured in an accident years ago, and seem to explain the slight difference in length in my case. I also wear additional pads under the balls of both feet, to compensate for slightly shorter 1st metatarsals, which are known to lead to muscular compensation through the hips. The formula I am using has been working for a few years now, allowing me to run long mileage, including marathons, without any lingering pain. It was once noted that one of my arches was lower than the other, but that no longer is evident. That is another common reason for apparent LLDs, though a collapsed arch can be reversed with various therapies. There can be structural explanations for a collapsed arch (including the short 1st metatarsal), possibly involving over-pronation, that can cause it to persist despite therapy. In these cases a more elaborate solution may need to be applied in the shoe, similar to what I am using.

     

    Yours may turn out to be entirely functional, based on your hip dysfunction, in which case you could eventually drop the supports, but I suspect there may be more involved.

  • JamesJohnsonLMT Legend 1,162 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Nov 6, 2011 6:52 PM (in response to MouseRN)
    Anyone else with leg length discrepancy?

    My pain was severe neuroma pain, like a spike being driven through my foot, after growing numbness in the center of the metatarsals. Ruined a few marathons, but the pads seem to have reversed the problem so far, and the length of my long runs has increased. I ran 26.2 miles today, but the soreness on the bottom of my feet after those kind of miles was not focused in any particular place, and I've since been walking and standing without pain.

     

    The purpose of a 1st metatarsal pad is to reverse overpronation by allowing the ball of the foot (in the case of a short 1st metatarsal) to contact the ground sooner, making excess pronation unnecessary. Otherwise, there is a concentration of pressure onto the ball to stabilize the foot, leading to pressure on the ball of the foot and between the remaining metatarsals. Many neuromas begin this way, but I agree the numbness you feel may be something else. Most importantly, excess pronation can be very hard on the muscles of the hip and glutes, possibly causing a functional LLD.

     

    There are differing philosophies out there for rehabbing this issue. Some work from the foot up, and others work from the hip down. Doubtless a dysfunction in one end can lead to a problem in the other, but it is a chicken or egg issue that can distract us from the importance of all of these elements in the power train. My money's on the foot though, because without a firm foot plant the problem will eventually work its way up.

     

    Unfortunately, most interventions there involve overcompensation by stiffened shoes or supportive orthotics, without giving the body a chance to do its own proprioceptive correction. That's why I stick with the minimalist quarter-sized pads, as prescribed by podiatrist Dudley Morton over a half-century ago.. Deceptively simple, remarkably effective, and cheap as dirt since I make them myself by cutting them out of larger gel pads.

     

    If the footstrike is stable, the hips do not need to externally rotate in support of a pronated foot. If the problem persists for too long, those hip muscles will lock into a pattern that needs to be retrained, but the retraining will only stick if the foot does not require rotation of the hip. By all means get the muscles ready for gait correction, but make sure the cause is addressed in a way that does not stifle natural movement, or the rehab may be in vain.

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