By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TWO TYPES OF SHORT-LEG SYNDROME REQUIRE DIFFERENT TREATMENTS

Question: I went to the doctor because my back hurt, and he told me that I had a short leg that was causing my back pain. I have never noticed that my legs are short. What does that have to do with my back hurting? Can this be fixed?

Answer: There are two types of leg length discrepancy -- true and functional. Both problems are sometimes called “short-leg syndrome.” Your treatment depends on which type you have. Let me tell you about them.

A true leg length discrepancy is caused when one leg doesn’t grow enough or one leg grows too much. When the legs are measured from one fixed body point to another fixed point, there is a difference in the measurements. The problem can be in either of the major bones of the leg. That is, either the femur -- commonly called the thigh bone, or the tibia -- known as the shin bone in ordinary parlance -- may be shorter than the corresponding bone on the other leg. Problems with your back can develop with a difference of as little as a fourth of an inch. Injury to a growth plate or infection in a bone can cause this type of growth discrepancy. Usually, however, no specific cause can be identified, and you just have to chalk it up to “the way you are built,” and perhaps, genetics. There is a tendency for short-leg syndrome to run in families.

On the other hand, a functional leg length discrepancy does not involve legs of unequal length; rather, this of form short-leg syndrome has an underlying biomechanical cause. While the legs -- when measured from fixed points -- are the same length, one leg may appear shorter when the patient is evaluated in a laying or sitting position. This is usually caused by a tilt in the pelvic bone, or a hip or sacroiliac joint.

Both types of short-leg syndrome can present as back pain. True leg length discrepancies can be the underlying cause of scoliosis. A true leg length problem is treated with a heel lift or prosthetic device to correct the short side. If the length difference is very large, surgical intervention is sometimes needed.

A functional leg length problem is treated by fixing the underlying biomechanical problem. Osteopathic manipulative treatment can correct many problems in the pelvic, hip and sacroiliac regions, thus relieving your back pain. Osteopathic manipulative treatments can also be used to relieve pain caused by a true leg length problem while the body is adjusting to a lift that elevates the shorter leg to its correct position.

All in all, you must know the correct diagnosis before you can get the correct treatment. That’s why I’d recommend that you return to your doctor and ask what type of short-leg syndrome you have and what the recommended treatment would be in your case. If your doctor doesn’t feel comfortable treating this condition, ask for a referral to an orthopedist or a podiatrist.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.