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Thread: leg length discrepancy? question for Linda

  1. #1
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    leg length discrepancy? question for Linda

    I've recently run across some literature about leg-length discrepancy as a possible cause of functional scoliosis (which I understand is usually mild and appears to correct itself in bending x-rays). My left leg is slightly longer than my right leg, or at least it appears to be longer (or FEELS longer, anyway). But no one has expressed any interest in this, including Dr. Boachie. When I'm standing, my pelvis in x-rays appears to be pretty level, so I'm sure the discrepancy is small.

    But shouldn't every scoliosis patient be screened for this before surgery, and wouldn't untreated leg-length discrepancy affect how you heal and maintain correction after surgery??

    Thanks,
    Chris
    Last edited by Singer; 09-22-2006 at 01:22 PM.
    Chris
    A/P fusion on June 19, 2007 at age 52; T10-L5
    Pre-op thoracolumbar curve: 70 degrees
    Post-op curve: 12 degrees
    Dr. Boachie-adjei, HSS, New York

  2. #2
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    Hi Chris,

    Thought I would share my leg discrepancy experience with you. My Sr. yr. of high school the nurse sent me to my Dr. for scoli check. He proclaimed I had one leg longer. That was it, no x-ray & no looking at my back. Fast forward 19 yrs. when I was diagnosed with scoliosis, my hips weren't level due to it, thus the leg length discrepancy was solved. After P.T. I was able to straighten out the level of my hips somewhat. Now post-op I am level permanently and legs are the same length. (They always were but appeared different due to my pelvis tilt & leaning.) Your legs are probably the same length but when hips aren't level they appear different lengths. I think that is why Dr. Boachie wasn't too concerned. I had heard this from other P.T. and Dr's. Your pelvis may appear level but when they measure it then you see the difference. I had thought I was pretty level till my Dr. showed me on my x-ray how off I really was.

  3. #3
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    very interesting...I was thinking of this recently too!
    My left leg has always felt longer to me, of course I was very crooked prior to surgery....now after, I still feel it's the same????maybe I'll ask about it at next appmt...........Ly

  4. #4
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    Had a heel lift for years

    Before my surgery, I wore a heel lift (about 1/2 inch) in my left shoe. (My lumbar curve goes to the left. A chiropractor prescribed it; my medical dr. confirmed that it was the right size. I had developed sciatica on the right side (the higher side). Wearing the lift did take a lot of stress off that right side. If I went without it for 2 or 3 days, the pain became extreme enough that I was limping.

    Another chiropractor that I went to later told me that I should not wear the heel lift because it threw the rest of my body out of whack. He thought that the adjustments should realign things so I didn't need it. I tried to go without it and get the adjustments for a year, but the pain made me start wearing it again so I could stand up for my job. Also among the physical therapists I had over the years, one would tell me I didn't need the lift and the next one would say I did. Both my mother and grandmother had leg-length discrepancy but did not have scoliosis with it.

    Since my surgery, I went without it for the first month, but the second month the same old pain started up even worse than before, so I started wearing it again. It has calmed down unless I walk more than a few yards. My surgeon says to wait another month for things to settle down before going to physical therapy for it, so I am hoping that time and healing will help settle it down. My pelvis appears even in the x-rays, but I think that the severe scoliosis twisted it enough that even surgery didn't realign it enough to stop the sciatic/sacro-iliac problem. Plus it can't make a short leg grow!

    Chris, I hope that someone soon will research this problem in scoliosis patients. It would need to be diagnosed very early to be treated correctly. It is the chicken before the egg problem. Does the uneven leg length cause the scoliosis or is it the scoliosis that causes the pelvis and legs to be uneven?

    Deb
    age 47
    posterior surgery 7/24/06
    for T70,L76 S curve
    30 degree correction
    "DON'T WAIT!!"

  5. #5
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    Hi...

    I've been told that the only way to be certain that there actually is a leg length discrepancy is with special xrays. The legs are xrayed with a special cassette that includes a ruler.

    When I was growing up, I was told that I had a leg length discrepancy, and even wore a lift in my shoe for several years. As it turns out, my legs are of almost identical lengths, but my pelvis is tilted (which is very common with thoracolumbar or lumbar scoliosis).

    Regards,
    Linda

  6. #6
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    Wow, what an interesting subject. As a child I was told that my left leg was 3-8ths of an inch shorter than my right leg. I have worn a lift in my shoe since 1972.

    Before I had my surgery, if I didn't wear it for any length of time while being on my feet, I had a lot of pain.

    I asked my Dr. after the surgery if I still needed it and he said no, that my hips were level. But the xray was taken with my shoe's on and my lift in.

    I still wear it. How do we know what is the right thing to do???

    Shari

  7. #7
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    Wow, these comments are all really interesting and somewhat scary too. I know that if I have to stand for any length of time, I habitually stand on my right leg with my left (longer) leg a little to the front and the side, and then I feel somewhat balanced.

    It sounds like some people's apparent discrepancy is resolved through surgery and others (like Deb's) are not. I am really surprised this isn't addressed as part of the overall surgical treatment. Shari, I can't believe you aren't given specific instructions on what to do with your shoe lift after surgery! It's only a PT issue?? That doesn't seem right....

    Deb, you hit the nail on the head with your chicken-and-egg comment. It makes me wonder if a functional curve caused by an untreated leg-length discrepancy can turn into a structural curve over time. Hmmm.
    Chris
    A/P fusion on June 19, 2007 at age 52; T10-L5
    Pre-op thoracolumbar curve: 70 degrees
    Post-op curve: 12 degrees
    Dr. Boachie-adjei, HSS, New York

  8. #8
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    Quote Originally Posted by Shari


    I still wear it. How do we know what is the right thing to do???

    Shari
    That's a good question, and I think in a lot of cases the answer is so simple. For me, I have found that when I do something and it feels like I have less or no pain, I don't care what dotor or therapists say, I go with it. That's why I appreciate most of the PT's I have met in my life who all said that when something hurts for too long(like an exercise for example), to just stop doing it and/or try something else. I wear orthotics and every single doctor prior to surgery and before I started wearing them told me that scoliosis was the cause of all my knee/heel/hip/leg pains. They were all wrong, they were due to my feet mostly. For my sciatica I find that bending with my knees and not stretching it like I used to helps with the pain much more.

    Like I always say, it's always best to do what we feel best and when we're in the least amount of pain, and no doctor or therapist is right all the time.
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

  9. #9
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    leg length and scoliosis

    From the National Library of Medicine:

    1: J Bone Joint Surg Am. 1982 Jan;64(1):59-62. Links
    Scoliosis associated with limb-length inequality.Papaioannou T, Stokes I, Kenwright J.
    We reviewed the records and physical findings of twenty-three young adults who had had significant untreated limb-length inequality, present since childhood. The spine was studied radiographically and clinically before and after neutralization of the discrepancy of limb lengths with a lift. Movements of the spine also were measured. A significant asymmetry of lateral flexion of the spine remained in nearly all of the patients after neutralization of the discrepancy. The lumbar scoliosis associated with the limb-length inequality was compensatory and non-progressive, but abnormalities of the Cobb angle and of axial rotation remained in the young adults. No relationship was found between the underlying cause of the anisomelia or its duration and the severity of the spinal abnormality. The scoliosis was minor in patients with discrepancies of less than 2.2 centimeters. No patients complained of significant discomfort in the back, nor were degenerative radiographic changes evident there.

    Medical Dictionary anisomelia (ăn-ī'sō-mē'lē-ə, -mēl'yə)
    Inequality between paired limbs.


    PMID: 7054204 [PubMed - indexed for MEDLINE
    I wished it was so simple.

    In 1956 my surgeon(Cobb) measured my leg length and found a very slight difference(normal) yet my curves were very severe.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  10. #10
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    Huh?

    Karen -- so they're saying that the only scoliosis associated with leg-length discrepancy is mild and not progressive? And that anything severe or progressive is structural? I wasn't quite sure.
    Chris
    A/P fusion on June 19, 2007 at age 52; T10-L5
    Pre-op thoracolumbar curve: 70 degrees
    Post-op curve: 12 degrees
    Dr. Boachie-adjei, HSS, New York

  11. #11
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    Hi Singer...

    I don't think anyone knows for sure.

    I have a niece who had the special leg length xrays. She has almost a 1-1/2" difference. I was certain it was scoliosis, but when her spine was xrayed, it was completely straight.

    Regards,
    Linda

  12. #12
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    Leg length and Scoliosis

    My MD gave me a long explanation when I asked him about this and he explained that my legs appear uneven because of the scoliosis. Standing and supine xrays look very different... The basic principle that he stressed is that scoliosis is a 3 dimensional curve so judgments can't be made based on looking at only one plane. My undeducated assumption is that there is no simple rule and each case needs to be examined individually and from several angles.

  13. #13
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    For Singer

    ... No relationship was found between the underlying cause of the anisomelia or its duration and the severity of the spinal abnormality
    ...(1: J Bone Joint Surg Am. 1982 Jan;64(1):59-62.)

    It sounds like they mean there is no connection, in those studied, in leg length differences and the severity of scoliosis. In other words it seems not to cause idiopathic scoliosis.

    I read another study where heel lifts were used where appropriate but it only slightly changed the lumbar curve but basically had no affect on scoliosis.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  14. #14
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    Thanks Karen,and Linda, and for everyone's insights....
    Chris
    A/P fusion on June 19, 2007 at age 52; T10-L5
    Pre-op thoracolumbar curve: 70 degrees
    Post-op curve: 12 degrees
    Dr. Boachie-adjei, HSS, New York

  15. #15
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    Here is one of my previous post:

    I wear a quarter inch shoe lift in my left shoe. Although, a quarter inch may seem like a little...I can really tell the difference when it is not in my shoes.

    I had growth arrest surgery on my right leg 31 yrs ago because there was an inch difference(tibula, fibula and femur all measured different lengths). I wore a one inch built up shoe, then 1/2 inch and then a shoe lift insert until the short leg grew out the length of the other leg. I went about 29 yrs without using any kind of lift.

    After spinal fusion surgery, I had to go back to a quarter inch lift in my shoes.

    Kindest Regards,
    Gail

    P/S All of my leg xrays were made with a wide flat metal type ruler that was positioned at the center of my body while lying down on an xray table.
    Last edited by Gail; 09-23-2006 at 09:24 PM.

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