•  MISNOMER
• May be unrelated to leg length. have multiple sx and finding: sacral-base unleveling, innominate rotation (compensatory), caudal side-bending away from side of low sacral base, most often.
• DX and TX: treat all possible before sending them to radiological evaluation.
• Radiology: measure coronal values of iliac crest heights, femoral head heights, sacral base unleveling, compensatory scoliotic curves (type, location, degree)
• Remember: 2mm human error=25% bony distortion.
  

• left image: C-scoliotic response- convexity toward the short leg.
  
• Right Image:  S-scoliotic response
  

What's true discrepancy?

What's apparent discrepancy?

• True Discrepancy: check fixed point (ASIS to med. malleolus/ femur and tibia).
• Appearent discrepancy: nonfixed pt to fixed pt. (establish no true discrepancy exit first-check for pelvic torsion)

• Trendelenburg-gluteus medius weakness
• straight leg raising-lumbar radiculopathy
• stinchfiled-intra-articular hip pathology
• FABERE/Patrick's tesT: flexion, abduction, external rotation, extension. Hip, SI joint pathology.
• Fadir/Fair: flexion, adduction, internal rotation, piriformis, hip
• Thomas: iliopsoas contraction
• Erichsen's tesT: SI and early spondylitic arthritis
• Ober's tesT: contracture of ITB
• Hip drop: assess lumbar involvement.

• Heel Lift Therapy
• OMT is done first
• Heel lift is added to the heel on the side of lower sacral base. This is the process of reeducating the patient's whole body.
• ex: right leg short, left leg long--> the body will side bend toward the left to compensate.

David Heilig's formula: L< [SBU] / [D + C]

sample heilig formula calculation:

Patient age 35, injured in early youth, minimal compensation

SBU= 1/2

Duration is -2 (35-10=25yrs)

Compensation= minimal (-1)

L= (1/2)/(2+1)= (1/2)/(3)= 1/6"

Dx and evaluation of short leg syndrome.

What should the lift obtain?

what is the maximum lift in side and outside a shoe?

• should obtain a negative standing flexion test, hence no more dysfunction.
• maximum lift inside the shoe is 1/4 inches
• maximum of 1/2 in between patient's heel and the floor. variable placement of the lift is possible.
• When the heel is lifted too high, rotation may occured, add to the anterior portion of the shoe also to prevent rotation.

• compressive forces can cause a bone to grow faster, esp in growing children. need to monitor heel lift tx in children carefully.
• anterior lift therapy: affects pelvic roation to the same side as the lift.
• overal goal-reeducate patient towards an ideal posture.

• OMT: relax and stretch muscles, correct somatic dysfunction, increase mobility
• Exercise: to stretch and tone
• Lift therapy: based on sacral base unleveling, length of time present, amount of compensation.