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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

November 1996

Treating The Lopsided Dancer

By Rick Allen, DC

In the previous article we looked at the impact of leg length inequality (LLI) on your dancing and overall health. Remember that the causes can be structural or functional. Structural LLI is a true difference in the length of the legs, perhaps due to unequal growth rates, fractures, deformities or altered joint structure. Functional LLI results from excessive foot pronation (flat feet), muscle contractures or pelvic distortions. Functional LLI is more common.

As I pointed out, your doctor will look for five "red flags" when examining your legs:

  • foot flare different from the normal 5 to 10 degrees,
  • unusual wear of your shoes -- excessive pronation will result in greater wear on the outer edge of the heel,
  • medial facing patellae -- "squinting" knee caps,
  • medial bowing of the Achilles tendons, and
  • lack of the medial arches or painful plantar fascia.

Your doctor will palpate spine, looking for tenderness, altered temperature, muscle spasm, and altered joint play. Your doctor will also test reflexes, skin sensation, and muscle strength, which may indicate nerve involvement.

They will evaluate your gait, looking for smooth, symmetrical body motion, a normal even stride, and proper alignment of the knee, ankle and foot. They may use a treadmill to evaluate your gait, but oftentimes a sufficient clinical picture can be obtained by just observing you walk or run. If the problem is severe or difficult to treat, the doctor may take an x-ray.

Treatment

Effective treatment depends on examination of three primary factors:

  • cause of LLI - LLI usually responds to a combination of (1) myofascial release and stretching of the pelvic musculature, especially the psoas, to relieve distortion, (2) heel lift to lengthen the short leg, (3) orthotics to correct distortion of the foot, most commonly pronation, (4) correction of the position of the atlas, which is the top vertebra in the spine, by chiropractic adjustment. Structural LLI will require a permanent lift to correct for the physical difference in leg length.
  • degree of LLI - Usually up to 6 mm (approximately 1/4") can be corrected with a heel lift inserted in the shoe; from 6 to 12 mm may require reducing the opposite heel as well as adding a lift on side of the short leg; beyond 12 mm (1/2") will require specially modified shoes.
  • age of the patient - Most postural deficits begin in children, with the body adapting to the LLI by the pelvic and spinal alterations described above. A lift may be undesirable if the LLI occurred during the childhood growth phase, but was undetected, the body has compensated and you are not experiencing a problem as an adult. It may be better to leave it alone.

There is a happy ending even for someone with a drastic LLI. I have treated a triathlete who had hip displasia as a child, grew up with a 25 mm (1 inch) short right leg, and had pain back until her condition was corrected with lifts built into her shoes. She successfully completed her second ironman competition last summer!

Now you are aware of how common and how serious the effects of LLI are. The decision of how to best treat any case of LLI should be made in cooperation with your health professional.

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