From the Guidelines
Treatment for acquired short leg syndrome primarily involves the use of heel lifts or shoe inserts to compensate for the leg length discrepancy, as this approach has been shown to effectively reduce symptoms and improve quality of life. For mild discrepancies (less than 2 cm), a heel lift made of cork, rubber, or ethyl vinyl acetate placed inside the shoe of the shorter leg is typically sufficient, as recommended by the American College of Foot and Ankle Surgeons 1. Start with a lift that's about half the measured discrepancy and gradually increase to full correction over several weeks to allow the body to adjust. Some key considerations for treatment include:
- Using orthoses or accommodative padding to reduce pressure on the affected area 1
- NSAID therapy for short-term pain relief, with options like ibuprofen (400-600 mg three times daily) or naproxen (250-500 mg twice daily) 1
- Physical therapy focusing on core strengthening, pelvic stabilization exercises, and stretching tight muscles, particularly in the lower back, hip, and leg, to address musculoskeletal compensation patterns 1
- Weight loss, if indicated, to reduce strain on the affected leg and promote overall health 1 It is essential to note that while corticosteroid injections may be considered for some conditions, they are not recommended for initial treatment of heel pain 1. By prioritizing a comprehensive approach that addresses both the mechanical imbalance and resulting musculoskeletal compensation patterns, patients with acquired short leg syndrome can experience significant improvements in symptoms and quality of life.
From the Research
Treatment Options for Acquired Short Leg Syndrome
- Conservative treatment options include:
- Shoe inserts
- High shoes
- Orthosis
- Surgical treatment options include:
- Surgically induced slowing of growth by blockade of the epiphyseal plates around the knee joint
- Leg lengthening with osteotomy and subsequent distraction of the bone callus with fully implanted or external apparatus
- Epiphysiodesis, a bone growth retardation procedure, which is normally performed on the long limb in pediatric patients 2, 3
Factors Influencing Treatment Decision
- The extent of the leg-length discrepancy is not the sole determining factor for the mode of treatment
- The decision to treat is always elective and must be discussed with each patient individually
- The predicted leg-length discrepancy can be estimated with predictive algorithms to within 2 cm, and if it exceeds 5 cm, initial leg-lengthening treatment can already be considered during the patient's growing years 2
Diagnosis and Evaluation
- Scanograms or orthoroentgenograms are useful in diagnosing, quantifying, and prognosing short-leg syndrome
- The Anderson et al. remaining growth charts can be used to predict the projected discrepancy
- The level of compensation, including foot, pelvic, and spinal compensations, should be evaluated 3