Our adventure in Scoliosis these past couple of weeks involve my daughter’s feet. Yes, her feet. She has been complaining of mild foot pain for a few weeks, so I made an appointment for her to go see my Podiatrist, a man who has helped my husband and I get past some major foot pain issues. So, I trust him. He is not always conventional, but he will take as much time as necessary to explain how his methods work. When we went to see him, he examined my daughter’s legs and he claimed that one was shorter than the other, due to her bones on one side being shorter than the other. I was surprised – not so much that she had this discrepancy, but that nobody had ever checked for it before. It makes complete sense that a limb length discrepancy can effect everything above it on the body – including the curvature of the spine. He explained that he wanted to first determine the discrepancy amount by an x-ray of her hips to see if they were off-level [PLEASE SEE MY NEWER POST “Getting Another Leg Up” FOR A CORRECTION AND ELABORATION ON THIS]. Then he wanted to OVERcompensate for the discrepancy by boosting the shorter leg ABOVE the longer leg with a heel lift. Since she is young and her growth plates have not developed fully, he feels that by providing extra pressure on the short leg, that it will stimulate the growth more in the shorter leg than the longer leg. Theoretically, in a couple years, she will be close to equal in limb length. My first thought was that this could only help her spine, and probably could do no harm. I am glad that I did some further research…
I wanted to do a little reading and research to see what others have to say on this topic. The online reading I did was contradictory, but that seems to be par for the course when it comes to Scoliosis. One site quoted a 2001 Article from “The European Spine Journal” that claimed that they found a significantly reduced spinal curvature on one patient who had shoe lifts to compensate for the limb discrepancy. They hypothesize that correcting lower limb discrepancies may prevent further curvature. However, they only mention one patient, which really isn’t enough to make scientific inferences from, as her Scoliosis could have improved for any number of reasons. One article in the NY Times Health Guide points out that it may NOT correct existing curvature. One site said that 1/5″ to 3/5″ is a normal leg length discrepancy and shouldn’t cause much issue for the patient. Another states that less than 2 cm doesn’t seem to be a problem. But, our Podiatrist said that every 1 mm of discrepancy could affect her Scoliosis, so 2 cm would be significant if the patient already has a curve! [PLEASE SEE MY NEWER POST “Getting Another Leg Up” FOR A CORRECTION AND ELABORATION ON THIS]. There are also sites that claim that leg length discrepancies do NOT cause Scoliosis and some (such as Boston Children’s Hospital) that claim that it can cause Scoliosis. This is not surprising – contradictory results run rampant in the field of Scoliosis. It was interesting to read that the incidence of Scoliosis is higher in patients with leg length inequality. (what DOES come first – the chicken or the egg?) The same article stated that if leg length inequality caused Scoliosis, one would expect it to compensate for it (with the convex curve going toward the short leg), but that this isn’t true in 1/3 of cases. WHEW! All I learned from this research is that there is much research to be done in this field. So, I called a couple members of our “Scoliosis Team”.
I contacted Luke Stikeleather of Orthotic Solutions and Dr. Morningstar of the Natural Wellness and Pain Relief Centers of Michigan about their opinion on the matter. I am really glad that I had these medical professionals on my “team” for my children’s Scoliosis, because they had some very valuable insight for me. First, Dr. Morningstar pointed out that he does NOT feel she has a leg length discrepancy (he has been treating her for years and is very thorough, so it would make sense that he would have a strong opinion on this), that leg-length discrepancies are difficult to measure, and that Scoliosis can cause one hip to appear higher than the other on a 2-D x-ray because of the three dimensional pull of the spine. In other words, even if a patient is standing on both legs and an x-ray of the hips shows they are off-level (which is how my podiatrist measures this), they could be off level simply because of the pull of the spinal curvature in the three dimensional plane. He also said the latest research he read claims that there is no improvement on spinal curvature from the use of a heel lift. Furthermore, if you just boost the heel, you could be creating other issues, because you are not actually boosting the entire foot, and the patient will end up walking like they are on high heels all day. Luke Stikeleather claimed that he had not heard of the method of overcompensating to stimulate growth in the growth plates. He also felt that just measuring the height of the hips was inaccurate – that the actual leg bones should be measured to determine if they are different lengths. So, this means that if the method to measure her legs was inaccurate, and the overcompensation method (to stimulate the growth plates) worked, then we might be CREATING a leg length discrepancy instead of fixing one. Both advisors felt that a difference of less than 1 cm was pretty minor. My daughter measured at a mere 2.8mm difference, which is well below that threshold.
So, the question is always: where to go from here? Nobody argued that foot orthotics would help regional foot pain and help with over pronation. The problem lies simply in the use of a heel lift. As Luke pointed out, my daughter has such a significant curve, that it would be highly unlikely that a few mm of difference in leg length could have either caused it, nor could it really fix it. I would have to agree. This does not seem like a “magic bullet”, even if I want it to be. My question to the readers is: what have been your experiences with leg length discrepancies and Scoliosis? I would love to hear from you and see what others are doing. For the time being, we plan to ask the Podiatrist to create the orthotics withOUT the heel lift and see how my daughter does. I just feel that there is too much uncertainty to proceed at this time and I don’t want to create any additional problems. I feel that since our Podiatrist, while being great at what he does, may not be used to working with Scoliosis patients with such severe curvatures. Therefore, I weigh more heavily on the opinions of our “Scoliosis Team”, who have. These decisions are just so HARD, but they are ones we must make as parents and patient advocates every day. It is our responsibility to sift through the studies, the opinions, and the advice and decide on the best solution for our individual needs. I will, as always, keep you posted.