If the Difference in Leg Length Is Large, What Should We Aim For?

Key points in 30 seconds

1. Evening out the leg length itself isn't possible.
2. But the tension and twisting that built up from bearing that difference can be worked on.
3. Much of the pain comes from that bearing.
4. We support the shorter side, loosen the overworked side, and build up the muscles that hold you up.
5. If surgery is needed, we tell you that first.

What we often hear

• "I was told one of my legs is shorter."
• "My shoes wear down only on the outside of one heel."
• "Can this be fixed?"

If the difference in leg length is large, can it be corrected?

Evening out the length itself isn't possible. So we set the goal not on the shape of the legs but on easing the burden the body has carried while making up for that difference.

There's a reason we say this first. If we say something can be done when it can't, you spend time and money and are left only with disappointment. We tell you first what can't be done, then what can.

How much is a 5 cm difference?

It's enough that one side of the pelvis visibly sits lower even when standing still. In photos, the upper body looks tilted, and when walking, you lurch to one side.

One person we saw in the clinic had been born with a left thighbone about 5 cm shorter than the right. They said that standing, their body felt like it sank to the left, and their limp was obvious when walking.

If the length can't change, what's left?

What's left is the tension and twisting the body has built up while bearing that difference. This part can be worked on, and a large share of the pain comes from here.

To hold their tilting body upright, this person's right lower back and buttock muscles were always overworked. As a result, low back pain kept coming back for years, and over time the spine even curved sideways as it tried to keep balance.

Here's something important. This curve wasn't there from the start; it formed while trying to make up for the length difference. When the cause is different, the way to handle it is different too.

So where do you set the goal?

On living with less pain, and on keeping the existing twisting from getting worse. We don't set evening out leg length as the goal.

We support the shorter side to spread weight evenly between left and right, loosen the side that has been overworked, and build up the muscles that hold you up. When this is done, the gaps between bouts of pain get longer and walking feels less unsteady. But if you go back to walking without the support, things return to how they were.

Why did injections and manual therapy only help for a while?

Treating the painful spot helps in the moment, but if the cause of the pain is still there, the same spot hurts again.

This person had received injections and manual therapy whenever the pain was bad, but said it only helped for a while. Even when tight muscles are loosened, the reason for them to tighten again repeats with every step, every day. That's why support has to go along with it.

What are the limits of this judgment?

When the length difference is large, there's a clear line to what we can do. Some cases need the option of surgery to even out the length.

In those cases, we bring that up first. Considering age, how large the difference is, and how much discomfort you're living with, we may recommend consulting an orthopedic surgeon. Not trying to find every answer within our own care is a line we hold to. Also, this record follows one person's progress, and there's no comparison data.

We don't set evening out the length as our goal. What actually changes is how evenly weight is spread between left and right, and how evenly you walk.

If you don't know what to do about a leg length difference, come see us. We'll start by sorting out what can realistically be aimed for.

The burden that can be eased differs from person to person, depending on the size of the difference and how long you've lived with it.