I get quite a few questions about running shoes and running gait via e-mail, some of which I can answer, others which I cannot. I try to be open and honest about my limitations in answering questions, and if a question extends beyond my range of knowledge or experience, I will say so. Such was the case when a I received the following question in an email about a week ago from a reader named Angela:
“I have a leg length discrepancy (LLD) of 1.3 cm (confirmed by leg length study with x-rays), and my podiatrist wants me to wear a heel lift on the shorter side at all times. I’m able to wear a 5mm lift without much discomfort however it’s starting to hurt my ankle. Is it pointless to wear the 5mm lift while running if I’m landing midfoot? I would like any information you have on LLD and midfoot landing or if you know of anyone running in Newton or other minimal running shoes who have a true LLD and whether or not they wear the lift while running. I just don’t want to ruin my Achilles or cause other injuries since I’m using a lift.”
As far as I know, I don’t have a leg length leg length discrepancy (I’ve never been tested), nor have I spoken to anyone who does firsthand. I offered to post Angela’s question here on the blog in the hope that somebody out there might be able to help her out. If you have any experience with Angela’s situation, I encourage you to leave a comment – she would greatly appreciate it!
About Peter Larson
Unfortunately like you I have no familiarity with the appropriate treatment for an individual like Angela with one leg significantly shorter than the other. However, my entirely amateur intuition is to agree with her perspective that a heel lift would indeed make much more difficult consistently landing mid-foot (since her shorter leg with the heel lift would of necessity be more angled to the ground than the other foot.) Accordingly, it seems to me that she should talk to her podiatrist about an alternative lift/pad that would ideally entirely fill her entire sole from heel to toe so-as to preserve a comparable heel-to-toe drop on both feet (while addressing her doctor’s understandable concern in attempting to prevent all of the adverse compensations).
Well, I have been facing the same problem (fortunately not as big of a difference as Angela’s). My solution – and I have no idea if that’s the best, it’s just the best that I found – is to remove my insoles in all my shoes from the ‘long’ side and put double insoles in the ‘short’ side. This way, the whole shoe is ‘lifted’ and not just the heel. Works for me, I have had a lot less trouble with my ‘long’ leg since and my lower-back problems are completely gone :)
Maybe one could take a shoe like the Newton Distance that has a
completely flat insole, remove it from the longer side, flip it upside
down and place it under the insole on the shorter side? The Newton
insole is about 5mm, so doubling it up would compensate about 1cm of
the discrepancy.
Pete
On Wednesday, September 29, 2010, Disqus
Someone asked the same question on THE RUNNING BAREFOOT, I think the answer made a lot of sense, READ BELOW, or go to this link;http://therunningbarefoot.com/…
Also i would recommend a trip to a good chiropractor and find out if any injury issues are related to a different problem than a short leg.RICK
Comment from invisibleshoe.com
Time 2010 March 17 Wed at 11:13 pm
This is just me thinking out loud, but I can’t understand how leg length would be an issue when running. Your legs (like many people) are different lengths when they’re straightened and, possibly, not under tension… but when you’re running, your leg length is determined by the flexion of the foot, ankle, knee and hip. And it changes, like a spring, moment-by-moment.
A TINY change in the amount of flexion/extension in those joints would negate any differences in length.
Add to that the fact that running is, in a way, hopping, and I just can’t understand how a leg length imbalance would show up when running.
I also think about the single-leg amputee runners I know who don’t describe having problems with what is a serious discrepancy! (even with their prosthesis on)
Curious what others think.
I also have a leg length discrepancy of 2cm! Not visible to others but very to me. It took me years to have it diagnosed and up until then I suffered back spasms and most notably when running or doing a lot of walking a burning sensation in my hip. I’ve also suffered knee problems since teenage years on the longer side and weakness in the longer side. It makes a huge difference having an LLD above a certain length and running/ walking / high activity levels of that sort make it worse unless properly addressed, do to the consistent way in which the entire pelvic girdle is thrown out of alignment. The best solution for me has been as @Hodie said – to elevate the shorter leg with a FLAT sole. If the lady in Angela’s query wants to run barefoot as possible I recommend well fitting water barefoot shoes which are stretchy , and allow a double insole to be placed in the shoe, the other worn without insole.
Michael Sandler of runbare.com has a 10mm leg length discrepancy. Maybe some info can be found there.
My mom has a leg length discrepancy and runs only in vibrams. She is 52 and runs three days a week. She does wear a lift in her other shoes and her movements are physically very awkward. She also swims ~5 days a week and bikes 1-2 times. The discrepancy doesn’t seem to be a problem for her running.
After taking a “New Trends in the Prevention of Running Injuries” course (By Blaise Dubois,PT) this past weekend, this is what I learned regarding Leg Length Discrepancy based on research:
X-rays:
Errors of the machine= 0.9cm
Intraexaminer errors reading the x-ray= 0.4cm
Interexaminer errors= 1 cm
Measurement error between lying and standing x-ray= up to 12mm.
Leg Length Discrepancy occurs in 90% of the population with an average of 5.2mm
2 research articles conclude that more than 20mm of leg length discrepancy is necessary to negatively affect the patient
Lastly, he states we really don’t know the effect of the lift.
In my practice, we rarely put in a lift. In fact, I think I put in a lift for one patient who had a herniated disc and we only did it for his bike shoes which helped. However, we use it as a temporary solution for the body to adapt.
Bottom line, our feet should be as close as we can get with the ground. Many of us have leg length discrepancies and do not have injuries. We have adapted to our leg length discrepancies over the many years we existed. Any acute change is a recipe for an injury.
Thank you for your response! This has been an ongoing issue with 2 different podiatrist. One wanted me to run with the full corrected lift on the bottom of my orthotic which I did. I ended up with a fracture in my foot (3rd met). After 6 weeks of healing Doc decided to try adding 1/2 the amount of my LLD. No fracture although I strained/pulled my TFL and was unable to run another 6 weeks.
I decided to get a second opinion from another podiatrist and he didn’t recommend a lift because of my previous injuries using a heel lift and also based on his visual observation. This doc said I may have a 1/4″ difference at most and that if I want to I could use a 3mm lift if any at all.
Looking at the bottom of my running shoes I heel strike on the longer leg and midfoot strike on my shorter leg. I do believe my body compensates for the difference.
I had no idea that LLD xray studies could be inaccurate by so much.
Peter, I’ll e-mail you more later, but my general take w/ the runners I treat is that I leave most leg length discrepancies alone unless they’re significantly more than the amount you described. I’m surprised that a podiatrist would recommend a heel lift that dramatic – it skews the rearfoot and forefoot mechanics and would force even more of a heelstrike on that sideand and a rather abrupt transition into midstance (not to mention the issue of adding weight to a training shoe). On top of it all, leg length measurements (even those taken radiologically) aren’t that accurate.
Wouldn’t the leg length discrepancies being proven inaccurate need a control measure? How is the error being found? If they are found by x-rays of dead people on tables, then perhaps it could be accurate with a standing x-ray?
Pete,
Angela should try the Somnio running shoes. The shoes are customizable using a 3 component system with variable cushioning, varus wedges and different arch heights. With Somnio, she can dense up the midsole of the shorter leg and add more varus to the shorter leg to make up for the LLD. This is more effective than adding a lift due to the smoother transition. Earlier this year I fitted a women who had scoliosis which created a LLD. Her heel lift was uncomfortable. We were able to add 6mm(medical limit) to the shorter leg while adding a 65 durometer to stiffing the midsole. It wasn’t perfect but she was able to run up to 4-5 days a week. Check them out at somniorunning.com.
Michael Sandler, author of “Barefoot Running” shattered his femur in a roller blading accident in 2006 while training for a 4000mi charity skate. He was left with a titanium femur and a 1″ leg length discrepancy. He eventually discovered that by changing his running form to a relaxed forefoot/midfoot strike as Pete discusses here he was able to compensate and now runs 15-20miles a day pain free.
He is a guru of barefoot running and from my experience running barefoot is the post way to transition to this form, but my no means required so don’t be put off with “barefoot”. His book is great resource and you can listen to his inspiring story in a recent episode of The Living Barefoot Show available on the web or iTunes. It is a worthwhile listen, he went to great lengths and great frustration trying to run pain free prior to discovering a barefoot running form.
My legs are the same length but one of my hip sockets is 1 inch higher than the other due to a broken pelvis I sustained 20 years ago, so in effect, I have a 1 inch leg length discrepancy. I used to heel-strike and over-stride when running and this coupled with compensatory plantarflexion on the short leg gave me terrible Achilles tendinosis on that side. Now that I have adopted better running technique and wear only vibram KSOs for running, problems have disappeared. I find running much easier now and barely notice the leg length discrepancy. It did take me about 6 months to adapt to the KSOs and strengthen my feet and ankles.
Russ how much are you running (miles per week) and what and kind of terrain with your KSO’s? Glad you have found a successful combo! This may be just a strange coincidence but since I’ve switched to light weight and lower heel to toe ratio running shoes (Kinvara esp) I haven’t had as much difficulty with my running form. I can land more midfoot on my long leg, or so it seems. I may be wrong though.
I am not a very high mileage runner – about 20 miles per week at the moment with a couple of circuit training sessions on top. I used to run about 30 miles a week before the tendon trouble and hope to gradually get back to that level. I run about half on roads (quite hilly) and half on rough tracks (also quite hilly). Occasionally I’ll hit a stone but never enough to bruise my feet. The pads on my feet have got a lot thicker but no calluses.
I got into the whole Pose running thing for a while and doing all the drills but it began to feel a bit like a cult, so now I just run. I think it helped me correct my gait though.
Russ, how did you learn to adapt your running technique. Can you offer any resources? I’ve started wearing my vibrant all the time. My foot pain is gone, but I still get hip pain and have been told my left leg is 1/2″ longer
I have the about same discrepancy, also confirmed by x-ray. I wore a lift 24/7 for about 6-7 years. I’d get injured pretty consistently, long leg hip pain, and I even switched to biking for a few years .
I chucked the lift about 6 months ago, when I switched to a mid/ forefoot strike and have no issues or regrets. Like you, I’ve noticed that my body subconsciously has adjusted my stride to compensate. I land a bit more midfoot on my longer leg, and a bit more forefoot on the shorter. I do occasionally wear VFFs but do most of my miles in fairly cushioned shoes; Kinvaras seem like a perfectly reasonable choice. Anyway, sounds like you are on the right track.
That’s very encouraging to hear! I’ve been trying to adapt to the lift however I keep getting injured. It’s frustrating because the Podiatrist and Physical Therapist kept telling me I need orthotics and the lift 24/7. So I try and wear the lift 24/7 and for the past 4 weeks have been only able to bike because of a new injury from wearing the lift. I chucked the lift and orthotics 2 weeks ago. My feet are sore and are certainly getting a workout but I sure feel much better and natural.
Thanks for comments Ben! It really helps!
Usually trying to correct with a heel lift will create other injuries and more problems – try to see a good sports med doc and get PT to see how to compensate w different exercises and techniques. Everyone is different. You need someone to take into account your specific needs.
I have leg length discrepancy of about 2.5″. I have hemihypertrophy and my entire right side is larger than the left. I have never used a lift, but am looking at it now due to some ankle ligament issues when running. I am running about 35 km per week. I do sometimes use double insole on my small side, but that is more to get my small foot to fit a shoe that is too large for it than to compensate at all for length.
Generally, a lift is only recommended if you have LLD of 1″ (2.54 cm) or more. And generally, the lift is only for half of the LLD (so if you have a 1″ variance, then the lift is only for .5″, not the whole LLD).
I would certainly never correct with a heel wedge, it would have to be a whole-sole lift. A heel wedge is just going to cause more problems.
The problem with running with a large LLD is that your short leg takes a harder pounding than your long leg. You are falling further and harder between strides.
You are also not supposed to add more than a couple of mm to the lift at a time, giving your body to adjust in between. That is my biggest concern, and the physio that I saw today agreed. My body has been used to a big LLD for 39 years, and throwing a lift of .5″ or something at it would cause more problems than it would solve. I would have to start with a very small lift, and then get a slightly higher one when I buy the next pair of shoes.
But we’re not going immediately to a lift. The physio is going to film me running on the treadmill and see what my body is doing to compensate for the LLD before attempting to make any changes.
pdw
Thank you for the information P Workman. It sounds like you have a great physio! I’m glad they are taking the time and film before they add the lift. Have you noticed significant differences when you double up the insole? Less pain? Also do you wear orthotics?
I’m not getting use to the heel lift at all. I’ve tried and tried. Anything more thank 3mm is causing ankle pain and I’m suppose to be at 5mm which feels so awkward while walking. Like you my concern is that for 40 years I’ve been compensating for it although all my injuries are on my longer leg.
Please let me know what your physio recommends for you. Also when and if you get the entire sole lift I’d like to know if you notice any extra weight or if it feels significantly different during foot strike.
The only difference that doubling the insole really makes for me is that it helps my smaller foot to fit inside the shoe. Because my entire left side is smaller, my left foot is about a shoe size smaller than the right. I don’t buy two separate sizes, so one way to get a better fit is to double the insole and learn how to lace the shoe more snugly.
I don’t wear any orthotics.
Have you tried a whole-foot lift instead of just a heel lift? I would be really concerned about it holding my foot in a different position. Have you had any gait assessment done to see what you are doing with your longer leg when you are running? I understand that many people pronate with the long leg to compensate for the extra length.
If you want to e-mail me at pdworkman@gmail.com, I will send you a couple of studies on LLD and running injury prevention that my physio sent to me.
You asked about minimalist runners with true leg length discrepancy. This is the only one I have come across in my last few days of research:
http://www.runbare.com/836/3-s…
In his case, unlike ours, this is an adult-onset LLD due to break/surgery, so his body was not used to an LLD. The study that I can forward to you suggests there is a big difference between the mechanics of someone who has had LLD from childhood and someone with an adult-onset LLD. The studies also suggest that a lift is not required for someone with an LLD under 2 cm (which is in line with the practices followed by orthopedists treating children with LLD today – a lift is only used in cases where the LLD is 1″ or more.)
I would also be concerned about only using a lift while running. Obviously our bodies adjust to different kinds of shoes – different heights, angles, etc. – all the time, but a significant difference in LLD from one shoe to another and from one activity to another doesn’t sound like a good idea to me. As you might tell, I’m a bit leery of the whole idea of starting a lift this late in life . . .
Pam
I just got back from seeing the physio and having him film my gait while running. Very interesting appointment. I had read various ways that runners with a significant LLD compensate when running, and paying attention to my running could not detect any such compensation in my stride. But it is there on the film! I run with my center of gravity entirely over my right (longer) leg. I turn in the ankle and knee on the left side when I land and push off to keep my weight to the right. I “hop” over my right leg to be able to clear the extra distance. Fascinating stuff. So he is referring me to an ortho to consult about a lift (building up over time) and possibly orthotics to keep me from turning in my left ankle. He has given me some exercises to work on strengthening my left hip, because right now it is not doing any work while I run, and if we correct with a lift while running, it is going to have to work a lot harder.
But he confirms that a heel wedge or regular orthotics would just compound the problem. He also advised that the doubled insole in my left shoe is probably not a good idea, as it will not be properly fitted and is probably messing up my landing.
Pam
So I saw the orthopedist yesterday and after a consultation he gave me an internal lift (he calls it a “raise” rather than lift, I don’t know if that’s just a Canadianism) to try out. [Between my previous posts and now, I have been having hip problems on the long leg.]
Measuring LLD accurately is difficult, and using direct and indirect measurement, he puts mine between 1″ and 1.5″. He agrees, though, that my hip involvement is definitely more than that (I measure the LLD to the hip as 2.5″ difference), but that is being exacerbated by the shape/tilt/twist of my pelvis rather than the length of my leg bones. So the good news is that we don’t need to compensate for 2.5″ difference, the bad news is that we can’t do anything about the pelvic issues. We have started with a 3/8″ internal lift (heel wedge), and I am to gradually get used to walking with it before starting to run with it. If it causes any pain we’ll go to an outside lift instead. If it does not help the injury rate a few months from now, we’ll build (outside) higher than the 3/8″, anywhere up to 3/4″.
He was amazed at the amount of wear on my runners. When I told him I got them in September, he asked me “September of this year or a year ago?” I looked up the date of purchase yesterday, and it was exactly two months ago. The entire sole in the back half of the shoe is worn away, and some of my Ice Spikes, installed less than two weeks ago and rated for 500 km, are completely worn down after 50 km. (I just contacted the company and they are sending me more for free.) I *definitely* heel strike when running! I will need to get new runners to use the lift in anyway, as the heel counter is not tall enough to keep my foot snug in the shoe with the lift installed, too much up/down movement. I need something with a taller heel counter and more lace eyelets further back to allow me to snug the shoe (on the small foot) up tighter. Hopefully without gouging my achilles.
At the rate I am wearing through runners, I hope that I will not need an outside lift. I’m looking for better quality runners this time around, and hopefully these ones will last longer than 2 months!
So I feel very weird walking around in my lift today. I keep waiting for someone to ask me why I’m limping, because my gait feels so awkward.
Pam
Hi Pam, Can you please give me an update on how you are doing with the lift? Also what size of a lift are you in now? What shoe have you found helpful with accommodating the LLD lift?
I know I have a lot of questions it’s that I’m still struggling with finding the right combo and lift.
I am using 3/8″ and it is great. I use it in all of my shoes, except the ones I wear at church. No ankle or hip pain whatever since I started running in it. It took a while to train up to it – slow, short runs, gradually working my way up to longer faster runs. Lots of sore back muscles while I was training up. I just went slow and gave it time.
The best shoes for me are Asics. I took my lift to the store and ran in a bunch of different shoes to see how the lift fit with them. Needed to put longer laces on the Asics to lace them right to the last holes and loop them so that the heel stays snug. Have to make sure to wear an insole on top of the lift and anti-blister socks or Asics give me a blister in the arch even without the lift.
Pam
THANK YOU SO MUCH! That is a huge help! So glad to hear it is working out! I will check out the Asics! Are you using the adjustable heel lift or a special one made for running? Doc wants me to try the 3/8″ lift for walking around and other activities other than running for one week then try running with the heel lift for a short run.
Thanks again and congrats on finding the right combo!
Work up to using your lift very
slowly. Start with it in your regular
daytime wear shoes. Wear it for an
hour. Even if you’re feeling okay at the
end of the hour, still take it out. The
next day work up to two hours, and so on, until you are able to wear it for all
of your walking without any muscle fatigue or pain. Wear it for a month for all of your regular
activities.
Then start with it in your runner. Walk a block.
Jog a block. Repeat for only a
short distance. Maybe just a km. The next time go further. Then work on 2 min run and 1 min walk. Then 4 min run and 1 min walk. Once you are up to a good distance, say 5 km,
then start working on increasing your speed and distance and training back up
to what you were at before. At any time
during this transition period you start having muscles cramp up or get sore on
your run, walk until it eases. And don’t
push it any further the next day.
Both when I was getting used to the lift walking and with running,
the first couple of days I had a lot of muscle cramping and fatigue in my
back. And it makes perfect sense, you
are moving and holding yourself completely differently than you were
before. The muscles are having to work
in a whole new way.
Make the change really gradually! It may make you crazy, but it is worth it not
to get injured again, right?
And BTW, do not let a doctor correct for more than half of
your LLD! If he’s doing that, he doesn’t
know what he’s talking about.
I have the same condition as Angela. I have a leg length discrepancy of around 1cm. I’ve worn a lift / orthodic in my right show for a number of years (flat foot along with leg length discrepancy). My subsequent si problems had me sidelined for 8 YEARS from running! I’ve recently returned with the help of the Newton shoes as well. No lower back pain, but now my ankle hurts when running with my lift / orthodic (hard plastic type). I’m finding that if I don’t use the lift while running and stretch extensively I’m doing okay but now tweaking my back slightly. My mileage is low still but building (runs of 3 and 5 miles). I’m thinking the answer for me might be a softer insert that makes up some of the discrepancy but most importantly to continue mid foot / forefoot striking. I’ve also done a lot of ankle, hip and core work. Hope this helps!
Thank
you very much for your comments Lou and what has been working for you!
I’ve been sidelined off and on over the past 2 years with multiple
injuries on my longer leg. I plan to go back to the Newton’s when my
Achilles is healed – yes on my long leg. In the meantime I’ve been able
to run 3 – 5 miles with my orthotics and a 5mm heel lift at around
20-25 mpw. ½ of my typical mileage 2 years ago but I’ll take what I can
get! Regardless of the current stance of most people on using foot
orthotics I can honestly say I’m in a lot less pain running with them
then without and plus with the orthotic I don’t even notice the heel
lift.
Did you have injuries on one side of your body more than the other? Or is it mostly lower back?
I’m so glad you are able to run again after your 8 years off! That is so great!
I can’t imagine trying to run on a hard plastic orthotic. I’d be looking at other options too.
Lou are you only wearing an orthodic & lift combo on the right side to help with your LLD? Also is your back ok and did you find a softer solution for the lift? Are you exclusively running in the Newtons and if so which model. Thank you in advance for any feedback!
I don’t know about you, but if your LLD is causing pain like mine does, I would definetly correct for it. To me, even if it’s not causing pain (yet) then correcting it would only seem to make things better, putting your hips and spine back in line. I have about an inch LLD and it causes hip pain, back pain, and nerve pain that fires up badly especially when I have to go around without my corrected shoes, like if I’m at a barefoot activity. I’m a young 30 year old runner and before correcting for it, I already had degenerative changes in one hip. So, yes, your body can and does compensate, but that is throwing your body out of line and can cause pain. I just got a new 3/4 inch full length adjustment on a shoe and I can’t wait to try it out. I’d been using a 3/4 inch just on my heel to run in and it’s taking me from I can’t run at all due to the pain without it, to now I can run 10 miles without any pain.
Nicole, did you experience any midfoot pain with the lift? I just got fitted today for a 5mm lift in my new orthotics but after reading numerous comments about midfoot pain, I’m concerned.