The Foot Bone is Connected to the Back Bone – Why Limb Length X-rays are Important

We frequently see many patients with heel or foot pain that is inexplicable or does not respond to traditional treatments. Why is this? These patients have heel pain in the morning (sometimes both heels, not just one) and their pain increases with standing and walking, which is unlike plantar fasciitis. Examination may reveal pain on the outside of the heel, over the tarsal tunnel, or no pain at all. Gait evaluation frequently demonstrates very poor shock absorption and a shoulder drop with asymmetry.

I  have seen limb length discrepancies of as little as 2-3mm causing significant lower extremity pain, which is why a limb length x-ray, down to the millimeter, not just centimeter, is vital in determining which leg is shorter and how much of a lift needs to be applied to an arch support or (preferably) a custom orthotic. Additionally, many patients with these symptoms will need lumbar physical therapy, even in the absence of lower back pain. It has been my experience that patients with structural and neurogenic heel pain have some combination of lumbar disc dysfunction with a limb length discrepancy (LLD). Many of these patients report a sudden onset of heel pain with no specific injury; however, a long car drive, gardening, bending or lifting, wearing the wrong pair of shoes, children with flatfeet, or recent hip or knee replacement surgery (in which too much or not enough bone is removed) can incite painful symptoms.

Differences in leg length can prevent your feet from absorbing shock properly; these shock waves will go up and reverberate off the weakest link in your kinetic chain. People can experience arch pain, heel pain, ankle pain, leg pain, hip pain, back and even neck pain from inefficient shock absorption by the feet. Podiatrists will often use custom orthotics to help, however, if the limb length issue is not addressed, the patient can still have painful symptoms.

This is why a leg limb length x-ray is important.  The discrepancy measured in the x-ray study can be incorporated into the orthotic device to maintain proper alignment of the spine and lower extremity. I have discovered discrepancies in my practice ranging up to over 25mm.

It is important for our homes that we live in, as well as our feet and bodies that we walk on, to have a level foundation. Who would want our house or our bodies to be tilted to one side?





Dr. Peter Brieloff works in our Rockville, MD (Shady Grove)and Wheaton, MD offices for your convenience.

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