Heel Lift Instructions for Short Right Leg Syndrome

Should it be determined through assessment of structural posture and symptomatic response that trialling heel lift treatment is recommended, preliminary fitting should be carried out to test appropriate size.

Put the heel lift under the right foot to lengthen the right leg.

There can be confusion about this where symptoms may be present in the left leg but it is the right leg that is structurally shorter than the left. Put the heel lift under the right foot.

This is a trial and error process. There is no expectation of being able to realign mature adults into full symmetry. It is uncommon for negative outcomes but they are possible. There can be spinal injury aggravated by the change imposed by a heel lift. This is unfortunate and it may not be possible to proceed until resolved.

Should the heel lift generate niggles, pain or symptoms that are perceived as worrying and nasty, reduce the thickness of the heel lift.

If these sensations persist, remove the heel lift.

The heel lift is required when standing, walking, doing gym training and heavy lifting.

It is not required when sitting but attention should be paid to seat bolsters and it is preferable to have the right butt cheek slightly elevated. Hence, when I was young and carried a wallet in the back pocket, it felt wrong on the left side but actually had a beneficial effect on the right.

Disciplined use of the heel lift is recommended. To use it during the day and come home to kick off the shoes and stand barefoot in the kitchen for two hours will sabotage the process. Reports of painful symptoms recurring within a short time when forgetting to put the heel lift into footwear on going out are not uncommon.

Fitting a heel lift to all footwear is recommended. I am able to do so for sandals, runners, moccasins, boots. Only highly moulded Birkenstocks have been problematic. They would need to be taken to a cobbler or shoe repair shop and have the thickness of the sole altered.

For runners, I am not sure about the necessity of using it while running because gait characteristics are completely different. If it is a shuffling jog thing that you do, use of the heel lift is probably beneficial. I do not think more athletic style running off the front of the foot will benefit from or require a heel lift. I have little experience with this so cannot speak authoritatively.

I have heard of bike fits where a 3mm to 5mm chock was placed between the cycling shoe and cleat to adjust for leg length discrepancy. This was practised by a Physiotherapist in Kensington VIC some years ago. I think he has moved north. I will do so too when returning to cycling...that is; the chock thing, not move north.

Transition Period

There is an initial period where new or unusual sensations may be experienced causing heaviness or where extra exertion may be required through one side or the other. Balance and gait is being altered slightly. Loading shifts slightly side to side. This aspect of transition does not last long.

Some benefits may be quickly apparent. Often from the very next day subtle changes may be noted. It is not uncommon for lumbar strain and discomfort to be resolved in four or five days and in the Thoracic spine within a month. The higher up the spine the longer change takes to occur.

The older the individual, the longer it will take to change. Juvenile cases may be resolved within weeks while the aged can take years. I have encountered elderly cases that do not respond to heel lift treatment where restrictions to movement and change are too entrenched.

In the absence of acute symptoms from leg length discrepancy, it is better to proceed slowly. Changes can create joint instability as ligaments loosen when joints unwind, ie; the left SIJ. Rather than accelerating the process, time allows these ligaments to re-tighten as joint position normalises. Where there are acute symptoms causing high degrees of pain and affecting mobility, it is possible to accelerate the transition process through the use of rehab exercise but attention to how the SIJ is managing this must be considered.

The transition process from a highly distorted and strained pelvic condition to a normalised position can take several years. The transition process can have difficulties. In my own case, I was still being affected by significant lumbro-sacral injury. Also too, the left SIJ which had been in high range anterior rotation for five decades, had degenerated and become unstable prior to commencing heel lift treatment. The nagging disk bulge resolved itself in four days. The left SIJ unwinding under the influence of the heel lift and moving into a normalised position, increased the joint’s instability. After half a dozen injuries to the SIJ sustained doing heavy lifting…acute pain and affecting ability to walk for two weeks each time…I eventually realised I needed to stop lifting heavy until the joint recovered. Twelve months later I was able to resume wood chopping and fire wood duties. This degree of difficulty during transition is unusual.

Recent incidences where heel lift treatment had been in use for several years and then dispensed with, symptoms came back with greater intensity than originally and took several months of treatment to overcome. I am thinking from birth we adapted to the leg length discrepancy gradually. On eliminating it with a heel lift, the pelvis is gradually freed from distortion and strain over several years. To have that distortion applied suddenly again escalates symptomatic response.

Monitoring Progress

Periodic assessment of progress is recommended in the first six months to determine whether the heel lift size is correct. Initial thickness is limited to 3mm or 5mm. This is usually only one third or one quarter of the structural discrepancy.

There is a limit to the amount of change the body accepts when beginning this process. This may be insufficient to realign the left hip rotation fully and clear rigidity about the right hip. This result may be improved by a few simple mobility and stretch exercises. Failing that, increasing height of the heel lift should be considered.

Longer term annual reassessment is worth considering too. Few clients commencing this process revisit once their initial complaint has been resolved. This does not mean their condition has been optimised and it is probable right sided rigidity issues associated with the Second Cardinal Sign of SRLS still persist. In the longer term blocking the Bladder meridian, impacting mobility in the right leg and generating Kidney deficiency.

After prolonged use of the introductory 3mm or 5mm heel lift has reduced distortion and strain through the pelvis, it is possible the body will accept greater adjustment and more fully resolve symptomatic effects from SRLS.

This was my experience where early in the treatment process anything greater than 5mm was not accepted. Then at the two and a half year mark an increase to 7mm was accepted but had no noticeable effect. Throwing caution to the wind, I increased it to 10mm which is slightly less than half my leg length discrepancy...I am a high range case with 21mm discrepancy. Significant benefit resulted. After several months at this elevated size I am still monitoring hip alignment for sign it is too great. So far the only sign of change has been for the better, sign of Kidney deficiency has reduced, the Bladder meridian choke point at the Biceps Femoris insertion to the head of the Fibula is no longer painful, right knee inflammation has decreased and ROM has increased.