Determining Size of Heel Lift Adjustment

 

There is no formula for determining the size of heel lift adjustment...it is not a function of leg length discrepancy...it is more a matter of what adjustment the body will accept. Typically it is between 3mm and 5mm in the initial transition phase of commencing heel lift treatment. Following initial transition, once pelvic distortion and strain has been reduced, it is possible to trial taller heel lift adjustment to further improve outcomes.

 

Initially, two vastly different cases can have the same adjusting heel lift. ​ There is no expectation the body's asymmetry caused by a structural leg length discrepancy will realign into perfect symmetry from the treatment of Short Right Leg Syndrome. There is some permanent change that will not be undone. Bones and joints have been changed from decades under the influence of gravity as we go about our lives. The pelvis is tilted and mild scoliosis of the spine has distorted the shape of the vertebrae. When placing an adjusting heel lift under the short leg, we are only trying to incrementally back off stress and strain on the soft tissue sufficiently to release tightness and allow energetic Qi flow to resume. To go further over compensates, causing pain and injury.

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I do not measure structural leg length to the accuracy of a tenth of a millimetre or even a millimetre for that matter. It is not necessary to know precisely what the leg length discrepancy is in order to determine the magnitude of the adjustment. Examining for the Signature Traits and Cardinal Signs indicates a discrepancy exists. A comparative assessment of the limbs verifies the bones of one leg are longer than the other. We are able to estimate whether it is low, medium or high range case...5mm, 10mm or 15mm and greater. Considered in conjunction with the symptomatic nature of the condition, guides fitting of the heel lift. Can the subject feel the thinner heel lift pushing their hip up? If so, go with that one before progressing to anything thicker. It comes down to trial and error to determine how the subject's body responds to adjustment.

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Should uncomfortable niggles or low back pain occur, heel lift thickness should be reduced. If the unwanted symptoms persist, it should be removed altogether. This will generally be apparent soon after commencing use (hours/days). A negative outcome is uncommon.

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Longer term monitoring is necessary. In addition to an adjusting heel lift, rehab exercises may be prescribed. Where the adjusting heel lift is too thin, the body may not respond despite the exercise. I am not really sure if this is the true nature or they are just not really doing their rehab exercises. In any event, a 3mm heel lift may have little effect in some cases. After two to four weeks with no improvement, progressing to a larger 5mm heel lift can see major change occur in one week. Apart from reduced discomfort and pain, and increased mobility, a key indicator is the First Cardinal Sign of anterior rotation of the left hip begins to normalise.

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Once the initial phase of heel lift treatment has played out and the pelvic posture has begun to normalise, with distortion and strain reduced, it may be possible to increase heel lift thickness and achieve a better outcome. Unfortunately, the bulk of clients once resolving their immediate symptomatic effects do not revisit to monitor progress. Once the initial transition process has unwound pelvic distortion and cleared soft tissue tightness to some degree, it is possible to improve outcomes by trialling a slightly thicker heal lift. This has been my experience starting 5mm thickness. Early attempts to go higher than this was not accepted by my structure. However, this was eventually increased to 9mm after three years with improved outcome for my high range 21mm leg length discrepancy.