Question:

Hi, I’m 28 and just got a number of xrays done by my chiropractor. He says that according to the xray of my pelvis area (taken straight on from the front) my right femur is 25mm shorter than the left, and that I need to get an inch added to my shoe. I did some analysis at home with my wife, and my right hip bone is indeed pretty obviously lower when I’m standing with both feet flat on the floor (and it appears to even out when I elevate my right foot by 1″, although my right knee is then about 1″ higher than the left).

But I was a bit skeptical about having a short femur, since my experience fits pretty closely with the classic symptoms of Slipped Capital Femoral Epiphysis (I was obese as a kid, experienced hip pain at 13 during my growth spurt, and now my right leg appears short and the foot angles outward). I raised this question to my chiropractor on my next visit. He was nice enough to pull up the xray again next to an xray of someone with SCFE, and we could both clearly see there wasn’t any irregular gap in my hip/femur socket as one would expect of SCFE, and he reasserted that there’s no question but that my femur is simply an inch short. He’s professional and seems to know what he’s talking about, but I just want to cover my bases before rushing off to the cobbler to pay hundreds in getting my footwear customized.

Is there any possibility that getting additional xrays from other angles would reveal something he missed, or that getting a second opinion from someone in a different area of medicine would result in a different diagnosis, or would those steps be a waste of money? Thanks for any advice you can offer!


Answer:

We’re limited in our ability to give you specific information without doing an examination of your hips but can give you some general guidance.

Leg length differences can be difficult to fully appreciate. Some people have a “true” leg length difference which means that one of their bones (femur or tibia) is just shorter than the other. Other people have a “functional” leg length difference meaning it’s from their pelvis or back like if they have scoliosis. Their legs are the same length, but one looks shorter because their spine is curved. To help determine if you have one of these, a clinical exam of the lumbar spine, pelvis, and hips should be done by a medical professional such as a physical therapist. Your legs could also be measured with a measuring tape in addition to the x-rays for confirmation.

Even if someone has a leg length difference, it does not mean they necessarily have to wear a lift or change their shoes to accommodate it. Many people feel much better with a heel lift in their shoe or customizing their shoes, but others find it’s more painful since they are so used to the leg length difference. Before customizing all your shoes, you may want to purchase an inexpensive heel lift to try inside your shoe to see if it makes you feel better. This can help you decide if you want to customize your footwear.

Finally, a slipped capital femoral epiphysis (SCFE) can be very serious if not treated. It is more common in overweight teenage boys and can lead to the top of the hip bone dying from lack of blood flow. Thankfully, it sounds as though the x-rays you have are clear. However, if you are concerned about this possibility, it would be beneficial to discuss it with your primary care physician and follow up with additional imaging if needed.


**This reply is for informational purposes only. It’s not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, physical therapist, or other qualified health provider with a medical condition.