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Even though the discrepancy in my leg lengths was just over a half inch, I chose to lengthen my short leg to achieve symmetry. In my case, the cost was well worth the effort. The short leg was creating scoliosis in my spine, which led to a number of physical problems, slowing me down and tiring me out.

When people ask me if a half inch discrepancy is significant, I like to use this analogy: imagine if you pasted a half inch thick rubber block on your car tire. As long as you only drive around at 5mph for short distances and otherwise stay parked, you may not even realize the block is there. So for a sedentary lifestyle, a half inch leg length discrepancy can be managed. But, if you travel long distances at 55mph or more in your car with the half inch block on your tire, then your entire suspension system will loosen over time and eventually break down. So for an active lifestyle, the half inch difference in leg length must be addressed to maintain the structural integrity of your spine, joints and other points of stress. It is relevant to consider that maybe people with leg length discrepancies would tend to lead a more sedentary lifestyle because movement is more painful due to their imbalance.

Most doctors would recommend a shoe lift for patients with small discrepancies in leg length, like in my case. But shoe lifts bring their own problems. An orthotic of more than a quarter inch in thickness designed for inside the shoe will not leave enough room for the foot, so a lift of a half inch or more must be added to the outside of the shoe by a cobbler. I generally spent over $300 per pair of shoes for the proper lift. There are several problems with the shoe lift that is added to the outside of the shoe. First, the shoe with the lift will weigh more than the other shoe, so there is an imbalance when running, sending a neuro-muscular signal to the mind to stride differently on the short side. Also, the thicker sole on the shoe with the lift will not bend at the ball of the foot correctly if it bends at all, requiring a different motion when propelling forward off of that foot. So the stride of the runner with a shoe lift is not symmetrical, creating an imbalance all the way up through the spine. But the main reason why shoe lifts did not work for me is that the probability of rolling the ankle while running and even walking is much higher with a shoe lift, which was inevitable with my active lifestyle. As the ligaments stretched and loosened from rolling my ankle so many times, the chances of rolling the ankle again increased. I ended up rolling my ankle on the short side so many times, that I need to go into surgery to tighten-up the ligaments on that side.

With the shoe lift solution, I constantly had to adapt my lifestyle to maintain a level pelvic region and a straight spine. I never walked from one room to another without a shoe lift. I could never walk on the beach or anywhere else with bare feet. As the problems and costs inherent in a shoe lift added up, I sought out another solution. For me, lengthening my short leg to attain symmetry was the solution.

To understand why a half inch could make a big difference, I also like to use the metaphor of a 25 story building. Like said building, our spines have 25 vertebrae stacked vertically. A building, like our spines, also need to be straight vertically (from the anterior and posterior angles of the spine) to maintain structural stability. A vertebra is generally about 1 inch tall, and one story of a building is generally about 10 feet tall, so in the analogy one inch of the spine is equal to 10 feet in the building. My spine is about 25 inches long and has about 8 inches between the two crests of my pelvis where we can check the level of the foundation. My pelvic crest on the short side was lower by a little more than a half inch. With each story of the building being about 10 feet tall, for the base of the building to remain proportional to the spine in this analogy, the building would be 250 feet tall and 80 feet wide. Now envision the foundation of that building being dropped down about 5 feet on the one side, the same proportionately as my spine. That would mean the elevator inside the building would need to rise and fall diagonally, drifting more than 15 feet to the side from bottom to top. That is a lot of diagonal movement. To keep the analogy going, one must consider that each vertebra is held together by ligaments which are elastic and can stretch, so every floor of the building would therefore be held together by an elastic material. Now put that building through the activity of most humans. Have the building bounce about, bend over, fall down while walking, running, biking, skiing, and other activities that are equivalent to an earthquake for a building. What are the chances that over time there will be one story of the building that slips out of alignment by a foot or two? In my case, that was inevitable. Without proper alignment, the elevator has a hard time moving past that one floor. Similarly, the cerebral spinal fluid needs to flow up and down freely inside of our vertebrae. But when one vertebra of the spine is out of alignment, that flow is inhibited. The free flow of our cerebral spinal fluid is essential to our well-being. If our cerebral spinal sack is ruptured or cut, and the fluid begins to drain out, we will die instantly. And so a small imbalance in our structure can be magnified throughout our body.

In my case, with equal length legs after my Paley procedure, all these structural and lifestyle issues were eliminated.

The Paley Institute has always been at the frontier of leg lengthening worldwide, creating most of the innovation in the technology. Dr. Paley has completed several times the number of leg lengthening procedures than any other Doctor over his career. If you choose to lengthen your short leg, Dr. Paley is clearly the best way to go.

Furthermore, the enhanced technology available today for leg lengthening, primarily due to Dr. Paley’s technological innovations, makes the procedure much less invasive than in the past. For most of my life, a leg lengthening procedure would have involved an external fixator, with a cage around the leg and metal rods puncturing through the skin from the outside, through the bones and out the other side. The external fixator needs to be kept very clean at the insertion points of the metal rods to avoid a staph infection. The risk and reward of the external fixator did not appeal to me. But now the lengthening technology can be inserted into the center of the bone with Paley’s Precice Nail which is not visible from the outside. Much better.

I am relieved to have symmetry again in my body. My spine is better off. My life no longer revolves around the shoe lift. Thank you Dr. Paley.

Sausalito, California

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