How Iatrogenic (Complications Caused by Medical Treatment) Leg Length Inequality Can Lead to Low Back Pain and Scoliosis?

Leg length discrepancy, a condition where one leg is shorter than the other, is a common cause of low back pain and spinal issues such as scoliosis. While this problem can occur congenitally, a growing number of cases are iatrogenic, meaning they result from medical interventions, particularly hip or knee surgeries. A recent study by Aykan Ulus and colleagues discusses how iatrogenic leg length inequality can lead to degenerative scoliosis and chronic lower back pain, especially in elderly patients who have undergone joint replacement surgeries.

The Link Between Leg Length Inequality and Back Pain

Low back pain is one of the leading causes of disability worldwide, and its prevalence increases with age. One overlooked cause of this pain is leg length inequality, particularly when caused by medical procedures. Iatrogenic leg length inequality occurs when surgeries such as knee or hip replacements unintentionally alter the length of one leg. This type of inequality can lead to spinal misalignments like degenerative scoliosis, which is a sideways curvature of the spine.

In the cases studied by Ulus and his team, patients who developed leg length discrepancies after knee or hip surgery experienced scoliosis concave to the side of the longer leg. This spinal curvature increases pressure on the intervertebral discs and muscles on one side of the body, leading to chronic low back pain and sciatica.

Case Studies: Real-Life Examples

The study presented four cases of patients with low back pain related to leg length inequality:

• Case 1: A 73-year-old woman experienced severe lower back pain and weakness in her lower extremities following a knee arthroplasty. Her left leg was 4 cm shorter than her right, resulting in degenerative scoliosis and significant discomfort. Although surgery reduced her pain, she continued to have motor deficits.
• Case 2: A 64-year-old woman had undergone knee replacements on both legs, which resulted in a 2 cm leg length discrepancy. This patient also suffered from scoliosis and found relief only after surgical intervention and the use of a shoe insert to correct her leg length inequality.
• Case 3: A 62-year-old woman with a previous lumbar discectomy and knee replacement surgery developed a shorter left leg, which led to scoliosis and ongoing back pain. Like the second case, her pain subsided after spine surgery and the use of a shoe insert.
• Case 4: A 28-year-old woman with a congenital 6 cm leg length discrepancy developed severe scoliosis and back pain following her second childbirth. Surgery and shoe inserts helped alleviate her symptoms.

Why Do These Issues Occur?

The human body strives to maintain balance, compensating for asymmetry in the legs by tilting the pelvis. This pelvic tilt leads to compensatory scoliosis, especially when leg length differences exceed 11 mm. The study emphasizes that younger patients or those with strong muscles can sometimes compensate for mild discrepancies, but older adults, especially those with weaker abdominal muscles, are more likely to develop degenerative conditions such as scoliosis.

Solutions and Prevention

For many patients, correcting leg length inequality with shoe inserts can be a simple yet effective solution to alleviate back pain. In more severe cases, however, surgery may be necessary to address both scoliosis and the underlying leg length discrepancy. This study highlights the importance of measuring leg length as part of routine examinations for patients presenting with low back pain, especially after joint surgeries.

Conclusion

Iatrogenic leg length inequality is an emerging problem in the aging population, especially as more people undergo hip and knee replacement surgeries. When not properly addressed, this condition can lead to degenerative scoliosis and chronic low back pain, severely affecting the quality of life. Fortunately, solutions like shoe modification or corrective surgeries can offer relief and restore balance to the body.

For individuals experiencing chronic low back pain following surgery, seeking an evaluation for leg length discrepancy may provide insights into the underlying cause—and lead to simple yet effective treatments that improve both posture and comfort.

By ensuring that leg length discrepancies are addressed promptly, patients can avoid long-term spinal issues and enjoy a better quality of life post-surgery. American Heelers has helped over 20,000 individuals worldwide by providing non-invasive, cost-effective solutions for leg length discrepancies, reducing pain, and improving mobility. The overwhelmingly positive feedback from patients highlights the success of these shoe modifications in alleviating symptoms without the need for expensive or painful surgical interventions. For those suffering from back pain and scoliosis caused by leg length inequalities, American Heelers’ custom shoe modifications offer a much-needed alternative, allowing patients to regain comfort, balance, and a better quality of life without undergoing invasive procedures.