Case Study Reveals Underlying Limb Length Inequality

By: Mitch Mally, DC

CASE STUDY: 19 year old male pitching marvel for a west coast collegiate baseball team, presents with recalcitrant right elbow pain. Having failed traditional chiropractic and multidisciplinary treatment for medial epicondylitis, he was faced with the inevitable Tommy John surgery. Researching the surgical reviews, post-operative outcomes, complications, etc., he elected NOT to have the potential career-ending surgery and opted to contact me for yet another opinion. The patient was escorted by his mother to my Iowa office for additional consultation, evaluation and further discussion regarding viable treatment options. Given my expertise in extremity conditions, injuries and syndromes, and as with numerous others, they too were referred as a last resort to possibly avoid surgical intervention. Examination disclosed a fairly unremarkable right elbow for the exception of the expected slight laxity of the ulnar collateral ligament (UCL). Minimal palpable tenderness was also identified in addition to an excessive valgus humero-ulnar joint motion consistent with a UCL injury. No other direct orthopedic or neurological findings noted.  Unique to my biomechanical protocols, ALL patients are assessed with a 3D Foot scanner (Footlevelers) measuring the amount of pronation (pronation stability index), percent weight-bearing differences, arch height differences, etc.  X-rays were taken of the spine and bilateral feet, as well as a specialized leg length x-ray to determine structural vs functional short leg.
Findings demonstrate this patient is a moderate pronator, with a revealed 9 mm short left leg and 12lbs heavier weight bearing on the left leg. As a former pitcher and quarterback, power, velocity and control are best achieved with balance from the structural foundation (feet) and core.
A 5mm heel lift was first prescribed and the response was incredible according to the patient. Moreover, his balance, speed, power, and accuracy each dramatically improved as his pitching wind up motion clearly demonstrated. As this patient continues to provide clinical updates, he returned to Los Angeles after four days of intensive care in July. He acknowledges marked improvement in his pitching, velocity, accuracy all with minimal fatigue factor and NO elbow pain! The final correction of 9mm to his shoes and cleats transpired after 4 weeks accommodation. Next was the removal of the 5mm lift affording complete correction of the biomechanical cause of this athletes near premature ending of his career. Structural Leg length inequality is more common than most give credit.  Patients with refractory migraines, TMJ, shoulder, spinal and numerous maladies of complaints may indeed have an underlying limb length inequality.

Dr. Mally practices in Davenport, Iowa and has pioneered one of the largest case studies in the work on leg length with over 4,000 cases evaluated. The findings reveal approximately 92% of the studies had 3mm and greater anatomical short leg deficiency, and those with prosthetic hips and/or knees suffer with 98% limb length inequality.

A nationally renowned speaker in chiropractic technique, Dr. Mally has presented for the Tennessee Chiropractic Association continuing education events, and has contributed for the TCA Journal publication.