Ten years ago, as digital scanning first became part of my exam routine, a visual presentation of the foot became available. After examining hundreds of young athletes and other patients, it is my opinion that everyone has structural imbalances that originate in the feet. I have yet to examine a person with perfectly balanced feet.
In addition, because the arches of our feet are determined by the strength of the soft tissues holding them, our arches fall over time due to gravity and stress that weaken the supportive tissues. This is why people may feel like their feet are growing as they get older. Their feet are not growing longer. The arches are falling, which makes the feet appear longer.
Physical exams of young athlete yield many findings. Range of motion of the major joints, for example, will often reveal restrictions in one or more joints. These restrictions are usually caused by increased weight bearing in a joint, which over time produces a contraction of the muscles that support the added weight.
If this is left unattended, the joint will be compromised and will predictably break down prematurely from the increased stress. Not by coincidence, hip and knee replacements are becoming the standard of care for those over the age of 50. In many cases, however, broken-down joints are caused by neglect during the athlete’s growing years.
Leg length is also important. Most people have a difference in leg length, which, if not addressed, will lead to an imbalanced stance and gait as the athlete walks or runs. This leads to compensation from other joints, tendons, and muscles, which increases demands on specific areas.
There are two types of leg length differences. The first is functional, where the legs are actually even in length, but due to imbalances elsewhere (as in the pelvis or low back) they appear uneven in length. This is the case in the majority of the population, and a lift is not recommended in this situation, as inserting a lift into the shoe of the short leg will only encourage further distortion of the underlying problem.
The second type of leg length difference is the anatomically short leg, when one leg actually measures shorter than the other leg (see Figure 9). This occurs in a small percentage of the population. In this case, a lift is needed in the shoe of the shorter leg, but the lift should not measure higher than seven millimeters. If the leg length difference is greater than one-half inch, the entire bottom of the shoe should be built up rather than inserting a lift that high.