Can a true shorter leg can cause facial assymmetry?

How would be the mechanism?

Can a true shorter leg can cause facial assymmetry? If yes, how would be the mechanism? (Ascending dysfunction)
Also; can facial assymmetry at time cause true shorter leg? If yes, how would be the mechanism? (Descending dysfunction)
To be clear; I am not talking about functional leg lengthy dyscrepancy because of pelvic misalignment -just true difference: one femur bone larger than the other.
Any input would be appreciated.

Discussion

Dan Broszef
Go take a look at the lead singer of weezer.

Melissa Kovach McGaughey
I was like “huh?” But after a Google Image search I’m like “Ohhhh there’s something interesting going on there.” Plus, 90s flashbacks!

Leandro Ormachea
Interesting. In his case it seems like the left leg was shorter, and the right side of the face shorter. So the face collapsed contralaterally. Do you see that his right side of face is shorter too?

Leandro Ormachea
I think a good idea is to check pictures of people with diagnosed anatomic shorter leg and check which side of the face is shortened as a prevalent pattern

Thelma Louise Davis
but according to his bio it says it was corrected as a child, maybe not fully as they used the bone lengthening “stretching” procedure which is quite painful. but if it did have an affect then one has to differentiate developmental true short leg issues from acquired short leg issues due to trauma/injury or amputation.

Patrick Benavoli
It’s not necessarily this simple. Developmental true short leg can be caused by misaligned jaw. It’s actually much more logical when you think about it. Look how far the ankles are bending inwards or outwards for instance, to compensate jaw misalignment.

Leandro Ormachea
Thelma Louise Davis he has corrected at 25 years old approx. He was already weezer leader when he went to Russia to fix the leg

Leandro Ormachea
Patrick Benavoli I understand that there are different possible scenarios of dysfunctions. Still it would be interesting if you could provide a brief sequence of theoretic events starting from a misaligned jaw and ending with a compensatory true developmental shorter leg to better understand how could it take place in a real case. Could you? (If not, a link to an article on the topic would be welcomed too)

Patrick Benavoli
Leandro Nehuén Ormachea the scenario I’ve read about was a teenager with a short leg who was prescribed compensating soles (the sole on the side where the leg was shorter was thicker). Six months later doctors realized the short leg had become even shorter.

Leandro Ormachea
Patrick Benavoli And what would be the logical explanation for that unfortunate outcome and how mandible/facial dysfunction is related to that specific case? I’ve read similar thing in functional leg length dyscrepancy but I understand that you are talking about a true leg length in this example, so trying to understand a bit more.

Patrick Benavoli
Leandro Nehuén Ormachea they were talking about true short leg.
Whatever the phenomenon originating the body imbalance (which obviously can’t be the legs in that case), the weight distribution isn’t the same on both legs. The leg with more weight on it will have a tendency to grow slower, which explains this unfortunate evolution.
On the other hand we know that imbalanced body weight distribution can be caused by cranio-mandibular malocclusion. Hence cranio-mandibular malocclusion (or jaw misalignment) can cause true shorter leg.

Leandro Ormachea
Patrick Benavoli Interesting concept and completely makes sense what you describe. Do you remember where have your read that case? And also: following your logic, if load distribution is therapeutically equalized in a growing subject, let’s say by
means of cranio-occlusal appropiated treatment, it would be expected the leg length discrepancy to have tendency to self-correction, isn’t it?

Patrick Benavoli
Leandro Nehuén Ormachea I doubt I’ll able to figure out which place I saw this case report but it most likely was in a french book dedicated to posturology (I’ll give it a try when I return from vacations).
I think your suggestion is damn right in case of teenagers where some growimg is still expected. Indeed I either don’t believe a true short leg could gain additional missing length in adult cases.
It’s just a guess but I bet decades will still be necessary for medical education to integrate the benefits of cranio-mandibular adjustment in postural, psychic or other chronic conditions.

Leandro Ormachea
Patrick Benavoli Bumpiing a bit. It’s curious because it study says that the leg that carries more load is the one that will grow actually quicker because of more mechanical stimulation of the growth center. They claim to have equalized LLD in growing patients by adding a lift in the shorter side via the above mentioned mechanism.

Leandro Ormachea
Patrick Benavoli “Remodeling of bone … occurs in response to physical stresses – or to the lack of
them – in that bone is deposited in sites subjected to stress and is resorbed from sites where there is little stress”

Patrick Benavoli
Leandro Nehuén Ormachea the explanation given by Bricot (and to which I adhered) seems a little bit flawed indeed.
I suggest the following: the shorter leg will naturally get more axial load, which will trigger or accelerate its growing. We know that legs grow alternatively during puberty, this is why putting a shoe lift on a shorter leg may be wrong at this age. The effect of the shoe lift will depend on how axial the load results on the shorter leg. If we admit that shorter leg naturally gets more load and that load triggers growth (which explains natural bilateral length equalization) than we admit that shoe lift on the shorter leg makes poor sense, except if it just allows getting the load more axial on the shorter leg (but the shoe lift should still under compensate the difference for the growing process to take place).
Does that make sense?

Leandro Ormachea
Patrick Benavoli It does makes sense. I did not know that legs grew alternatively.
And Yes I guess they are talking basically about more axial loading in theory promoted (ok, supposedly this was checked by electronic platform device) by the imposition of a Shoelift. I am not sure if undercompensation would be enough to cause that percentual relative increase in axial load regarding the longer leg. If we take as valid the hypothesis of:more axial load, tendency to stimulate vertical bone growth, we should ensure that the amount of lift imposed to the shorter leg actually generates that differencial between loads in favour to the shorter side if equalization is expected. Although what you say makes sense since why a leg would grow more if the lift puts it at the same level that the longer, but according to the study that is what happened.
May be it is important (at least in my case that am affected personally) to do further research about the characteristics of the lift and more similar studies.

Patrick Benavoli
Leandro Nehuén Ormachea please feel free to keep us informed of your progresses.

Patrick Benavoli
Leandro Nehuén Ormachea one question: are you sure your jaw is correctly aligned (both in frontal and horizontal planes)?

Patrick Benavoli
Leandro Nehuén Ormachea one other thing: It’s likely they under-compensated because part of the structural debt is known to be naturally absorbed by the sacroiliac joint. Look for « downing test » for more information on this topic (in case you did not know it)

Leandro Ormachea
Patrick Benavoli I am sure that the jaw is not correctly aligned neither in frontal nor horizontal planes. Te jaw is back and up in the left and forward and down in the right (I mean, one relative to the other).

Leandro Ormachea
Patrick Benavoli I did not know about that test. Very interesting. So the passive tensile strains associated to int-ext rotations of the hip put ipsilaterally the iliac into either post/ant torsion at the sacroiliac creating a functional short/long leg

Patrick Benavoli
Leandro Nehuén Ormachea , About under-compensation: Not exactly. I meant that there was a possibility that they did not think of doing downing test manipulation before putting the shoe lifts, hence potentially leading to incomplete compensation. If they did use the measurements on the radiography to size the shoe lifts then my assumption does not hold.
Purpose of the compensatory mechanism of the sacroiliac joint:
My current understanding is that it either compensates for a true short leg of for a functional short leg. I believe the compensation would go in opposite directions depending on the trueness of the short leg.
About misaligned jaws: AFAIK there’s a high probability that a rotated jaw will cause the hip to rotate in the same direction, causing a functional short leg in that direction. But other cases exist. It really depends on the instantaneous craniomandibular relationship.

Leandro Ormachea
Patrick Benavoli Thanks. About the under-compensation, I agree with your comment. Also it seems like they measured the shoelifts heights by clinical block testing the patients instead of xrays so it is quite probably what you say. About compensatory mechanism is interesting what you say. From what I understand in true short leg then the shorter leg goes into anteversion torsion and the longer goes into retroversion torsion. I have read that in functional short leg there usually exists retroversion in the shorter side. But I did not knew that was part of the compensation, I thought that was just the cause of the functional LLI. So meanwhile it would be true that in functional LLI and anatomical one we would have inverted patterns of pelvic torsion In one case the sacroiliac motion wouldbe a compensatory mechanism (anatomic LLD) meanwhile in the other would be a pathologic causative of the shorterning (functional LLD). But because I don’t want to continue doing more questions, since I have already did quite a bit, at least for the moment, I will research by myself more about the association between functional short leg and pelvic torsion patterns. About misaligned jaws: I agree with your propossed pattern although in my case it don’t occur but I can see the logic behind that. In my case my left leg is longer and my left mandible is shortened right now, but of course, so many years of compensations and dental treatments it is a very non-linear and not easy to follow the behaviour of the assymmmetry timeline.

Sandra Henderson
Yes this is exactly me. I didn’t have a shorter leg or hip and back issues until I had tmj for 5-8 years. I am 20 + yrs now and have to wear a lift in my left shoe to help with my back. When I look at old pictures of me before I was diagnosed both my legs and back were straight but my head was always tilted to the side

Tammy Rosa
That’s me too.

Leandro Ormachea
Sandra Henderson Do you have true shorter leg diagnosed or just functional one?

Sandra Henderson
Leandro Nehuén Ormachea not sure what that means but my foot doctor diagnosed me with a shorter left leg showed me how my hips were off and gave me a lift for that side I haven’t had a back issue since. I didn’t have that before my tmj issues. Oddly the left side of my face is also the shorter and the teeth on that side. I think I have a little nerve damage from having undiagnosed tmj for so many years

Tammy Rosa
Sandra Henderson my shorter side is on the right side.

Serhat Roj
Leandro Nehuén Ormachea A heel lift ist only considered with anatomical leg lenght discrepancies right? A tilted hip caused by tmj is functional. So heel lifts are contraindicated?

Leandro Ormachea
Sandra Henderson Good explanation. Makes total sense what you explain but I guess that your case is a functional shorter leg. I mean that your leg bones have the same anatomical vertical size but the problem is misalignment of the pelvic associated to the tmj issue. It would be interesting to go see a PT or a medical doctor that tells you if you have a true difference in size of the legs (which at first sight don’t mean to be the case) or is a functional problem.

Leandro Ormachea
Tammy Rosa I understand that you are refering to your right facial side as being shorter. Do you have a shorter leg? If yes: is the right leg or the left one?

Tammy Rosa
Leandro Nehuén Ormachea my right side of face and right leg.

Leandro Ormachea
Tammy Rosa Ok. And do you know if the leg is anatomically shorter (femur and/or tibia have different vertical sizes) or is the pelvic that is misaligned?

Tammy Rosa
Leandro Nehuén Ormachea unfortunately I’ve never had the proper X-ray because I’ve been told that it’s functional. I believe it is too. Everyone has some leg length discrepancies but it only matters if it’s significant. I never noticed leg length differences until my jaw/head injuries.

Leandro Ormachea
Serhat Roj I am not completely sure. I’ve even read that heel lifts are not corrected and maybe shoelifts (not heel) are better in anatomic shorter leg. About functional ones associated with TMJ I suppose that correcting the facial problem should allow for natural correction of the descending pattern dysfunction so not sure if temporarily a lift could be correct or not, but for sure eventually once you correct the face, the lift should be removed because if not, you are locking your body in a faulty position after the cause of that position was already fixed. However it is possible as you suggest that lifts are always not-recommended in functional TMJ cases. I am not sure about that and I am trying to research more on the topic currently so I can’t answer tbh.

Leandro Ormachea
Tammy Rosa Yeah, most probably.

Sandra Henderson
I know once I had my tmj corrected with a splint I needed the lift because I couldn’t function my back was always out and I would sometimes take a step and fall to the left. I also notice i stand straighter and it’s easier to control my posture. When I wear sandles or bare feet I can tell my back and hips hurt a lot

Tammy Rosa
Leandro Nehuén Ormachea have you been able to address your jaw alignment and facial symmetry? I tried to “fix” my “shorter” leg by wearing heel lifts and shoe lifts. Didn’t help.

Leandro Ormachea
Tammy Rosa I got a complex case. Working on that currently. I tend to think that heel lifts are not very good because they change the inclination of the foot. Entire shoe lifts are supposed to better but still if the problem is functional shorter leg It doesn’t seem to be a solution. You are locking the leg in an incorrect posture with the lift. So working in the face alignment plus physical therapy in theory makes more sense than putting a lift under the feet in a case like yours.

Tammy Rosa
Leandro Nehuén Ormachea that’s what I plan to do. It’s such a difficult problem to solve using a single modality. So once the jaw is properly aligned, hopefully the other issues can be addressed correctly.

Jess K-ohw
Tongue/lip ties or cranial nerve damage can cause it. (j)

Tammy Rosa
Can you test for cranial nerve damage?

Jess K-ohw
I think you can. I just learned about both for my baby. Also learned aluminum toxicity can also cause nerve damage and can cause the cranial nerve damage. If you detox sometimes the body can self heal but it’s not a fast fix it’s a slow process could take a few years to see results. (j)

Tammy Rosa
Cam-Jess Kartak thanks!