Once we have established that someone has a true anatomical short leg, we have to decide if the patient is a candidate for a heel lift, what type and how much.There are a few contraindications to a heel lift. Patients with scoliosis on the opposite side of the short leg, or significant shifting of the cervical spine contralateral may do poorly with a heel lift as they will develop problems above the pelvis. The decision about a heel lift always needs to be made by looking at how the whole spine will fare by changing the foundation. There are a few less common reasons not to give a lift, including severe spondylolisthesis or hyperlordosis in the lumbosacral area, since the heel lift tends to slightly increase the pelvic tilt angle.The amount of heel lift correction is rarely going to be the full measurement on the standing pelvic views. The body will already have absorbed and compensated for part of the short leg and a full correction will result in a symptomatic overshoot reaction. My rule of thumb is two thirds of the measurements. However, we add lift correction very gradually, starting at 3 mm and going up 2 mm every two weeks. At each visit we monitor standing posture of the whole spine, knees and the patient's gait. At some point you achieve a good mix of leveling the pelvis without overshooting the rest of the spine and that becomes the final correction.For everything up to 9 mm, we can usually correct it using an internal heel lift, worn inside the shoe. Beyond 9 mm, you have to use a full length foot lift, which takes up so much room in the shoe that it may not always be feasible, in which case retrofitting a shoe lift on the sole becomes the only option. However this is a more cumbersome option that we reserve for cases where stabilization cannot be achieved with a shorter correction
