Expert: J.R. Strecker, B.S., D.C. - 6/19/2008

Question
I went to a chiropracter for help with restless leg syndrome. In addition to acupuncture and adjustments, he gave me 1/2" lifts to put in my shoes to address scoliosis, which I have had since childhood. The scoliosis has never bothered me, and I did not and do not have back pain. He felt that the lifts would help with the restless leg. He also said that as I get older (I am 54), the effects of the scoliosis will increase and I will have back problems. I have been wearing the lifts for over a year now. I can tell that they have straightened my back somewhat, but the effect on the restless leg is minimal, and wearing the lifts is a real hassle. I would like to stop wearing the lifts. Will that cause any problems? I really don't want to wear lifts for the rest of my life because I *may* develop pain in the future. But I am concerned that I could cause problems by stopping wearing them. Thank you for your advice.  

Answer
Disclaimer: please do not take any of my advice without at least consulting with your doctor(s) first.  If necessary, print this email in its entirety for your doctor(s) to read.  In addition, please do not attempt to use this website or my advice as a substitute for your healthcare needs, as a substitute for the advice of your doctor, or as a substitute for any legal advice.  There is no way a thorough health evaluation or assessment of any medical condition can be properly made via email.  Please only use the contents discussed as a guide or tool to address your health matters with your doctor(s).  If any of the information I provide conflicts in anyway with the information your doctor(s) provide, it is always best to default to the information provided by your consulting doctor(s) or to seek additional opinions from qualified, licensed healthcare providers as needed.

Hello B.,

It’s really tough for me to answer your question without it appearing as a second opinion -- one of the biggest obstacles for the health experts on this website.  So I’m not going to mention whether you should or should not wear the heel lifts.  Rather, I’ll try to present the major reasons for them so that you can be better informed on their purpose (if you are not already).

To start, there is a little bit of subjectivity regarding heel lifts.  Not all doctors are “big” on heel lifts.  I, for one, am not a big orthotic/heel lift doctor.  But that doesn’t mean they aren’t great.  Because there is some subjectivity to lifting, I don’t do it unless it’s 100% clear cut.  Then there are those doctors out there that want everything to be perfect and will lift 80% of their patient.  Your scoliosis may be clearly needed for heel lifting and it might not.  The only way I could know is to see your x-ray.  In my opinion (not necessarily unique to your case), not all scoliosis patient need heel lifts – only some of them.  But then there are doctors who would disagree with me on this statement.  I don’t know your doctor, so I don’t know his/her stance.  For example, if the scoliosis is secondary to an anatomical short leg – a leg that is actually (not just functionally) a shorter leg than the other – then sometimes a C-shaped scoliosis is seen in the patient, rather than the traditional S-shaped scoliosis.  This is a very clear scenario where I personally would lift the patient.  However, if the patient has an S-shaped curved, I would need to see the x-ray to properly evaluate the patient.  If the scoliosis comes from a wedge-shaped vertebra, rather than a short leg, than I would likely not lift the patient.  But as I said, there is some subjectivity that goes in to each patient evaluation.  It’s not always an exact science or a straightforward recipe that you can follow from a cookbook.  And as with your case, I try to factor in patient comfort because I do realize heel lifts are a bit annoying to maneuver around from shoe-to-shoe.  And it can seem impractical if you are walking around your house barefoot.

Regarding your questions, the biggest immediate effect of you discontinuing the heel lifts is some possible soreness in the back, neck, or head as your body readjusts over the next couple of weeks.  I wouldn’t do it without consulting with your doctor.  Your chiro is not just doing it to save you from pain in the future.  Because of the structure of scoliosis spines, the spine is likely to degenerate at a much faster rate as you age in the areas where the curve puts greater stress on the joints.  In scoliosis, one side of the spine is stretched and the other side is compressed.  The joints on the compressed side undergo more wear and tear, usually causing a greater amount of damage.  Wolff’s Law: bone remodels to stress.  So, in extreme situations (depending on the degree of curve, prior history of spinal trauma, etc…) arthritis can develop, eventually putting pressure on nerves.  When this happens, radiating pain down the arms or legs, such as sciatica, may develop.  I’m not mentioning this to scare you.  And I’m not saying this will definitely happen to you.  Keep in mind, there are 90 year old patients with severe scoliosis and have no back pain.  I’m only mentioning what can occur in severe scoliosis patients that are left untreated.  Your symptoms will also depend on the region affected.

Because of everything I’ve mentioned – the subjectivity of the doctor, the patient’s individual presentation, and the unpredictable degenerative remodeling of your spine as it ages, I strongly recommend you talk to your doctor.  Tell your chiropractor you don’t like the lifts.  In addition, go get a second and third opinion from a couple other chiropractors, and maybe even a physical therapist.  Two other chiropractors may look at your x-ray and say the lifts won’t do you too much good.  There are too many variables for me to know if the lifts are needed for you.  

Best of luck, and I hope this helps you see some of the flexibility of heel lifts.  Good luck!
Dr. J.R. Strecker, D.C.