Doc: Leg-length discrepancy common in polio survivors
Dear Dr. Roach: I had polio when I was 11 years old, many years ago, and miraculously, recovered enough to live a normal life. When I was in my 40s, I developed constant back pain and visited a renowned orthopedist in Stamford, Connecticut. When I told him I’d had polio, he rolled up a paper towel and placed it under my right heel. He told me that “all people with polio have some degree of scoliosis.” The pain went away almost immediately.
He gave me a prescription for a 1/4-inch heel pad (to take to a shoemaker) and to wear it in my right shoe all the time. The doctor said that for over 30 years, my back muscles have been straining to force my body to stand straight, causing the pain. I also was advised to do a set of floor-stretching exercises, which I did every morning.
I am now 85 years old and never had back pain again. Whenever someone mentions they have pain from scoliosis, I tell them my story.
Dear E.R.: Poliomyelitis is a devastating complication of poliovirus with no proven treatment. The virus may damage many of the nerves of the body, including those to the muscles necessary to breathe (hence, the iron lung). For survivors, the resulting weakness is usually permanent. Fortunately, there is very little wild polio left in the world, with 15 cases as of this writing reported in 2018, all in Pakistan and Afghanistan. However, there are still hundreds of thousands of survivors of poliomyelitis living with the long-term effects of the disease.
Scoliosis is a common complication of poliomyelitis, but it is not universal. Scoliosis may develop years after the acute infection along with muscle weakness as part of post-polio syndrome. Muscle and joint pain go along with PPS.
One possibility of apparent scoliosis in your case is of a leg-length discrepancy (one leg longer than the other), which is exceedingly common in polio survivors. When one leg is longer than the other, it may lead to changes in the body to compensate. Over time, this causes hip and back pain and scoliosis due to functional changes of the spine. When the leg-length discrepancy is addressed, the scoliosis goes away. I suspect you had a leg-length discrepancy that the orthopedist addressed. Normally, the legs would be measured, and a lift would be given for no more than half the discrepancy. It’s also possible there is both some scoliosis and some leg-length discrepancy.
It’s very important to hear from people who survived polio. Until the disease is eradicated from the planet, we need to be vigilant about vaccinating.
Dear Dr. Roach: I wanted to write after reading about a knee replacement in a recent column. I had a knee replacement, followed by physical therapy, but still had stiffness and pain requiring surgery. My friend recommended a massage therapist, and I had a dramatic benefit even after the first session. I continued massage, and the pain and stiffness went away. I had my other knee done years later, and it was a breeze.
I’m 91 now, but doing the knee replacements was the best thing I ever did for myself — but thank goodness for the massage therapist!
Dear M.K.: I thank M.K. for writing and giving a useful resource. Studies have shown that people who get massage therapy improve their pain and swelling faster. However, not everyone has as good an outcome as M.K.’s.
Email questions to ToYourGoodHealth@med.cornell.edu.