Chronic Proctalgia from Leg Length Discrepancy Relieved by a Shoe Insole

Background: The pathophysiological mechanism behind chronic proctalgia is not fully understood. The study investigated whether treatment of lower limb length discrepancy (anisomelia) with an insole could relieve levator ani syndrome and chronic proctalgia. Patients and Methods: Nine patients with proctalgia were identified as also having anisomelia. The patients underwent clinical evaluation, including proctoscopy, flexible endoscopy, anal ultrasound and a digital rectal examination to identify tenderness of the levator ani muscle. The patients were treated with an insole worn in the footwear of the short leg, and the effect was observed on proctalgia and tenderness of the levator ani muscle. Results: The patients had experienced proctalgia for a mean of 41.8 months. The leg length discrepancy ranged from 1-3 cm. Eight patients had left-sided tenderness of the levator ani muscle. The tender levator ani muscle was on the same side as the short leg in five patients and the long leg in four. Two patients showed tenderness on both sides of the levator ani muscle, and three had additional tenderness from behind the rectum to the apex of the coccyx. All patients except one were completely relieved of proctalgia after treatment with a permanent insole worn in the footwear of the short leg, and digital examination showed no more tenderness of the levator ani muscle. Conclusion: The study demonstrates that chronic proctalgia may be due to the levator ani muscle that has become strained and tender because of pelvic tilting from lower limb length discrepancy, a relationship which until now has been undiscovered. The pain was resolved by wearing a permanent shoe insert to compensate for the short leg. Patients with proctalgia should be examined for leg length discrepancy.