Leg length evaluation:
Several methods available – generally indicated from observations made during gait analysis (eg head and shoulder tilt, asymmetrical arm swing).
1) Measurement from anterior superior iliac spine to lowest point of medial malleolus
2) Measurement from the umbilicus to the lowest part of the medial malleolus
3) Patient seated, with back against wall. Firm pressure is applied to the extended limb to push it against the wall. Compare level of malleoli
4) Patient supine, traction is applied to the foot to stretch the entire body. Observe the level of the malleoli
5) Allis’ test – patient supine, malleoli placed together, knees flexed – look from distal to proximal and compare level of knees. From lateral side – if knee of short leg is anterior to other knee shortness in tibial segment. If knee of short leg is posterior to other knee shortness in femoral segment.
6) Patient standing in angle and base of gait. Compare levels of shoulders, hips, sacroiliac joint, popliteal creases.
7) Palpation of iliac crests add wooden blocks under short limb until iliac crests are level
Reliability of leg length measurements: