Leg Length Difference



"A functional leg length discrepancy is often diagnosed when there is some form of sacroiliac joint dysfunction": http://www.nielasher.com/blogs/video-blog/testing-for-leg-length-discrepancy

Defined as a condition is which there is a discrepancy in the length of paired limbs.
Occurs in 40-70% of population.

Two types:
Structural – fixed osseous shortness in one or more segments
Functional – due altered mechanics eg asymmetrical foot pronation/supination or unilateral soft tissue contracture in the spine and/or pelvis  pelvic or hip rotations, contractures or obliquity

Additional classification – had since childhood or develops in later life (development in later life tends to be more debilitating.


Clinical features:
Mild cases can be easily hidden by walking with slight bend in knee or tilting the pelvis.
Uneven shoe wear

Galeazzi’s sign – patient lies supine with knees flexed and feet on table – if knees are at different heights  LLD

Gait analysis:
Head may tilt towards longer side; shoulder usually lower on shorter side; pelvis higher on long side; arm swing may be greater on short side; step length longer on long side; flexed knee on longer side

Clinical significance:
Contentious issue
May depend on signs and symptoms

Measurement – some inaccuracy with all measurements of LLD

Some authors argue forcefully that less than 20mm should be ignored found that a discrepancy of 5-9mm was more common in those with low back pain.
>1cm is a guideline for many
Gait is inefficient
? predisposition to osteoarthritis in hip of longer leg

Many authors have found associations with low back pain while others have not .

Heel lift ( may cause an anterior pelvic tilt  secondary problems)
Manual therapy of hip, sacroiliac joint and pelvis

If severe in a child – epiphyseodesis procedures to arrest growth of longer leg or leg lengthening procedures for short leg

Related Topics:
Leg length evaluation | Cycling and Leg Length Difference

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