The recognition and treatment of leg length discrepancy (LLD) is often a topic of considerable debate among medical professionals. Many believe that the body can adapt to a variety of ills, and that reasonable body symmetry is not an area of concern. At CWG Footcare, we believe that this view is applied too broadly in many cases of LLD. Sufferers of leg length discrepancy require proper assessment to determine functional versus anatomical causes and the best method of treatment.

Leg Lengths illustration

Above:Classic points to observe LLD at the medial malleoli and anterior superior iliac spine (ASIS).In this case the LLD is functional caused by a left ilium “upslip”.

Adaptations and consequences to LLD

The body does indeed compensate for LLD; however, these compensations, while considered normal by some, are usually at the expense of other joints and tissues. Much like a heart working harder to offset poorly conditioned muscles, LLD often results in long term tissue wear and tear.

Common adaptations to LLD include increased hyperpronation on one side as the body attempts to shorten the long limb. External rotation results at the hip and foot on the short side as the body “reaches” in an attempt to lengthen itself. Manual therapy to modify pelvic function will either equalize the LLD or improve function at the SI joint, and subsequently unload pressure at the spinal column.

The greater the LLD, the more a “side-to-side” gait occurs where the patient drops hard to the short side and “pole vaults” over the long side. The short side lands with the rear foot in an inverted position. More weight and time is spent on the forefoot, and more patellofemoral stress occurs on the long side.

Other unilateral complaints include metatarsalgias, iliotibial band friction syndrome in runners, hip and back pain, and so on.

Leg Lengths article illustration

Determining the cause

LLD can be a manifestation of either an anatomical or a functional shortcoming. The best way to determine this is to use a tape measure or radiograph to compare the length of the femurs, tibiae, or feet. A measureable difference is anatomical, while equality indirectly proves a functional LLD.

Anatomical LLD is best treated through the use of a lift and has the greatest potential for good results.

Pelvic assymmetries are by far the most common causes of LLD and spinal pain. LLD is so common that we often make the assumption that it is normal. If not for pelvic assymmetries there would be little compensating at the more vulnerable spine. Treatment aimed only at the site of pain is often futile or short term at best. It is helpful to look at pain being a “liar” in terms of a cause and effect in spinal conditions.

The long and the short of it

From a pedorthic and therapeutic point of view, the goal of treatment for LLD should be to ensure that a spinal condition is neither provoked nor aggravated. Exact predictability is not always possible but the great majority will benefit. Careful assessment of the patient will help determine whether the cause of LLD is
anatomical or functional. Once this is determined, treatment can begin to provide clinically effective symmetry for the individual, either through lifts for anatomical differences or manual therapy for functional differences.

Correct assessment and treatment can reduce acute and chronic pain and return proper function to patients even after years of spinal malfunction.

** The above information is not intended to replace a physicians advice. Seek a physicians advice first.

Author Ottawa Footcare

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