Best Shoes & Best Insoles
Leg length discrepancy [Best Treatment, Exercises, Shoes & Heel Lifts]
Do you have a leg length discrepancy? We review how to diagnose, how to measure leg length & the best leg length discrepancy treatment!
Functional leg length discrepancy treatment video summary:
🦶Do you have one leg longer than the other? Uneven hips? Hip misalignment? Or unequal leg length? We review leg length discrepancy and the BEST treatment!🦶
There are 2 types of leg length discrepancy: a functional leg length discrepancy and an anatomical leg length discrepancy. We review leg length discrepancy exercises,
leg length discrepancy shoes, leg length discrepancy symptoms & how to use a shoe lift for leg length discrepancy.
0:00 Leg length discrepancy LLD diagnosis & treatment
0:41 Uneven hips, hip imbalance & hip misalignment symptoms
1:03 knee pain caused by hip alignment
1:28 One leg longer than the other
2:09 One leg shorter than the other
2:38 One leg bigger than the other
3:25 How to measure leg length,
4:14 Scoliosis hip pain and uneven hips
4:30 What causes one leg to get bigger than the other
5:47 how top fix uneven hips
6:13 Hip misalignment & one hip higher than the other
6:34 leg shortening surgery, can you get surgery to get shorter
7:47 leg length discrepancy exercises
9:19 unequal leg length treatment & uneven legs treatment
10:07 one leg shorter than the other shoes
11:20 Best insoles for short leg syndrome
11:58 Best custom orthotics for the leg length difference
12:45 Best ankle braces for hip misalignment symptoms
13:01 Best shoes for hip imbalance & one leg in one leg out
13:29 Misaligned pelvis & hip misalignment treatment
14:08 uneven hips exercises & uneven knees exercises
What is Leg Length Discrepancy & Causes:
Leg length discrepancy is also known as Anisomelia. It is a condition where there is noticeably an unequal length between the 2 lower extremity limbs. It can be classified into 2 categories; anatomical and functional.
In anatomical type, there is a structural inequality in limb length. This may be due to a congenital abnormality at birth, such as scoliosis or acquired conditions like fractures, trauma (injury), bone infections, bone cancers, surgical problems like following joint replacement, and certain orthopedic degenerative disorders. In anatomical type, there is a true difference in your bone length.
In functional limb length discrepancy, the asymmetry is not structural, and there is no shortening of bones of your lower limbs. It is due to alteration of the lower limb mechanics. Ex: Muscle weaknesses, ligament shortening or laxity, joint contractures, mal-alignments, abnormal knees, hips, feet, and ankles. Radiography does not help to diagnose these faulty mechanics. Leg length discrepancy may become problematic to active, involved in sports, and those on their feet most of the day.
This is the major cause of leg length discrepancy & is important for how to treat leg length discrepancy.
How common is limb length discrepancy?
Around 90% of the population has some degree of leg length discrepancy.
- Usually, many are asymptomatic who have a mild degree of discrepancy.
- The average discrepancy is around 5mm.
- However, if the discrepancy is more than half an inch, it is considered clinically significant.
- It is quite a common condition, although we may not be fully aware of it.
- Research by radiographic measurements has found that 70- 90% of the normal population had some discrepancy in their bone leg length.
- Out of which 20% showed a difference of more than 9mm.
What is an acceptable leg length discrepancy?
- You may wonder how much leg length discrepancy is normal. A difference of 10 – 20mm is considered normal or insignificant by many clinicians.
- Limb length discrepancy up to 20mm can be passively compensatory.
- But if it is more than 20mm, active muscular compensatory measures are needed.
Leg length discrepancy symptoms:
Functional leg length discrepancy symptoms can be:
- Lower back pain.
- Hip pain.
- Hamstring pain.
- Knee pain.
- Calf & ankle pain:
- Plantar fasciitis.
- Ball of the foot pain.
- Heel pain.
- Muscle imbalances & joint pain.
- Difficulty walking.
- Difficulty standing for long periods of time.
Is leg length discrepancy a disability?
Usually, if the leg length discrepancy is 5mm or less, it is not significant, especially in the absence of pain and dysfunction. Leg length discrepancy becomes a disability when severe indifference or the symptoms that the patient experience interferes with their day-to-day routine and lifestyle. Disability is usually associated with the long leg. When there is a compensatory mechanism for the discrepancy, such as scoliosis or pelvic tilt, these also can associate with the disability.
Inequality of the limb length can be divided into 3 categories;
- Mild – when the leg length discrepancy is from 0- 30mm
- Moderate – When the discrepancy is between 30 – 60mm
- Severe – if the discrepancy of leg length is more than 60 mm
Intervention is needed if the patient is symptomatic and depending on the magnitude of the discrepancy.
Who to see for leg length discrepancy?
- You should see a pediatric podiatrist or a pediatric orthopedic surgeon if you have any doubts regarding any discrepancy between your or your child’s leg length.
- A podiatrist can help evaluate and treat your functional leg length discrepancy through heel lifts, custom orthotics, insoles, and shoe lifts.
- After taking a complete medical history and physical examination, your doctor will calculate the difference in leg length.
- Investigations like X-rays or CT scans will be ordered to confirm.
- In functional type, although there is an apparent difference, the measured length will not differ.
How to diagnose Leg length discrepancy?
Radiography helps to identify a lower limb discrepancy accurately. Usually, X-Rays are adequate, but CT scans may be used to identify any contractures of knees and hips.
What is a scanogram for leg length discrepancy?
This is a method for measuring discrepancy in leg length by using digitized radiographs by a CT scanner. It is a rapid method that delivers 50 – 100 times less radiation than the conventional radiographic method.
How to measure leg length discrepancy?
How to perform a leg length discrepancy measurement:
Manual tape measurements are taken between 2 points while the patient lays supine. Commonly defined points are between your anterior iliac spine and the medial malleolus, the anterior inferior iliac spine, and the lateral malleolus. It is a direct method but may not be exactly accurate.
In an indirect method, your doctor can palpate bony landmarks while you are standing. For example, your iliac spines or crests are palpated together and see whether both are at the same horizontal level or whether there is an angle that means there is a leg length discrepancy.
By using PALM or the Palpation meter:
It is a valid and reliable instrument to measure any difference in your pelvic height. PALM is cost-effective and convenient.
Your clinician may also use blocks to measure the limb lengths, although accurate measurements depend on the clinician.
Leg length discrepancy test:
The best leg length discrepancy test is to get seen by your podiatrist, biomechanical specialist, or a physical medicine and rehab specialist for a biomechanical evaluation. We specialize in gait analysis (walking analysis) to assess for functional limb length discrepancy.
It is rare that a bone measurement with yields useful information. We find that most unequal leg length is due to muscle, tendon, or soft tissue causes.
This means that it manifests and shows itself during walking and running. Thus it is not as simple as just getting a shoe lift, shoe insert lift, or a heel lift to fix the problem. The true solution is to identify why there is an imbalance and correct the soft tissue problem.
How to treat leg length discrepancy?
Surgery is not required for patients with mild leg length discrepancy. Mild cases do not need any intervention if they are asymptomatic. Even if there are symptoms, they are managed with non-surgical interventions.
The patient deals with moderate cases, and surgery may be needed for some, especially if there are symptoms like pain.
Patients who belong to the severe category need surgical correction.
Leg length discrepancy surgery:
Surgical intervention depends on the patient’s age and how severe the discrepancy of the leg length is.
For children and adolescents, bone growth in the longer leg is stopped or slowed. This is surgically induced by blocking the epiphyseal plates around the knee joints. A bone resection procedure (osteotomy) is preferred for adults or patients with skeletal maturity to shorten the longer limb.
Surgical limb lengthening is done if leg length discrepancy is more than 40- 50mm. It involves osteotomy followed by fitting an external fixation device to that limb. This device will apply continuous distraction longitudinally across the osteotomy site leading to limb lengthening.
How to fix functional Limb length discrepancy:
Non-surgical interventions manage functional leg length discrepancies. It involves physical therapy. These include;
- Stretching the muscles of your lower extremities.
- Lower limb exercises that strengthen different muscle groups.
- Watch the video above for leg length discrepancy exercises.
Leg length discrepancy shoes:
Shoe lift for leg length discrepancy:
This can be done as shoe inserts (up to 20mm correction) or by building up the sole of your shoe (up to 30 – 60mm correction) in the shorter leg.
Shoe lifts must be done in small increments and should be gradually implemented.
Custom shoe lifts can be designed with a prosthetist or a podiatrist to help address the functional change.
Best heel lifts for leg length discrepancy:
We believe that heel lifts for leg length discrepancy are not the best option for a functional limb length issue.
- The issue with leg length discrepancy lifts is that they will correct an imbalance by placing it somewhere else.
- The key is to get to the root of the problem and hold the feet, the ankles, and the legs equally while correcting the original imbalance.
- This means a podiatrist biomechanical analysis combined with leg length discrepancy exercises and reassessment to correct the original problem.
- We are much bigger fans of custom orthotics for leg length discrepancy. It is also possible to get premade full-length insoles for leg length discrepancy.
For this reason, we believe leg length discrepancy lifts alone are not the best treatment option.
Best full-length insoles for leg length discrepancy:
Best insoles for leg length discrepancy:
Our best option is to see a podiatrist for a set of custom insoles for leg length discrepancy.
- This treatment option can be combined with a comprehensive analysis of your biomechanics.
- A podiatrist can perform a full gait analysis and a comprehensive biomechanical exam to assess your unequal leg length.
If this is not an option for you, click on the following link to check our favorite premade insoles for leg length discrepancy.
Shoe inserts for leg length discrepancy:
Shoe lift inserts are another way of saying foot orthotics or foot insoles.
- These are also known as leg length discrepancy lifts.
- This can allow for assisting in correcting a functional limb deformity.
- Leg length discrepancy exercises and shoe inserts can combine to get to the root of the problem.
Leg length discrepancy exercises:
In the video above, we detail our favorite leg length discrepancy exercises.
Exercises can be some of the best ways to loosen up sore muscles and tendons that can be causing a functional contracture.
We believe that exercises and stretches can be the best options to get to the root cause of a functional limb length discrepancy or functional unequal leg length.
Frequently Asked Questions:
Can Leg length discrepancy cause hip pain?
Yes. Leg length discrepancy can cause hip pain, and lower back pain can occur due to the severity. However, shoe lifts may help hip pain and lower back pain in patients with mild leg length discrepancy.
How common is leg length discrepancy after hip surgery?
Initially, after a total hip replacement, there can be an apparent leg length discrepancy. This may be due to muscle spasms resulting in the tilted pelvis and an apparent limb inequality despite equal limb lengths. But most resolve within 6 months from surgery. Therefore, patient reassurance and education are important with physical therapy. Sometimes a temporary shoe lift may help.
According to a literature review, leg length discrepancy is a common and a recognized complication of hip surgery. However, true leg discrepancy is often a problem following a total hip replacement. It can adversely affect an otherwise excellent outcome, making it a common reason for litigation against the orthopedic surgeon. According to research, the incidence of leg length discrepancy after a total hip replacement has been reported to range from 6 – 32%. The average discrepancy may vary from 3- 17mm, and around 6% of patients have required shoe corrections following surgery.
Can scoliosis cause leg length discrepancy?
Scoliosis means a laterally curved spine or a sideways curvature of the spine, which is diagnosed often in adolescents. Although the cause for childhood scoliosis is unknown, it can occur in patients with cerebral palsy and muscular dystrophies as secondary scoliosis. It can make your pelvis uneven, known as pelvic obliquity. This can make one of your legs appear longer than the other, even though both your legs are actually the same length. Therefore scoliosis gives a functional type of leg length discrepancy.
Sometimes when there is a true leg length discrepancy, your pelvis may tilt to compensate. Therefore the spine may get curved functionally, and scoliosis may result. Therefore scoliosis can be either caused or exacerbated by leg length discrepancy.
If there is a true leg length discrepancy, keeping the patient supine will help measure the bony landmarks. But there will be no difference in measurements if it is an apparent leg length discrepancy due to pelvic obliquity due to scoliosis.
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