Leg Length Discrepancy

Many people have at some point in their lives been told that they have one leg which is longer than the other. This blogpost will help clarify what actually constitutes a leg length discrepancy, how to know if you have a leg length discrepancy, how it might affect the rest of your body, and what can be done in terms of treatment.

Definition

Leg length discrepancy (LLD) refers to significant and obvious differences between the length of a persons lower extremities.

Classification: There are two types of LLD

• Anatomical LLD: This refers to a difference in the bony skeleton of a person’s lower extremities. This can be either a result of congenital maldevelopment or from trauma.
• Functional LLD: This refers to an apparent LLD where there is no real bony difference between the lengths of a person’s legs. Other factors, such as muscle imbalances, postural disturbances, or other conditions such as scoliosis, create the appearance of one leg being shorter than the other.

Significance: Does LLD really matter?

• Most people are not perfectly symmetrical and have slight differences from side to side. A difference between 1.0 to 1.3cm is considered normal.
• Functional LLD is more common than anatomical LLD.
• Functional LLD is typically a symptom of other problems such as asymmetrical muscle weakness/tightness and prolonged poor posture. Therefore treating the root causes of functional LLD should restore symmetry of leg lengths.
• Anatomical LLD of greater than 1.3cm is only a problem if it is causing symptoms. The types of symptoms which are more common in people with anatomical LLD include low back pain, hip pain, gait (walking) abnormalities, and lower extremity stress fractures.

Assessment: How to know if you have LLD

• Physiotherapists are trained to measure for LLD when it is deemed appropriate for a given client. They can do this using a tape measure to measure the distance between the hip and ankle on each side with the client laying down.
• Xray or CT scans can also be used to measure LLD, and this would likely be done in severe cases if surgery were being considered as an option.

Treatment: What can be done if you have LLD?

• As mentioned above, in cases of functional LLD, addressing the underlying causes of the discrepancy will help to restore symmetry and alleviate symptoms. Physiotherapists are trained to assess for such underlying causes as muscle imbalances and poor posture. They can use a variety of techniques including manual therapy and exercise prescription to help people with this problem.
• In cases of anatomical LLD, a heel lift can be used in the shorter leg’s shoe to help minimize stress on the body during weight bearing tasks. Physiotherapists can help determine how much of a heel lift will be helpful to restore a neutral pelvic position and minimize symptoms of LLD.
• In severe cases of anatomical LLD, sometimes surgery will be indicated to either shorten the longer leg or lengthen the shorter leg. Physiotherapy plays an important role in the rehabilitation from such surgery, as it helps to stretch muscles and maintain joint flexibility, which is essential in the healing process.

If you are experiencing pain or discomfort and are wondering whether a leg length discrepancy is contributing to your symptoms, feel free to book a consultation with one of our knowledgeable physiotherapists.

Written By: Reanna Montopoli, FCAMPT Physiotherapist