Leg length discrepancy is a common condition with diverse causes. This review focuses on anatomical leg length discrepancy with measurable differences between the lengths of the lower-limb bones, including foot height.
Another term commonly used for leg length discrepancy of less than 2 cm is pelvic obliquity, which shows that the finding of a leg length inequality of this extent is frequently not a merely anatomical phenomenon but can completely or at least partially be the result of functional function abnormalities, such as pelvic distortion.
Large leg length discrepancy can be as severe as the complete absence of limb parts. These cases are typically linked to rare congenital malformations, which, in addition to the leg length discrepancy, are associated with complex changes in the entire limb. These patients have unstable joints, vascular malformations, severe malpositioning, and partial or complete absence of entire bones or toe rays.
It must be discussed with each patient individually whether the treatment should be conservative or surgical. The extent of the discrepancy is not the sole determining factor for the mode of treatment. The decision to treat is always elective.
How Does Leg Length Difference Affect Your Life?
Welcome back to Sports & Spinal Solutions Clinic. Your back pain, shoulder pain, and neck pain are all coming from your leg length; the difference sounds plausible, but does a leg length difference matter, and how big does the leg length difference need to be to play a role. In our daily practice, we come across a plethora of patients who blame their leg length discrepancy for their knee, hip or low back, shoulder and neck pain; many of them were informed about the leg length difference by the general practitioner specialist or physiotherapist; this can create a problematic attitude and fear that their situation might lead to poor alignment of the pelvis spine and even higher up in the body.
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How Do We Measure Your Leg Length?
Our first question to patients is usually how is this leg length difference measured? A study has shown that clinical assessment of leg length discrepancy is unreliable. An actual distinction can only be measured reliably by x-ray. Yet, almost 50 years later, physiotherapists and other professionals tell their patients that they have a leg length difference after measuring it or performing the liberbasto maneuver, for example.
We will continue to ask our patients, out of a hundred people, how many people do you think to have a leg length discrepancy?
A review by Knutson at all in the year 2005 estimates that around 90 percent of the population has a leg length discrepancy. Of those ninety percent, almost sixty percent have a leg length difference of five millimetres or more.
Now, let’s say that a patient has had an x-ray confirming an apparent leg length discrepancy can this influence his or her ankles knees hips and back etc. first of all the review above showed that the effects of an anatomic leg length difference is rotation of the pelvis often referred to as pelvic torsion in most cases the innominate bone rotates anteriorly on the side of the shorter leg and posteriorly on the side of the longer leg in patients with a leg length discrepancy of up to 22 millimetres but is this pelvic torsion related to low back pain the evidence from different studies included in this review shows that neither pelvic torsion nor pelvic and levelling or pelvic obligation is related to low back pain so now we have only one question left to be answered: when does a leg length discrepancy play a role in other words, when is it clinically significant there are quite a few studies that have tried to answer this question for more details, we would like to refer you to the review of knudsen in conclusion, the result of taking different papers into account is that a leg length difference of up to two centimetres is probably not clinically significant the human body is perfectly able to compensate for this difference mainly through passive structural changes such as minor scoliosis fasted angulation or changes in muscle length only past the two centimetres point active muscular compensation takes over.
Is a Leg Length Difference More Than 2 Centimeters Possible?
At last, it’s essential to realize that a discrepancy of this size is only found in around 1 out of 1 000 people, so in case someone has a leg length difference of more than 2 centimetres, how is this treated what we often hear and also see on social media is that practitioners try to reverse the pelvic torsion by manipulation of the sacroiliac joint. Your first question about this procedure would be, why would you want to change the pelvic torsion in the first place? If the pelvis is equalized, we expect other structures to take over the job and compensate even more, such as the facets or muscles. Second of all, we have learned that manipulating the si joint can never change the position of the innominate bones on the sacrum. The only treatment that makes sense and can be of value is the lifts to compensate for their discrepancy. Hence, if you find a leg length difference of two centimetres or more, referring this patient to a podiatrist makes sense.
Can Prolotherapy Help You If You Have a Tilted Pelvis?
Our patients often ask us about you know, a quote unquote tilted pelvis and how that can affect their pain or their treatment and what’s interesting about that the diagnosis you know of a tilted pelvis whether your pelvis is tipping forward or backward or whatnot um is that a lot of patients have a tilted pelvis but whether or not that is causing their pain for why they came in, you know remains to be seen until we get a complete history and exam what’s interesting about that as well is that you see a lot of us to have sitting jobs we sit at desks we sit you do on the computer or whatnot and chronic sitting can affect how your pelvis tilts as well, so you know to kind of untilt your pelvis or gadget may be as simple as getting a standing desk at work or standing more during the day or being more active in a non-sitting maybe non-crossing legs manner um to help to alleviate that however like I said it might not be something that’s affecting patients pain it just all depends on you know the history and physical exam for their condition.
