Limb length discrepancy (LLD) can be congenital or acquired. Some causes of congenital LLD include fibular hemimelia, tibial hemimelia, congenital femoral. Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length. Limb length discrepancies (LLDs) as small as cm can significantly affect gait, and some clinicians choose to intervene in cases of even smaller discrepancies.


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Based on a systematic literature search, we identified 42 articles dealing with various assessment tools for measuring LLD. Clinical methods such as use of a tape measure and standing blocks were noted as useful screening tools, but not as accurate as imaging modalities.

While several studies noted that the scanogram provided reliable measurements with minimal magnification, a full-length standing AP computed radiograph teleoroentgenogram is a more comprehensive assessment technique, limb length discrepancy similar costs at less radiation exposure.

Common causes and conditions of Leg Length Discrepancy (LLD)

We recommend use of a CT scanogram, especially the lateral scout view in patients with flexion deformities at the knee. Newer modalities such as MRI are promising but need further investigation before being routinely employed for assessment of LLD.

Level IV, diagnostic study. Methods In the 's studies limb length discrepancy to show that clinical measurements of LLI were inaccurate and the use of x-ray, controlling for magnification and distortion, was necessary [ 4 - 6 ]. By the accuracy of the measurements with the standing x-ray had been established, with Friberg then demonstrating reliability of the method on subjects [ 7 ].

Leg Length Discrepancy

For these reasons, this review starts in the 's with studies that used the reliable x-ray procedure as described by Friberg.

Genu varum,… may mask or accentuate a limb length inequality Asymmetrical limb length discrepancy of the umbilicus Joint contractures Indirect methods [5] [6]: Palpation of bony landmarks, most commonly the iliac crests or anterior iliac spines, in stand.


These methods consist in detecting if bony landmarks are at horizontal level or if limb length inequality is present. Palpation and visual estimation of the iliac crest or SIAS in combination with the use of blocks or book pages of known thickness under the shorter limb to adjust the level of the iliac crests or SIAS appears to be the best most accurate and precise clinical method to asses limb length discrepancy inequality.

You should keep in mind that asymmetric pelvic rotations in planes other than the frontal plane may be associated with limb length inequality.

A review of the literature suggest, therefore, that the greater trochanter major and as many pelvic landmarks should be palpated and compared left trochanter with right trochanter when the block limb length discrepancy method is used.

Exact procedure of the indirect measurement method using blocks Patient is standing with feet 10 cm apart, knees extended and equal weight on both feet.

Methods for Assessing Leg Length Discrepancy

Now the clinician visually assesses if there is a length inequality, and if so, places a wooden board of 0,5 cm under the foot of the shorter side. Keep placing thicker planks under the shorter side until equal length is reached, the thickness of the plank is equal to the leg length difference.

Although reliability is highly dependent on the accurate measurements of limb length discrepancy clinician, this method has shown excellent results in inter-examination results between highly trained clinicians and medicine students.

limb length discrepancy Confounding variables reported by literature are: Leg length discrepancy after Total Hip Arthroplasty THA Clinical signs Patients can be categorised into three types according to the presentation of symptoms: Patients flex their knee during gait to maintain level pelvis.

The initial limb length discrepancy LLD can be described as periarticular muscle spasm, lumbosacral scoliosis, and pelvic obliquity.

But, for children with disabilities, these compensations—knee flexing, pronating, supinating, making ground contact with an equinus foot instead of with the heel—are big problems.

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The debate is about when to intervene. They recommended that evaluation of gait abnormalities limb length discrepancy such children should not be limited to sagittal plane kinematics but should include 3D kinematics of the pelvis as well.

Leg Length Discrepancy - Physiopedia

To compare tibial lengths, he has the patient recline and put the limb length discrepancy malleoli together. Evaluating femoral length is more challenging, he said, because tightness in certain muscles such as the quadratus lumborum can affect pelvic tilt and apparent leg length.


There may also be issues in the ankle or foot. Pelvic rotation as a determinant of gait. A lateral view of the gait cycle with the knees and hips locked illustrates how the pathway of the center of mass creates an exaggerated sine wave, which is metabolically expensive because the hip abductors must raise and lower the center of mass through limb length discrepancy exagerrated ranges.

This type of sine wave pattern is more characteristic of a structural limb-length discrepancy than a functional one. Adapted with permission from reference Typically, Michaud will give patients a heel lift, then videotape them walking.

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