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Leg Length Discrepancy


Short Leg Syndrome

Chronic overuse conditions that continue despite appropriate care can be an indication of leg length discrepancy (LLD) in an individual. In Singapore, symptoms of LLD are often varied, vague and often confusing. Symptoms can range from “feeling uneven” or “one hip higher than the other” and include lower back pain.

 

Leg length discrepancy can either be caused by:

  1. structural factors where there is an actual difference in the length of the femur/tibia or;
  2. functional factors wherein the bony components are equal in length but surrounding muscles function asymmetrically. This asymmetry may be caused by tight muscles in the waist, hips or lower back, causing one hip to be higher than the other and function or look different to the collateral side.

Structural LLD can be caused by:

  • Congenital defect (unilateral coxa vara)
  • Traumatic (Road traffic accident)
  • Infection (polio)
  • Post-surgical shortening

Functional LLD can be caused by:

  • Soft tissue contracture
  • Unilateral pronation
  • Scoliosis
  • Anterior rotation of pelvis
  • Pelvic torsion

Some studies have shown that 90% of the population has some form of structural LLD. However, the majority of LLD cases are thought to be of little clinical significance except in overuse conditions. Symptoms are more severe on the LONG side in approximately 80% of cases due to increased stance time and excess pronation.

 

 

However, the majority of LLD cases were thought to be of little clinical significance and often asymptomatic except in instances of increased stress such as running. During gait movement, the longer leg experiences increased loading, often resulting in symptoms appearing first or being more severe in the longer leg. The body naturally compensates and tries to keep the head level at all times. This compensation can often lead to pain and tension in the lower limb.

Signs and symptoms of LLD

  • Back pain
  • Hip pain/Inter-tibial band syndrome
  • Early onset osteoarthritis
  • Neurological pain
  • Pronation of the subtalar joint
  • Uneven shoulders
  • Achilles tendinopathy
  • Early heel lift

How you can be diagnosed

Podiatrists or foot specialists are trained to differentiate whether an individual is affected by structural or functional LLD. A podiatrist’s knowledge of the musculoskeletal system and clinical testing makes it easy for them to diagnose individuals and implement an appropriate treatment plan. X-rays or clinical tests can be directly carried out by podiatrists. To avoid exposure to radiation, podiatrists carry out a series of tests to measure leg length from bony landmarks and a Galleazi’s test to check if the femur or tibia are different in length. LLD should be treated if symptoms present or there is a difference of more than 1cm.

Treatment

Podiatrists address LLD by utilising customised medical orthotics. These are adjusted to your specific needs and with caution as too much change too soon can cause more problems. To help your body adjust to the new posture, the podiatrist will devise specific stretching exercises to address the contracted muscle groups in the waist, hips and lower back. If the LLD is greater than 3cm, your podiatrist may refer you to an orthopaedic surgeon for corrective surgery.

 

 

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