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Leg Length Discrepancy


Short Leg Syndrome

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

 

Leg length discrepancy can either be caused by:

  1. structural factors which relate to an actual difference in the length of the femur/tibia or;
  2. functional factors which relate to the bony components are equal in length but surrounding muscles function asymmetrically. This asymmetry may be caused by tight muscles in the waist, hips and 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

A study carried out by Knutson 2005 says “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 as a result of increased stance time and excess pronation.

 

 

Individuals often present with compensation patterns to address the misalignment. For example at the ankle joint, an individual would plantarflex (foot moves downwards away from tibia) more on the shorter leg to accommodate for the leg difference.

Signs and symptoms of LLD

  • Low back pain
  • Hip pain/OA
  • Sciatica
  • Pronation of the subtalar joint
  • Uneven shoulders
  • Achilles tendinitis
  • 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. Their knowledge of the musculoskeletal system and clinical testing makes it easy for a Podiatrist to diagnose individuals and implement an appropriate treatment plan. Clinical tests can be directly carried out by Podiatrists or an x-ray can be taken for more reliable results. But to avoid exposure to radiation, Podiatrists carry out a series of tests to measure leg length from bony landmarks and Galleazi’s test to check if femur/tibia is longer. LLD should be treated if symptoms present or difference of <1cm.

Treatment

At East Coast Podiatry Centre, our Podiatrists address LLD by utilising heel lifts incorporated into customised medical orthotics. These are added gradually and with caution as too much change too soon can cause more problems. Podiatrists devise specific stretching exercises to address contracted muscle groups in the waist, hips and lower back. If the LLD is greater than 3cm then surgery can be considered by onward referral to Orthopaedics.

 

 

 

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