Chronic overuse conditions that continue despite appropriate care are an indication of leg length discrepancy (LLD) in an individual. 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 or 2) functional factors. 1) Structural factors relate to an actual difference in the length of the femur/tibia. 2) Functional relates 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:
Functional LLD can be caused by:
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.
Podiatrists are trained to differentiate whether an individual is affected by structural or functional LLD. Their knowledge in 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.
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. Podiatrists also encourage patients to participate in Yoga/Pilates to reduce tightness around the hips and lower back to improve individual’s clinical somatics. If the LLD is greater than 3cm then surgery can be considered by onward referral to Orthopaedics.
All in all, LLD are common and should not be ignored. If you feel you or a family member has a leg length discrepancy or has chronic back pain then seek advice from a Podiatrist today. I feel as a clinician that too many people accept the fact that they have chronic back pain, feel unable to take time off from work to recover and learn to live with chronic pain. Lower back pain may be from poor posture, hereditary or from multiple pregnancies but why haven’t we considered LLD? Pain is an indicator that something is wrong and must not to be ignored. Your health is your wealth and so make it a priority in your life today.
Author: Podiatrist Kerry SEAMAN