What is the definition of a leg length difference (LLD)?
Also known as a limb length discrepancy, LLD is an asymmetry in length between the two lower limbs. This can be divided into structural and functional.

Structural LLD is an anatomical difference between the two sides primarily caused by bone related asymmetry. For example, your thigh bone (femur) may be longer on one side OR you have an abnormal spinal alignment due to scoliosis causing one side of the hip bone to sit higher.

Functional LLD is a biomechanical abnormality such as muscle weakness or inflexibility of the pelvis, foot or ankle joint that leads to a limb length difference. For example, contracture of the hip muscles, knocked knee and excessive rolling in can all be secondary to LLD.

What are the symptoms?
– Most common is backaches or lower back pain
– Pain in hip or knee joint
– Pain at knee cap
– Pain in outer thigh muscle (ITB muscle)
– Shin splints
– Forefoot pain
– Pain underneath heel or at the back of the heel

How does the body compensate?
– Gravity shift to the shorter side causing the pelvis to rise higher
– Back bend (spine convex) toward shorter side
– Knee bends at longer side while straightens on shorter side
– More rolling in of the foot on longer side
– Tilting out of ankle/foot of shorter side

What to do – treatments?
It is ‘gold standard’ to get a low dose X-Ray called a SCANOGRAM to exactly measure the LLD. However, the measurements can be done fairly accurately by a podiatrist during your Biomechanical Assessment which saves exposure to radiation. Treatments will vary depending on the cause of the limb length difference.

Treatments commonly recommended by a Podiatrist include:
– Specific exercises – address muscle weakness or tightness
– Heel raise – increase height of shorter side to level hips
– Orthoses – correct alignment, LLD and biomechanics affecting walking patterns
– Building up shoes – usually recommended for LLD greater than 10mm
– Changing footwear – improve support and shock absorption
– Referral if required – paediatrician, orthopaedic surgeon

Reference: https://www.podiatrytoday.com/article/1035

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