Leg Length Discrepancy & Structural Short Leg
What is a Structural Short Leg?
Leg length discrepancy (LLD), sometimes referred to as a structural short leg, occurs when one leg is anatomically shorter than the other. If you have noticed that one leg seems shorter than the other, an examination can help determine whether there is a true structural difference or an apparent difference related to other factors.
A structural short leg should be distinguished from a functional short leg, where the leg bones are equal in length, but they appear to be different when you are lying on your back or stomach.
Causes of a functional short leg can include muscle tightness or shortening of muscles that pull the leg up towards the spine, joint misalignments, and rotation of the pelvis.
What are the Causes of a Structurally Short Leg?
- Congenital conditions a person is born with
- Growth differences between the right and left leg and/or thigh bones
- Fractures in the leg or thigh bones
- Osteoarthritis in the knee or hip
- Rheumatoid arthritis of the hip
- Legg-Calvé-Perthes disease (disruption of blood flow to the femoral head)
- Bone infections or tumors
- Total knee or hip arthroplasty (replacement)
- Fixed flexion contracture of 15 degrees or greater of the hip or knee
- Partial paralysis
What are the Potential Consequences of Having a Short Leg?
- Limping and gait abnormalities
- Difficulty balancing
- Pain when standing and walking
- Knee pain and meniscal degeneration
- Hip, thigh, and gluteal muscle pain
- Pelvic rotation, tilting and sacroiliac dysfunction and pain
- Scoliosis (curvature of the spine)
- Altered vertebral positioning and restrictions in motion
- Chronic back pain
- Sciatica
- Acceleration of spine osteoarthritis (degenerative disc and joint disease and potential related nerve compression with age)
- Acceleration of knee and hip osteoarthritis development
- Sport and activity injuries due to asymmetrical forces
- Headaches and jaw pain
- Ongoing pain, limp, and delayed healing after knee or hip replacement surgery
- Implant dislocation
- Aseptic loosening of a replaced hip and joint instability
- Significant patient dissatisfaction following replacement surgery
Do I Need to Wear a Heel Lift or Orthotics for a Short Leg?
When assessing a possible short leg, Dr. Horowitz examines several factors rather than relying on a single measurement.
The need for a heel lift can be determined in the clinic by applying lifts of different heights under the short leg, and checking for levelling of the leg bones. It is a simple, low-cost method that can quickly identify potential discrepancies.
Our doctors will correct differences of over 3 mm when pain is ongoing, particularly if you also need custom orthotics.
A heel lift of up to 10 mm can be added to a custom orthotic. For higher amounts of correction, an external lift is usually added to the heel/sole of the shoe.
While you may be able to tolerate a short leg after surgery, even a 5 mm leg length difference is often enough to cause continued pain while walking and delay healing after surgery.
Rarely can a patient tolerate the full amount of correction that some X-rays suggest, and using the figures from X-rays often causes the leg to be corrected too much. Over time she has discovered:
- Leg length measurements differ when the feet are together versus apart
- Measuring thigh and leg bones with a measuring tape involves a large amount of potential error
- X-rays are not required in fitting patients for a heel lift for a short leg
- Inspecting two areas on the greater trochanters offers the best way to determine a true short leg
- Heel lifts of various heights can be used to determine can be used to determine the best height of a lift for levelling the leg bones.
- Patient feedback is considered in the clinic when trying on different heights of lifts. Your immediate feedback is important in finding the correct lift height. You can feel when a lift is too high.
The accuracy of a doctor’s ability to measure leg lengths varies depending on the clinician’s experience.
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