Unequal leg length

Unequal leg length
A girl with a congenital, structural difference in leg lengths is walking in a clinic.
Classification and external resources
Specialty	rheumatology
ICD-10	M21.7
ICD-9-CM	736.81, 755.30

Unequal leg length (also termed leg length inequality, LLI or leg length discrepancy, LLD) is where the legs are either different lengths or appear to be different lengths because of misalignment.

Classification

There are two main types of leg length inequalities:

• Structural differences are caused by the legs themselves being measurably different in length, usually due to differences in the length of the femur in the thigh or the tibia and fibula bones in the lower leg. This may be a birth defect or it may occur after a broken leg, serious infection, or local damage to one of the growth plates in a leg.
• The other, more common, type is seen when the legs themselves are the same length, but due to neuromuscular injuries in the pelvis or upper leg, one leg or hip is held higher and tighter than the other (hypertonicity?) in the musculature of the pelvis or leg). These unequally tightened muscles cause the legs to seem to be different lengths, even though careful measurement would show equal lengths of the actual leg. This is called leg length alignment asymmetry (LLAA) and can be seen while lying down.^[1]

Treatment

The most common treatment for discrepancies in leg length is the use of a simple heel lift, which can be placed within the shoe. In cases where the length discrepancy is moderate, an external build up to the shoe is usually more comfortable. In severe cases, surgery can be used to make the longer leg shorter (or impede its growth), and/or make the shorter leg longer.

Measurement challenges

Although prone "functional leg length" is a widely used chiropractic tool in their Activator technique, it is not a recognized anthropometric technique, since legs are usually of unequal length, and measurements in the prone position are not entirely valid estimates of standing X-ray differences.^[2] Measurements in the standing position are far more reliable.^[3] Another confounding factor is that simply moving the two legs held together and leaning them imperceptibly to one side or the other produces different results.^[4]

Effect on Menstrual pain

Further research is needed on any corelation between unequal leg length and menstrual pain. However, as unequal leg length may contribute to a tilted pelvis, this may contribute to lower back pain.^[5]

A hypothesis is that the lower back pain caused by a tilted pelvis, easily may be mistaken for menstrual pain, as women with lower back pain experience increased pain during their periods.

References

1. Knutson G. A. (2005). "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry". Chiropractic & Osteopathy. 13 (12). doi:10.1186/1746-1340-13-12.
2. D W Rhodes, E R Mansfield, P A Bishop, J F Smith. The validity of the prone leg check as an estimate of standing leg length inequality measured by X-ray. J Manipulative Physiol Ther. ;18 (6):343-6
3. Hanada E, Kirby RL, Mitchell M, Swuste JM (Jul 2001). "Measuring leg-length discrepancy by the "iliac crest palpation and book correction" method: reliability and validity". Arch Phys Med Rehabil. 82 (7): 938–42. doi:10.1053/apmr.2001.22622.
4. Keeping Your Spine In Line, Adjusting the Joints, and Video, Alan Alda, PBS, Scientific American Frontiers. Video discusses Activator technique and leg length
5. Cooperstein R, Lew M (2009). "The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature". J Chiropr Med. 8: 107–18. doi:10.1016/j.jcm.2009.06.001. PMC 2732247. PMID 19703666.