Detecting And Treating Leg Length Discrepancies

Author(s): 
By Mark A. Caselli, DPM, and Edward C. Rzonca, DPM

Chronic overuse problems that persist despite appropriate care are the hallmarks of a leg length discrepancy (LLD) in an athlete. While the symptoms associated with LLDs are diverse and, at times, vague and confusing, you should suspect limb length asymmetry when athletes have back or lower extremity complaints. Leg length asymmetries appear to be the third most common cause of running injuries and occur in 60 to 90 percent of the population.
In regard to classifying LLD, the two major categories are structural and functional. The one minor category is environmental.
Structural discrepancies result from an actual anatomic shortening of one or more of the bones of the lower extremity. This can occur from a growth plate injury during childhood or adolescence, fractures or genetic and acquired conditions that affect bone growth. Structural leg length differences can also result from spinal abnormalities such as scoliosis.
Functional leg length differences usually occur as a result of muscular weakness or inflexibility at the pelvis or foot and ankle complex. They include pelvic obliquity, adduction or flexion contractures of the hip, genu varum, valgum or recurvatum, calcaneovalgus, equinovarus and rearfoot pronation.
Environmental factors such as drainage crowns built into roadways, banked running surfaces, and excessive wearing of shoes can create a situation that mimicks a leg length difference. These environmental factors can also either accentuate or correct structural and functional length differences depending on how the athlete is running on a given surface.

Know The Compensations And Symptoms Of LLD
The spine, pelvis and lower extremity are all involved in the compensation of leg length asymmetry. Leg length asymmetry causes the center of gravity to be shifted to the short leg side. Most commonly, the compensations associated with limb length asymmetry include pelvic tilt (to the short side), lumbar scoliosis (convex to the short side), knee flexion (increased on the long side), genu recurvatum (on the short side), subtalar joint pronation (on the long side), and ankle plantar flexion and foot supination (on the short side).
The most common symptom associated with LLD is backache. Other symptoms affecting the lower extremity with a structural discrepancy usually appear first on the long leg side and include flank pain, arthritis of the knee, psoasitis, arthritis of the hip, patellar tendinitis, patellofemoral pain syndrome, plantar fasciitis, medial tibial stress syndrome and metatarsalgia. Symptoms affecting the short extremity include iliotibial band syndrome with lateral knee pain, trochanteric bursitis, sacroiliac discomfort, Achilles tendinitis and cuboid syndrome.
If the patient just has a functional LLD, the symptoms will usually appear on the short side first and include plantar fasciitis, medial tibial stress syndrome, patellofemoral pain syndrome, illiotibial band syndrome, ipsilateral sacroiliac discomfort with contralateral low back pain, and secondary psoasitis.

Comments

VERY HELPFUL, THANKS

P.Mitchel,C.Ped

If patient has a verified structural LLD of 6-8 mm, would you recommend orthotic height for the full 6-8 mm or 3-4 mm?

I have heard that many DPM's recommend half the height of LLD? Why or why not?

Thanks for the reply.

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