The Indirect Method for Determining Leg Length Inequality

  1. Patient should be in an open backed gown and lower clothing loosened in order to view the spine, sacral dimples, iliac crests, shoulder level, and head tilt.
  2. Have the patient stand with their back to you, and their bare feet 8 inches apart.
  3. Place hands on top of iliac crests to help visualize unleveling. Determine if there is any unleveling of the sacral dimples. Place hands on the Greater Trochanters to determine any unleveling. Determine if there is a spinal curvature, shoulder tilt, or head tilt.
  4. If you have observed unleveling of the iliac crest, greater trochanters, or sacral dimples, have the patient fully suppinate both feet. If the greater trochanters, iliac crests, and sacral dimples are restored to level, then the leg length inequality if determined to be functional. If fully suppinating the feet does not correct the unleveling then the leg length inequality is determined to be structural.
  5. If structural leg deficiency has been determined then place about 2 layers of the Leg Inequality Measurement Pad under the foot of the low iliac crest.
  6. Recheck as in item #3.
  7. If some unleveling persists, continue adding or reducing layers of the Leg Inequality Measurement Pad under foot until you are satisfied with the iliac crest, greater trochanter, and sacral dimple level.
  8. Count the number of layers under foot and multiply by 3 mm. The result will be a very close estimate of structural leg deficiency, and the total amount of heel lift, foot lift or combination foot/heel lift required.
  9. If you note severe pelvic asymmetry, then a radiograph of the lumbar spine, pelvis, and femur heads is recommended. View How to Determine Whether a Heel Lift is needed.

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