Evaluating and Treating Leg Length Discrepancy

Leg Length DeficiencyAn interesting article in Podiatry Management in September of 2006; a CME module, entitled “Evaluating and Treating Leg Length Discrepancy“.

Dr. Caselli makes several good points concerning structural limb length discrepancy and how to evaluate it, but there are a few points in which I would like to comment further.

He states that structural limb length discrepancy is present in 6 to 12 percent of the athletes that present with apparent leg deficiency, and that functional leg deficiencies are more common. In my experience, not only with athletes, but patients in general, structural leg deficiency was more prevalent than functional leg deficiency. Especially, patients with chronic back pain.

The article also discusses the direct and indirect methods of measuring leg deficiency. The consensus of many writers and researchers is the direct method is prone to error, is difficult to duplicate, and inter-examiner reliability is poor. In my opinion why do we even discuss it further? If it isn’t a valid test then it shouldn’t be taught in the schools any longer.

Dr. Caselli also states that a CT scan is the most accurate method of determining structural leg length. That is true, but it is not necessary in the majority of cases. After examination and ruling out a functional leg deficiency. A simple A to P standing x-ray, which includes the femur heads, the pelvis, and the 5 lumbar vertebrae, will give you a wealth of information as to the possible cause of the patients back pain problem. It will show you the amount of leg deficiency, pelvic unleveling, sacral unleveling, 5th lumbar unleveling, and the spinal angle. You should think of it as a blue print to help with restructuring.

The CT scan should be the next image of choice, following the plain A to P lumbo-pelvic (postural view), for those patients with extreme leg deficiencies of 2cm or more, and when it is necessary to determine if the deficiency is coming from the femur, or tibia and fibula.

If you have time, have a look at this article concerning the evaluation and treatment of leg length inequality. It may give you a few more tips on the evaluation of leg deficiency and its relationship with chronic back pain patients.

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