Another, complaint is the patient starts to notice a difference in their gait. They feel they’re walking differently than they have in the past.
What is Limb Length Discrepancy?
Limb length discrepancy is where one leg is shorter than the other. It’s actually more common than not to have a slight difference in the length of your legs. Most differences in the length of legs is not significant enough to cause symptoms. Our body has a tremendous way of trying to compensate for a difference in limb length discrepancies. One of the most common ways the body compensates, and it’s what I see most frequently, is an over pronation of the arch of the longer leg, and this will cause that asymmetrical look between your feet: one arch will be flat, and the other arch will have a normal height. Other ways the body tries to compensate is a slight dip in one of your shoulders, a slight tilt of your head or a slight curvature in the back.When I see a patient with the complaint of limb length discrepancy, I like to classify this condition into two groups: structural versus functional.
- Structural is where there’s a true difference in the length of the bones in your leg. if we measure the bones of each leg we will see a true difference in that length.
- Functional is not a true difference in the actual length of the bones. The patient feels as if one leg is longer shorter than the other. However, the length of the legs are indeed symmetrical. This feeling or symptom of limp length discrepancy is actually coming from the pelvic area with joint or muscle contractors or ligamentous laxity. Most functional limb length discrepancy I like to classify as a soft tissue issue within the pelvic region.
What Are the Causes of Limb Length Discrepancy?
There are many causes of limb length discrepancy, and they may be treated differently depending on the cause. Some of the most common ones are:- Congenital - which means the condition is present at birth
- Trauma - which is an injury to one of the bones in the leg
- Bone disease or tumor
- Neurological conditions, such as cerebral palsy, spasticity or paralytic disorders
- Prior surgeries such as total hip replacements or total knee replacements
What Are Treatment Options?
When providing treatment, it’s very important to determine if the limb length difference is a structural issue or a functional issue. To help determine this I use a very low-dose bone scan that measures from the hips socket down to the ankle joint. this bone scan measures to the millimeter so when I get the results, I know exactly how long the left leg is versus the right leg. If the results come back, and there is no true structural difference in the length of the leg bones, this patient will be diagnosed with a functional discrepancy. These patients I will typically send to a physical therapy office or chiropractic office to help them with this issue.If the results come back from the bone scan that the patient truly has a structural difference in the length of their legs and the patient is symptomatic, I will recommend treating that difference. There are many ways to treat this difference.
If the difference is less than 1 cm, I try to correct that difference from within the inside the shoe. The easiest way to try to adjust for the difference from inside the shoe is to purchase an extra depth shoe or added depth shoe. These shoes typically come with multiple layers of insoles whereas you can remove layers on the longer side and add those layers to the shorter leg. Another way to correct for your discrepancy within the shoe is to have a custom insert or orthotic made. We can simply add a full-length lift that goes from heel to toe on the shorter limb insert.
If the difference is greater than 1 cm, I will recommend treating that difference on the outside of the shoe. if we’re trying to correct for the limb discrepancy on the outside of the shoe, I typically will send my patient to a shoe cobbler with my prescription for the exact amount of lift to be added to the outside of the soul of the shoe.
You can find many different styles of added depth or extra depth shoes that will help you adjust for a structural limb length discrepancy here.
Written by
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com
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