What is Leg Length Discrepancy (LLD)?
Leg length discrepancy, refers to a difference in limb length. It is actually a common occurrence as most of us are not fully symmetrical. We tend to be more dominant and have stronger muscles on one side of the body.
When does LLD become an issue?
For most people, a mild LLD does not cause major issues as the body is able to compensate for the difference. However, if the body mechanics are not aligned well, over or under compensation may occur and lead to symptoms such as:
- Aches or pains on the lower back, hips, knees, ankle or foot
- Tight muscles on one side
- Poor balance, tendency to trip and fall
- Bending of one knee when standing
- Difficulty standing for prolonged periods
- Uneven gait, drop in shoulder or hip on one side
What causes LLD?
Leg length discrepancy has many causes, which include:
Congenital: With congenital cases, a leg length discrepancy occurs at birth, and it increases progressively over time.
Developmental: The leg length difference may be caused by illness or a growth plate injury, where the discrepancy becomes more apparent as the injury or illness slows the growth of one leg.
Post-traumatic: Fractures and other traumatic injuries to the bone may heal incorrectly, causing one leg to be shorter than the other.
Post-surgery: Surgeries such as hip replacements, knee replacements, or foot and ankle reconstruction may result in a leg length difference.
Bone tumours: Both bone tumours and the treatments involved can affect bone growth. The impact is particularly noticeable if the illness happens in infancy.
Neuromuscular conditions: Conditions such as Poliomyelitis, Cerebral Palsy often lead to LLD.
Structural Malalignment: For people with musculoskeletal conditions such as Scoliosis or flat feet, compensation mechanisms may lead to development of LLD.
How is LLD diagnosed?
Our experienced podiatrists will conduct a series of assessments to measure your limb length using various bony prominent landmarks from your hips to the feet, whilst correlating that with examining how you walk to check for compensation mechanisms during gait. A thorough biomechanical evaluation also includes the assessment of the alignment of your spine, knees, ankles and feet joints.
How can a Podiatrist help?
Our highly experienced podiatrists will first determine if it is a structural or functional LLD, before advising on a customised approach to correct or reduce the leg length difference, as well as address any existing symptoms. The management plan often includes a combination of the following:
- Heel raises or shoe lifts
- Prefabricated or customised insoles
- Footwear modifications
- Prescribed stretching and strengthening exercises
- Manual therapy to relieve muscle tightness or joint stiffness
For patients experiencing symptoms due to LLD, there are often muscular imbalances across the spine, hips, knees and feet. Conjoint management with our physiotherapists may be required to best correct alignment issues across multiple parts of the body. Our physiotherapists will assess the flexibility and muscle strength around the affected areas, and advise on the appropriate treatment, which includes a combination of manual therapy, exercises, ultrasound or shockwave therapy, or sports taping. In certain cases, especially in young children, constant monitoring of the LLD and making adjustments to the applied corrections accordingly is crucial in achieving long term positive outcomes.