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Leg Length Discrepancy: Causes, Symptoms & Treatment
Leg length discrepancy occurs when one leg is shorter than the other. It can cause pain, postural problems, and gait abnormalities if left untreated.
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Leg length discrepancy occurs when one leg is shorter than the other. It can cause pain, postural problems, and gait abnormalities if left untreated.
What Is Leg Length Discrepancy?
Leg length discrepancy (also known as leg length inequality or anisomelia) is a condition in which the two legs of a person are of unequal length. Even small differences of a few millimetres can have long-term effects on posture, gait, and the musculoskeletal system. Medically, a distinction is made between a true (structural) leg length discrepancy, which involves an actual difference in bone length, and a functional leg length discrepancy, which is caused by pelvic tilt or muscular imbalances rather than a true bony difference.
Causes
The causes of leg length discrepancy can be divided into congenital and acquired forms:
Structural (True) Leg Length Discrepancy
- Congenital malformations (e.g., hip dysplasia, fibular hemimelia)
- Fractures during childhood affecting the growth plate
- Bone diseases (e.g., Legg-Calve-Perthes disease, osteomyelitis)
- Surgical procedures such as joint replacement (hip or knee prosthesis)
- Bone tumors
- Inflammatory diseases (e.g., juvenile rheumatoid arthritis)
Functional Leg Length Discrepancy
- Pelvic tilt due to muscular imbalances or poor posture
- Scoliosis (lateral curvature of the spine)
- Tightness or shortening of hip and pelvic muscles
- Foot deformities such as flatfoot or valgus foot
Symptoms
Symptoms depend on the degree of the discrepancy. Small differences (under 1 cm) are often well tolerated, while larger differences can produce significant complaints:
- Limping or an asymmetrical gait pattern
- Back, hip, or knee pain
- Pelvic tilt and spinal malalignment
- Muscle tension in the lumbar and pelvic region
- Premature wear of joints (osteoarthritis)
- Discomfort when standing or walking for extended periods
Diagnosis
Diagnosis is established through physical examination and imaging studies:
- Clinical examination: Measurement of leg length while lying down (from the anterior superior iliac spine to the medial malleolus) and while standing (assessing pelvic tilt using calibrated blocks)
- X-ray: Full-length standing radiograph of both legs for accurate bone measurement
- MRI or CT scan: When structural causes such as tumors or growth plate damage are suspected
- Gait analysis: To assess functional consequences of the discrepancy
Treatment
Treatment depends on the underlying cause, the magnitude of the difference, and the age of the patient:
Conservative Treatment
- Shoe lift or orthotic insoles: Often the first-line treatment for discrepancies of up to approximately 2 cm; functionally compensates for the length difference
- Physiotherapy: To correct muscular imbalances, improve strength, and retrain posture
- Osteopathy and manual therapy: Supportive treatment, particularly for functional discrepancies
Surgical Treatment
- Epiphysiodesis: Controlled growth arrest at the longer leg in children and adolescents
- Callus distraction (bone lengthening): Gradual lengthening of the shorter bone using an external fixator system (e.g., the Ilizarov method)
- Bone shortening: Surgical shortening of the longer bone in adults
References
- Hefti, F. - Pediatric Orthopedics in Practice, 2nd Edition, Springer Verlag (2007)
- Moseley, C.F. - Leg Length Discrepancy, in: Morrissy R.T., Weinstein S.L. (eds.) - Lovell and Winter's Pediatric Orthopaedics, 6th Edition, Lippincott Williams and Wilkins (2006)
- Gurney, B. - Leg length discrepancy, Gait and Posture, 15(2):195-206, Elsevier (2002)
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