Leg Length Discrepancy: Myth or reality?



One of the most frequently cited causes of biomechanical dysfunction is leg length discrepancy (LLD). This is a condition found in more than 33.3% of the population worldwide.

This alleged problem is widely discussed in medical literature and it is re assuring to know that the attitude of the medical profession towards the “shorter leg” has evolved over the years.

After neglecting this diagnosis for years, doctors started to prescribe heel wedges for every case of tilted pelvis, and routinely, their diagnosis rested on the observation of the posterosuperior iliac spine. Although the immediate results were good, in the long term, they were disappointing.

Realizing that something was amiss, orthopedic surgeons will tell you that there is no need to correct a “shorter leg” under 1.5 to 2cm. To think that dentists work on a precision of microns…One would hope, that precision in regards to LLD, is a must!

 

Leg Length Discrepancy Measurement
Disharmonic feet

The first thing to know is that all classical measures are false: pubis to malleoli, greater trochanter to malleoli or iliac crest to malleoli. An articulacy constrain, such as a slight valgus of one foot and a varus on the other foot, will cause one side of the pelvis to rotate forward relative to the opposite side.

To assume that a difference in leg length means that there is an actual difference in the length of the bones (femur and/or tibia) is most of the time a mistake. Most often what we are seeing is an apparent, or functional LLD. This is usually the result of disharmonic feet.

 

Leg Length Discrepancy and X-Rays
The orthogonal projection in X-Rays does not take into consideration the rotary pivot and the heights of the femurs. A simple articulary constraint (asymmetrical feet) can cause an X-Ray to show a difference of several millimeters. Unless you know for certain that the length of one of your legs is different than the other, you should be skeptical of shoe lifts as the first line of treatment for injuries.

 

What should be used?
The most accurate and reliable technique of measure is frontal teleradiography of a subject in the standing position.
The angle between the feet should be of 30 degrees. The angle of the radiography tube should be of 15 degrees. And the patient should not be pressed against the plate.
To be accurate, it should be performed at a distance of 4 meters away from the body by measuring the diaphysis of each bone.
If any doubts remain with respect to possible rotations. The measurements should be from the base of the greater trochanter to the inter-condylicus incisures. Unfortunately, it is rarely done this way.

 

What are the causes of Leg Length Discrepancy ?
Leaving aside genetic and traumatic factors, the two legs should grow symmetrically. To believe that the two legs could grow at different rates would suggest that there is two different types of growth hormones. In fact, asymmetries observed in growth period are linked to postural disequilibrium described in Delpeche’s law: “ Any increased pressure on a limb will slow the growth of that limb” the opposite is also true, “any decrease in pressure will stimulate growth”.

Leg Length Discrepancy and children
In children, most cases of short leg are linked to excessive pressure on the lower limbs caused by a postural disequilibrium. It is important to be aware of your child’s posture habits, as they could be creating an imbalance that will cause them grief in the future. The first thing to do is to reprogram the postural system. By inducing permanent equilibrium, asymmetrical pressure will be reduced. When in doubt, refer to a Posturologist near you.

 

Symptoms of leg length discrepancy:
1) Meniscus ruptures
2) Herniated disk DDD
3) Lower back pain
4) Coxarthrosis (exposure of the femoral head)
7) Hip pain, always on the side of the short leg.

The Posturepro Team
Changing Lives

 


 

About Annette Verpillot

Annette Verpillot is the founder of Posturepro, a diagnostics company specializing in Postural Recalibration and neuromuscular restoration. From an early age, Verpillot participated in a multitude of sports from 100 meter sprinting to swimming to football, skiing and rock-climbing. This diversity in the field of sports enabled her to have a global vision and drove her to seek out the best treatments available for her clientele. At first, she focused on classic post-graduate education by taking courses on manual therapy. An incessant curiosity and ambition to find the answer to "what can I do better?" led her to associate herself with orthopedic surgeon Dr. Bernard Bricot. Since 2008, Verpillot has been working along the side of Dr. Bricot and has received special training in the education and development of Posturology. Annette has had numerous opportunities to teach Posturology to professionals and Strength Coaches and Neuro Muscular Densits at the prestigious Las Vegas Institute and Dawson academy, on the benefits of incorporating Posturology into their protocols. Today she is one of the most experienced and regarded Posturologists in North America. Annette Verpillot continues to address the various factors that come into play in achieving optimum results and to stir interest in and amaze professionals who have an open mind and who truly wish to help their patients.

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