Leg length discrepancy is a condition where the length of one leg is different than the other (shorter or longer) because of either or both a functional (muscle/posture) or structural (bone/cartilage) abnormality. In the specific a functional leg length occurs when your legs are the same, but another condition such as pelvic tilt or piriformis shortening creates the appearance of one leg being longer or shorter than the other. A structural leg length inequality it means that there is a true difference. Osteopaths, chiropractors and physiotherapist should be able to determine the degree of leg length inequality using visual inspection and manual tests.
Causes

1.Neuromuscular

2. Trauma

Signs & Symptoms
The patient/athlete may present with an altered gait (such as limping) and/or scoliosis and/or low back pain.
Lower extremity disorders are possibly associated with LLD, some of these are:

Diagnosis
On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD.
–LLD in supine position–

The LLD should be measured using bony fixed points 
1. ASIS to medial malleoli
2. ASIS to knee joint line

X-Ray should be taken in a standing position. A full three exposure to a full spine film (divided in 3 sections). The osteopath, physiotherapist or chiropractor will look at:

Treatment/Management
Treatment of leg length inequality involves many different approaches, which vary among osteopaths, physiotherapist and chiropractor and whether the LLD is functional or structural. Thus is a combination of:

Hints.
Lift height should be built up gradually to allow body time to adapt to changes. Heel lift may reduce low back pain, scoliosis, improve weight distribution.
Athletes require a more precise and dynamic lift.
Orthotics, why do supinated or pronated foot influence leg length? (look at the figure below).

 

Dott. Emanuele Luciani
Osteopathphysiotherapist, hatha yoga teacher
Osteopath registered with the General Osteopathic Council (GOsC)
(number 8232http://www.osteopathy.org.uk/home/)
 "Centro Studi Tre Fontane"
Via Luigi Perna 51, Rome