Leg length difference

Synonyms in the broader sense

Leg length difference, Pelvic inclination
Investigation of the leg length difference in Frankfurt

English: different leg lengths

definition

A leg length difference means a different length of the legs. This phenomenon affects almost a third of the population and can go undetected for a lifetime. If there are major differences, however, problems can arise for those affected.

Medicine describes a difference in length of the lower extremity from the hip to the foot as a leg length difference. A distinction is made between the real leg length difference and the anatomical leg length difference. There is a difference in bone length. There is also the functional difference in leg length. This occurs due to contractures (loss of length) of the muscles and the ligamentous capsule apparatus or the misalignment of individual joints. The therapies for anatomical and functional leg length differences are different.

The functional leg length discrepancy is not treated with surgical limb lengthening. In addition to intensive soft tissue treatment, it may also require surgical soft tissue surgery. The anatomical difference in leg length can be caused by lack of, delayed or accelerated growth. Furthermore, an existing leg length difference can be corrected conservatively with orthopedic custom insoles. A differential diagnosis using a Treadmill analysis is advisable.

root cause

Congenital / congenital malformations are initially considered to be the cause of an anatomical difference in leg length. The congenital growth disorders are called osteochondrodysplasias. The disturbance in this group of diseases can be localized in the epiphyses, metaphyses, periosteally or endostally. This leads to reduced or increased bone growth. Tumorous or tumor-like diseases of the lower extremity can also lead to an anatomical difference in leg length. Bacterial and non-bacterial inflammation can lead to a breakdown of bone mass and thus also represent a cause. Neuro-orthopedic diseases that are associated with paralysis can affect the supply of the bones and thus their growth. The most common cause of anatomical difference in leg length is the injury (trauma) of the lower extremity. These include broken bones (Fractures) and injuries to the growth plate (Epiphysis). Other causes can be systemic diseases, which involve altered metabolic processes, and radiation after cancer.

Symptoms

If the leg length difference is greater than 6-10 mm, the affected person will experience the first symptoms. Since one leg is longer than the other, the hip tilts to the side with the shorter leg and the hip axis is inclined. This can cause problems and pain when standing and walking, and it can also affect the spine.

The affected person compensates for the difference with a curvature of the lumbar spine, which in the long run manifests itself in pain and causes a limp in the gait. The oblique hip axis also affects the shoulders when standing straight, which also slope towards the side of the shorter leg. In order to compensate for the crooked shoulders, the head is often tilted to the side at the same time.

In growing children, the occurrence of leg length discrepancies is not uncommon and should be observed first and foremost.

Possible consequences of a difference in leg length

The basin is Key point all movements that involve walking and standing. They anchor the legs to the trunk and are firmly connected to the lumbar and sacral spine, which ensure stability in the middle of the body. If one leg is longer than the other and the pelvis is permanently tilted, this affects normal posture. By trying to compensate for the difference through the muscles, tension arises in the cervical or lumbar spine, which even extends into Headache or jaw pain can express. Through the Bad posture in the spine, in addition to pain, it comes to faster wear the vertebral joints and intervertebral discs. In the worst case, the curvature of the spine can progress to scoliosis. Often those affected unconsciously compensate.

Then a putting greater strain on the toes of the shorter leg to be watched. The longer the leg length difference persists, the more one can notice a functional restriction in leg and hip mobility. Since the cartilage of the joints is also stressed differently by the different loads, there is uneven wear of the cartilage. Osteoarthritis can be a long-term consequence.

Appointment with a hip expert?

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

How can you measure a leg length difference?

At the hip joint, depending on the leg length difference, there is an inequality in the femoral head covering. The femoral head is roofed more closely on the side of the shorter leg by the acetabulum, which increases the angle between the femoral shaft and the femoral neck. This can be made visible when measuring the leg length difference.
This relieves the hips on this side. An additional relief of the hip joint on the side of the shorter leg is achieved by the fact that the upper body is shifted more to the side of the shorter leg when the limb is shortened, and the lever arm of the body's center of gravity or the load arm is shortened.

On the longer side, there is a functional change in the angle of the hip joint (Coxa valga) by reducing the angle between the thigh shaft and femoral neck with increased stress and increased Arthritis risk. From the hip splitters (Abductors) must because of the increase in the distance from the origin and attachment of the Muscles more muscle work can be done. This can lead to chronic bursitis (Bursitis) because the pelvic shin tendon plate (Iliotibial band) increased on the large rolling hill (Greater trochanter) presses. The muscles are influenced by differences in leg length. Electromyographic (Electromyography) Measurements show that even a slight difference in leg length of one to two centimeters leads to increased asymmetrical muscle activities in the various muscle groups on the trunk and lower extremities. Muscle fatigue pain can be felt subjectively.

There is increased inflammation of the tendon attachments (Tendinopathies) at the insertion and origin of the large lumbar muscle (Iliopsoas muscle), on the small rolling hill (Lesser trochanter) and on the transverse processes of the lumbar vertebrae, as well as at the origin of the Adductors on the pubic bone. Once massive degenerative damage has established itself, corrective surgery of whatever kind usually comes too late. The psychological stress on the patient due to the changed gait pattern is also a problem that should not be neglected. There are various clinical measurement options for measuring the leg length difference. Two measuring points are often determined, the large rolling hill (Greater trochanter) and the outer ankle (Lateral malleolus). A tape measure is placed between these points and the length is read off in centimeters. In addition there is the radiological measurement, where the bone length can be measured exactly. Therapy is either conservative with a shoe lift or surgically. In order to be able to get exactly one possible leg length difference, you should have a possible leg length difference measured. More about this under Running analysis Frankfurt.

therapy

A slight difference in leg length rarely leads to discomfort, as it is well compensated. A slight inclination of the pelvis is usually hardly noticeable.
But it can also have a shortening limp and a compensatory spinal curvature (Scoliosis) cause. Individual care of insoles is advisable. About 66% of the population have a leg length difference of less than one centimeter. A greater difference in leg length can have serious consequences for the muscular and skeletal systems. This is followed by a pelvic inclination and a curvature of the lumbar spine (Lumbar scoliosis) to compensate. In later stages this can cause a counter-curvature of the thoracic and cervical spine (cervicothoracic scoliosis) consequences. In 90% of all cases, these incorrect curvatures of the spine (scoliosis) fix and remain. To compensate for the difference in leg length, an equinus foot position is created on the shorter side and the knee on the longer side is bent. The consequences of the difference in leg length are incorrect loading of the spine and hip joint. Especially in the lumbar spine there is increased wear of the intervertebral discs, increased formation of bone mass (osteophyte formation) and osteoarthritis of the small vertebral joints (Spondylarthrosis).

Read more on the topic: Pelvic inclination

Deposits to compensate for the difference in length

A leg length difference does not always have to lead to the consequences mentioned above such as scoliosis or chronic loin pain. If it is recognized early, it can be improved by simple means. The best therapy should be determined together with an orthopedic surgeon.

Different insoles are used depending on the degree of difference. These raise the shorter leg and straighten the inclined pelvis. Also a orthopedic shoe with an increase in heel is often used. Up to 12 centimeters difference can be compensated for with an inner shoe on the shorter leg by placing the foot in Equinus position is brought.

In the case of greater differences, there are various orthopedic interventions that can be carried out Intramedullary nailing a leg extension or by one Fixator external leg shortening. An unconscious equalization of the leg length difference is brought about by walking on the toes and twisting the spine.