Leg Length Discrepancy

Samedy Srors, CPO, P&O Lecturer

True Leg Length Discrepancy

Apparent Leg Length Discrepancy

Real different in skeletal length Measured from ASIS to MM

Different in appearance of the legs, whereby one leg looks longer or shorter than another. Measured from Umbilicus to MM

No fixed deformities of the hip, knee and spine
Patient lies supine. Pelvis level and legs in line with trunk Right Side T = 85 cm A = 90 cm Left Side T = 82 cm A = 87 cm

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 87 cm = 3 cm

•The pelvis tilts to short side, and •The spine must curve to
compensate.

When sitting, curved spine disappears!

3cm block under neath left leg Level pelvis Straight spine

Patient lies supine. If no hip contractor, easy to get legs in line with body. Pelvis remains tilted and spine curved.

Right Side T = 85 cm A = 90 cm

Right Side T = 82 cm A = 85 cm

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

Patient in standing.

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

Spine deviating to short leg
Scoliosis not allow compensation.

Patient cannot stand this way!

3 cm block raised

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

Pelvis level
Trunk still deviates to short side.

Patient may be uncomfortable or not able to stand this way!

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

5 cm raised block

Trunk upright
Pelvis not level Spine not straight
Patient stands comfortabl y

Patient lies supine. Leg is slightly abducted. Straight spine

Patient lies supine. Legs in line with body but spine curves.

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 88 cm = 2 cm

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 88 cm = 2 cm

3 cm raised

Straight spine
Pelvis level But leg abducted

Difference

3 cm raised block Legs in line with body, but tilt pelvis Unaffected leg appears short Build-ups is too big

T = 85 cm - 82 cm = 3 cm A = 90 cm - 88 cm = 2 cm

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 88 cm = 2 cm

2 cm raised block

Legs in line with body but pelvis tilts
Curved spine

Patient can stand comfortably with both feet on the ground

What shall we do?

Lie the patient in supine. Get the legs in line with body. Try to get the pelvis level, but do not allow leg abducted or adducted. Measure from umbilicus to bottom of the heel.

This produced apparent leg length discrepancy

USE THIS MEASUREMENT FOR BUILD UP!

Patient lying supine Leg slightly adducted.

Leg in line with body

Right Side T = 85 cm A = 90 cm

Left Side T = 82 cm A = 85 cm

Tilted pelvis
Curved spine

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

3 cm raised block

Straight spine and level pelvis
Slightly adducted leg
Patient cannot stand this way!

Difference
T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

Legs in line with body

Tilted pelvis
Curved spine Build-up not enough

Difference

5 cm raised block Leg in line with body Tilted pelvis Curved spine

T = 85 cm - 82 cm = 3 cm A = 90 cm - 85 cm = 5 cm

Both feet on the ground

Patient can stand comfortably with both feet on the ground

What shall we do?

Lie the patient in supine. Get the legs in line with body. Try to get the pelvis level, but do not allow leg abducted or adducted. Measure from umbilicus to bottom of the heel.

This produced apparent leg length discrepancy

USE THIS MEASUREMENT FOR BUILD UP!

Patient lying supine One leg is abducted

Legs in line with body

Right Side T = 85 cm A = 90 cm

Left Side T = 84 cm A = 92 cm

Curved spine
Tilted pelvis

Difference
T = 85 cm - 84 cm = 1 cm (left side is short) A = 92 cm - 90 cm = 2 cm (left side is long)

2 cm raised block (unaffected side)

Leg in line with body
Tilted pelvis Curved spine

Difference
T = 85 cm - 84 cm = 1 cm (left side is short) A = 92 cm - 90 cm = 2 cm (left side is long)

True LLD is real shortening of the skeleton. Apparent LLD is how a patient actually stands. Buildups should always be done following apparent LLD. Using pelvis to measure leg length in standing can only be done if no fixed contracture or scoliosis exist.

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