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At least 19 recordsLinked to original sources
PubMed2001

Management of leg length inequality.

Leg length inequality is common. Treatment objectives include obtaining leg length equality, producing a level pelvis, and improving function. Clinical assessment should include determination of a level pelvis with the patient standing using a set of blocks of various heights to estimate the amount of leg length inequality. Radiographic measures include the teleroentgenogram, orthoradiograph, and computed tomography (CT). A prediction of the ultimate leg length inequality at skeletal maturity will be needed to determine treatment. Our guidelines for treatment of leg length inequality are as follows: <2 cm--no treatment or a lift in the shoe; 2 to 6 cm--an epiphysiodesis or shortening procedure is considered; 6 to 15 cm--a lengthening procedure is considered. A leg length inequality of 15 to 20 cm--may require a staged lengthening, lengthening combined with epiphysiodesis, or amputation. Numerous complications of limb lengthening procedures occur frequently, even in experienced hands.

Bone Lengthening↗
PubMed1988

Rheumatic disease aspects of leg length inequality.

Inequality of leg lengths is associated with low back pain, greater trochanteric bursitis, and degenerative hip disease. The pelvic obliquity that results from a discrepancy of leg lengths may contribute to degenerative changes in the lumbar spine. The diagnosis of leg length inequality may be overlooked. If this occurs, extensive and costly investigations are then often ordered to evaluate these secondary manifestations of leg length inequality. This is unfortunate because a simple shoe lift is all that was needed to provide symptomatic relief for selected patients.

Back Pain↗
PubMed2005

Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance.

BACKGROUND: Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. METHODS: Online database--Medline, CINAHL and MANTIS--and library searches for the time frame of 1970-2005 were done using the term "leg-length inequality". RESULTS AND DISCUSSION: Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1). The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches approximately 20 mm (approximately 3/4"). CONCLUSION: Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

Journal Article↗
PubMed1991

Biomechanical implications of mild leg length inequality.

The effect of mild leg length inequality (lower extremity length difference less than 3 cm) on posture and gait has been the source of much controversy. Many opinions have been expressed both for and against the need for intervention to reduce the magnitude of the discrepancy. This paper emphasizes the need for accurate and reliable assessment of leg length differences using a clinically functional radiographic technique, and reviews the biomechanical implications of leg length inequality as related to the development of stress fractures, low back pain and osteoarthritis.

Biomechanical Phenomena↗
PubMed1992

Leg length inequality. Implications for running injury prevention.

Leg length inequality is a relatively common musculoskeletal malalignment related to structural, postural and environmental factors. The inequality is a plausible aetiological factor in the development of a variety of overuse injuries because it alters the magnitude and distribution of mechanical stress within the body. Leg length inequality has been linked with lower extremity stress fractures, low back pain, hip pain and vertebral disk problems of runners. The appropriateness of using inshoe lifts to reduce or eliminate the inequality has not been rigorously evaluated. Further research is needed to quantify the biomechanical effects of leg length inequality as it interacts with other factors related to running injury.

Athletic Injuries↗
PubMed1988

Clinical assessment and treatment of leg length inequalities.

Controversy persists regarding the significance of leg length inequality, the diagnostic approach to the use of heel lifts, and the implementation of proper orthopedic support in treatment of anatomical leg length inequalities. The purpose of this paper is to review the literature and formulate a sequential examination for a patient with leg length discrepancy, then outline a formula for the treatment of the patient. The initial problem a practitioner faces in examining a patient with leg length inequality is to determine if a true (anatomical) leg deficiency exists. Through a series of measurements and pelvic assessments, an effective screening process can be accomplished before radiography (scanogram) is required. An understanding of the mechanics along the kinetic chain, anywhere from the foot to the lumbar spine, coupled with the information gained from radiographs, can provide a treatment plan detailing the size of the lift and location.

Algorithms↗
PubMed1986

Leg length inequality after total hip arthroplasty.

Leg length inequality (LLI) in 55 patients with cemented total hip arthroplasty (THA) was measured from weight-bearing anteroposterior (AP) hip radiographs. The mean radiologic LLI was 8.7 mm in unilateral and 11.6 mm in bilateral THA, differing significantly from the clinically measured values (2.8 mm and 4.2 mm, respectively). LLI as a cause of aseptic loosening and unexplained pain warrants investigation in THA patients.

Adult↗
PubMed2005

Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part II. The functional or unloaded leg-length asymmetry.

BACKGROUND: Part II of this review examines the functional "short leg" or unloaded leg length alignment asymmetry, including the relationship between an anatomic and functional leg-length inequality. Based on the reviewed evidence, an outline for clinical decision making regarding functional and anatomic leg-length inequality will be provided. METHODS: Online databases: Medline, CINAHL and Mantis. Plus library searches for the time frame of 1970-2005 were done using the term "leg-length inequality". RESULTS AND DISCUSSION: The evidence suggests that an unloaded leg-length asymmetry is a different phenomenon than an anatomic leg-length inequality, and may be due to suprapelvic muscle hypertonicity. Anatomic leg-length inequality and unloaded functional or leg-length alignment asymmetry may interact in a loaded (standing) posture, but not in an unloaded (prone/supine) posture. CONCLUSION: The unloaded, functional leg-length alignment asymmetry is a likely phenomenon, although more research regarding reliability of the measurement procedure and validity relative to spinal dysfunction is needed. Functional leg-length alignment asymmetry should be eliminated before any necessary treatment of anatomic LLI.

Journal Article↗
PubMed2004

Preoperative leg-length inequality and hip osteoarthrosis: a radiographic study of 100 consecutive arthroplasty patients.

OBJECTIVE: To assess the leg-length inequality in patients with hip osteoarthrosis (OA) and to evaluate a possible association between the length disparity and side of OA. DESIGN AND PATIENTS: Weight-bearing radiographs of 100 consecutive patients undergoing arthroplasty for primary OA were examined and measured for inequality of leg length, pelvic tilt and severity of OA. RESULTS: The radiographic results showed that preoperatively OA occurred more frequently in the hip of the longer (84%) than the shorter (16%) leg. However, the development of OA did not show a linear relationship with the magnitude of leg-length inequality. CONCLUSION: As hip OA occurred more frequently in the longer leg the authors speculate whether leg-length inequality might predispose to OA in the hip of the longer leg.

Adult↗
PubMedDate not supplied

Hip adduction/abduction deformity and apparent leg-length inequality.

The amount of apparent leg-length inequality attributable to given angles of hip adduction/abduction has been expressed quantitatively. The inequality is related to the sine of the angle of adduction/abduction and the distance between the centers of the femoral heads. In a study of 50 adults, the mean figure for this distance in men and women was 18.6 cm. As a rough guide, each 10 degrees of deformity up to 40 degrees produce approximately 3 cm of inequality.

Adult↗
PubMed2005

Leg length inequality in total hip arthroplasty.

Postoperative leg length inequality after total hip arthroplasty frequently leads to medical liability issues because no standard exists regarding the acceptable disparity. Modular stems allow control of offset, independent sizing of the distal femoral anatomy, as well as proximal medullary sizing. The authors compared the restoration of leg length in two cohort protocols. In the 2001 cohort, tapered stems were exclusively used, giving priority to fit and fill of the medullary canal. In the 2004 cohort, porous-tapered stems, or an S-ROM modular stem (DePuy Orthopaedics Inc., Warsaw, Ind) when needed, were used based on preoperative templating to restore the center of femoral head rotation. Prior to and after surgery, length from center measurements were taken (center of rotation of the femoral head to the top of the lesser trochanter) and the vertical vector to compare the difference in actual leg length. In the 2001 cohort, the mean increase of length from center was 9 mm (7 mm leg length). In the 2004 cohort, 25% of the hips were inappropriate for tapered stems. S-ROMs were used because a tapered stem would lengthen the leg. In the standard offset tapered stem, the mean increase of length from center was 6 mm (4 mm leg length). In the high offset tapered stem, the mean increase of length from center was 7 mm (5 mm leg length). In the S-ROM stem with varying offsets, the mean increase of length from center was 6 mm (4 mm leg length). Only the S-ROM consistently avoids overlengthening in the majority of patients.

Arthroplasty, Replacement, Hip↗
PubMed1991

Leg length inequality in total hip replacement.

Clinical and radiographic leg length inequality and pelvic tilt were measured in the erect posture in 36 patients before and after total hip replacement. Good correlation was observed between clinical and radiographic evaluations of pelvic tilt, assessed as height difference between iliac crests. Intraoperative alteration of leg length correlated well with changes in pelvic tilt but not with changes in true radiographic leg length inequality. It is suggested that adjustment of leg length during total hip arthroplasty should aim at correction of preoperative pelvic tilt observed during clinical and radiographic examination. True leg length, assessed as the height of the vertex of the femoral or prosthetic head is misleading. It does not reveal functional leg length, which is determined not only by the true leg length but also by the position of the hip joint on the pelvic wall.

Adult↗
PubMed1991

Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable.

Leg-length inequality was measured from radiographs at the level of the vertices of the femoral heads in 247 men and women aged 35-54 years. Of these, 53 had never had any low-back problem, but they had considerable variation in leg-length inequality (mean SD, 5.5 +/- 4.1 mm; range, up to 20 mm). This group of symptom-free individuals did not differ from a group of 78 persons who had disabling low-back pain (LBP) during the previous 12 months (mean SD, 5.3 +/- 4.0 mm; range, up to 17 mm). The adjusted relative risks (odds ratios) of having LBP ever and of disabling pain during the last 12 months were 0.78 (95% confidence interval, 0.43-1.17) and 1.02 (0.68-1.38), respectively, for an increase of 5 mm in leg-length inequality. The results from this study make an association between mild leg-length inequality and LBP questionable.

Adult↗
PubMed1995

Clinical significance of leg-length inequality after total hip arthroplasty.

Sixty-eight patients were interviewed and examined after total hip arthroplasty (THA) to determine the clinical consequences (patient satisfaction, shoe lift use, gait abnormalities, etc) of leg-length inequality. No patient met clinical or radiographic criteria for revision THA. Minimum follow-up was 2 years, and average follow-up was 6.6 years (range, 2 to 20.5 years). A questionnaire, with specific questions about leg-length inequality, was completed by each patient. Leg-length inequality was determined by orthoroentgenography and compared with clinical measurements of leg length. The average inequality in this series of patients was 9.7 mm. A significant number (32%) of patients were aware of this inequality; the average leg-length inequality in this group was 14.9 mm. More than half of these patients were disturbed by the inequality. The magnitude of leg-length inequality closely correlated with awareness of the inequality, abnormal gait, use of ambulatory assistive devices, the need for a shoe lift, prior leg-length inequality, and revision THA. Clinical measures of leg-length inequality correlated poorly with values determined orthoroentgenographically. The high rate of dissatisfaction among patients with a leg-length inequality and the untoward results associated with this inequality indicate that surgeons performing THA should familiarize themselves with a reliable method for equalizing leg lengths intraoperatively.

Adult↗
PubMedDate not supplied

Leg length inequality measured by ultrasound and clinical methods.

Leg length inequality (LLI) was determined by ultrasound and two clinical methods in 100 subjects without previous disorders of the lower extremities. The mean LLI by ultrasound was 4.1 mm (range: 0-16 mm). An LLI of 10 mm or more was found in 4% of the subjects. The mean inter-observer variation by ultrasound was 0.9 mm (range: divided by 5-8 mm), which was significantly less than that obtained by clinical methods. The 95% confidence interval of inter-observer variation (+/- 2 SD) by ultrasound was +/- 5 mm and this interval is assumed to represent the accuracy of the method. Because LLI measurement by ultrasound is more reliable than clinical methods, ultrasound is recommended for routine use in clinical practice.

Adolescent↗
PubMed1998

Reliability and validity of rigid lift and pelvic leveling device method in assessing functional leg length inequality.

Clinicians commonly include an assessment of leg length inequality (LLI) as a component of a musculoskeletal examination. Little research is available, however, documenting reliability and validity of clinical methods for assessing LLI. The purpose of this study was to determine the reliability and validity of assessing functional LLI using a pelvic leveling device. Subjects were 19 women and 13 men between the ages of 18 and 55 who reported having a diagnosed or suspected LLI. Clinical determination of LLI was made by placing rigid lifts under the suspected shorter lower extremity until the leveling device indicated that the iliac crests were level. This measurement was made twice by one investigator and once by a second investigator. Standing radiographic measurements of LLI using rigid lifts were used to establish validity of the clinical method. Intraclass correlation coefficients [ICC(2,1)] and absolute difference values were computed to assess reliability and validity. The mean absolute difference between the two clinical measurements of LLI by the same investigator was 0.29 cm (+/- 0.52), with an ICC = 0.84. The mean absolute difference between clinical measurements of LLI by the two investigators was 0.49 cm (+/- 0.46), with an ICC = 0.77. The ICC and mean absolute difference reflecting agreement between radiographic measurements and clinical measurements of LLI was 0.64 and 0.58 cm (+/- 0.58), respectively, for one investigator and 0.76 and 0.55 cm (+/- 0.37), respectively, for the second investigator. The intratester reliability, intertester reliability, and validity assessments included instances in which paired observations disagreed regarding which lower extremity was the shorter lower extremity. Factors that may be associated with the unacceptable reliability and validity of the clinical assessment method include asymmetric positioning of the ilia, body composition of the patient, and design of the clinical instrument. The authors discuss clinical implications related to assessment of LLI.

Adolescent↗
PubMed1983

Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality.

A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low-back and/or unilateral hip symptoms and 359 symptom free subjects. Statistically highly significant correlations of the symptoms and leg length inequality were observed. In the majority (79 and 89%), the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity. When correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved in the majority of the cases. The unilateral symptoms associated with mostly unrecognized leg length inequality of 5 to 25 mm were, at least in part, due to the biomechanical responses, like bending and rotational forces, needed for compensation of the lateral imbalance caused by leg length inequality.

Adolescent↗
PubMed1988

Accuracy and precision of clinical estimation of leg length inequality and lumbar scoliosis: comparison of clinical and radiological measurements.

The results of 196 clinical determinations of leg length inequality and postural pelvic tilt scoliosis in 21 patients were analysed and compared with reliable radiological measurements. Clinical methods proved to be inaccurate and highly imprecise, the observer error being +/- 8.6 mm for direct and +/- 7.5 mm for indirect measurement of leg length inequality, and +/- 6.4 degrees for the estimation of postural lumbar scoliosis. More than half (53%) of the observations were erroneous when the criterion of leg length inequality was 5 mm. Failure to determine the presence or absence of length inequality of more than 5 mm occurred in 54 measurements (27% of the total). In 12% of the direct and in 13% of the indirect measurements, the observers erred in deciding which leg was longer; discrepancies occurred even when radiological reading gave a leg length inequality of as much as 25 mm.

Adult↗