Leg Length Discrepancy
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Leg Length Discrepancy Samedy Srors, CPO, P&O Lecturer
True Leg Length Discrepancy
Real different in skeletal length Measured from ASIS to MM
Apparent Leg Length Discrepancy
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
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 87 cm = 3 cm
Right Side T = 85 cm A = 90 cm
Left Side T = 82 cm A = 87 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.
Right Side T = 85 cm A = 90 cm
Pelvis remains tilted and spine curved. Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Right Side T = 82 cm A = 85 cm
Patient in standing. Spine deviating to short leg Scoliosis not allow compensation. Patient cannot stand this way!
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
3 cm block raised Pelvis level
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Trunk still deviates to short side. Patient may be uncomfortable or not able to stand this way!
Difference
5 cm raised block
T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
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
3 cm raised Straight spine Pelvis level But leg abducted
T = 85 cm 82 cm = 3 cm A = 90 cm 88 cm = 2 cm
Difference
3 cm raised block Legs in line with body, but tilt pelvis Unaffected leg appears short Buildups 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
Tilted pelvis Curved spine
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Left Side T = 82 cm A = 85 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
Legs in line with body Tilted pelvis Curved spine Buildup not enough
T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Difference
5 cm raised block
T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Leg in line with body Tilted pelvis Curved spine 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
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)
Left Side T = 84 cm A = 92 cm
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.
Q & A
True Leg Length Discrepancy
Real different in skeletal length Measured from ASIS to MM
Apparent Leg Length Discrepancy
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
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 87 cm = 3 cm
Right Side T = 85 cm A = 90 cm
Left Side T = 82 cm A = 87 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.
Right Side T = 85 cm A = 90 cm
Pelvis remains tilted and spine curved. Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Right Side T = 82 cm A = 85 cm
Patient in standing. Spine deviating to short leg Scoliosis not allow compensation. Patient cannot stand this way!
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
3 cm block raised Pelvis level
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Trunk still deviates to short side. Patient may be uncomfortable or not able to stand this way!
Difference
5 cm raised block
T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
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
3 cm raised Straight spine Pelvis level But leg abducted
T = 85 cm 82 cm = 3 cm A = 90 cm 88 cm = 2 cm
Difference
3 cm raised block Legs in line with body, but tilt pelvis Unaffected leg appears short Buildups 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
Tilted pelvis Curved spine
Difference T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Left Side T = 82 cm A = 85 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
Legs in line with body Tilted pelvis Curved spine Buildup not enough
T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Difference
5 cm raised block
T = 85 cm 82 cm = 3 cm A = 90 cm 85 cm = 5 cm
Leg in line with body Tilted pelvis Curved spine 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
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)
Left Side T = 84 cm A = 92 cm
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.
Q & A
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