What is Leg Length Discrepancy?

The term refers to a difference in length between the left and right leg. It may be developmental, as the human body is rarely symmetrical, or can be as a result of trauma (usually resulting in a shortening of the affected leg) or joint replacement (sometimes resulting in a lengthening of the affected leg).

Symptoms

The most common symptom is low back pain which results from the postural adjustment which occurs in this area as a result of the discrepancy. Other symptoms include hip pain and knee pain.

Treatments

Treatment is based on equalising the leg lengths which reduces the postural adjustment and the unequal stresses on the limbs and is achieved by the use of either:

• A heel elevator which is fitted inside the shoe

• An externally fitted shoe raise

The type of raise (internal or external) is dependent on the amount of shortening identified.

What is Spina Bifida – Hip?

Spina bifida means “split spine” in Latin. It is caused by the incomplete closure of the developing spine during early pregnancy. This leaves the spinal nerves exposed to damage. What causes this incomplete closure is unknown but it has been shown that use of folic acid reduces the incidence of Spina Bifida by up to 70%.

Symptoms

There are various symptoms which may include: Pain in the affected hip which may radiate to the thigh or knee, stiffness in the affected hip, a limp on the affected side, a leg length discrepancywhere the leg on the affected side appears shorter. In adults, if the shape of the head of femur does not completely re-form there may be a persistence of the leg length discrepancy and the hip may develop osteoarthritis.

Treatments

In children, orthotic treatment can be very involved and may require the use of:

• Weight relieving Knee Ankle Foot Orthosis to allow the child to walk without putting any load through the hip.

In adults, treatment will typically be to address theleg length discrepancy using:

• Shoe raise adaptation.

What is Osteoarthritis – Hip?

Osteoarthritis is often referred to as a “wear and tear” disease. It causes the smooth articular cartilage to become rougher and thinner. The underlying bone responds by thickening and growing outwards. The joint capsule also becomes thicker and inflamed.

Symptoms

Osteoarthritis affects 8.5 million people in the UK. It develops over time, causing joints to become stiff, painful and sometimes swollen. There may be pain in the groin, side and front of the thigh or buttock or even in the knee. If severe there may also be a leg length discrepancy.

Treatments

Though the degenerative changes cannot be reversed, there are Orthoses which can help reduce the severity of the symptoms. These include:

• Shock absorbing insoles

• Functional Foot Orthotics to control excess pronation which may be increasing hip pain

• Raised shoe adaptation if there is any leg length discrepancy associated with the osteoarthritis

Symptoms

Symptoms of ITBS include: Pain which is aggravated by running, pain over the outside of the knee, pain when bending or straightening the knee which is worse when pressure is applied to the sore area.

Treatments

The symptoms associated with ITBS can be aggravated by poor foot biomechanics associated with over pronation or over supination. Functional foot orthotics to restore/improve foot biomechanics can therefore be helpful.

Symptoms

Symptoms include: severe pain in the hip especially when attempting to move the joint, the leg on the affected side appearing to be shorter than the other leg, pain or numbness on the back of the thigh a deformed appearance of the affected hip joint.

Treatments

• Hip abduction brace will provide some mechanical restriction to joint movement as well as sensory feedback enabling the user to self-protect the joint.

Symptoms

There is usually severe pain at the hip and the injured leg will appear shorter and the foot will be turned out.

Treatments

Following medical treatment to address the injury:

• Raised shoe adaptation to address any resulting leg length discrepancy.

Symptoms

When detected at birth there may be stiffness in the affected hip and a “clicking” sound when the hip is moved. If left un-addressed a leg length discrepancy often occurs and in adults there may be osteoarthritis in the joint.

Treatments

• Raise adaptation to footwear to address the leg length discrepancy.

• Shock absorbing insole may assist in reducing pain associated with the impact of the heel striking the floor where arthritic changes have occurred.