Use this search box to search our site





limb length discrepancy

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

--> limb length discrepancy

Contrary to popular belief and to findings in anatomy books, the human body is not symmetrical in appearance. One of the biggest potential problems in human asymmetry is when one leg is shorter than the other. Most of us are not symmetrical in regards to the length of our limbs. Limb length discrepancy (LLD) sometimes referred to as short leg syndrome is a problem of various origins which can lead to a multitude of problems.

In many situations this is a condition first noticed in adolescence. As the child begins to walk, the parents will notice what they perceive to be an abnormal gait. The initial complaint may be of flat feet particularly with one foot appearing flatter than the other.

short left leg

In other cases parents will state that their child experiences pain in one or both legs, severe enough to disrupt daily activities. This may be the classic "growing pains". There is some skepticism as to whether or not this is a real clinical entity. The thought here is that the osseus (bone) structures of the legs are growing at a faster rate than the corresponding muscles. Thus the muscles are over-stretched and therefore over worked in daily activity and pain ensues.

Most people have very small limb length discrepancies and probably will never require treatment as these differences are easily compensated for in gait. Obviously, the greater the difference in limb length the greater the potential for problems. In some individuals the difference in leg length will not become evident until later in life for the simple reason, the younger we are, the more adaptable the human body is to stresses placed on it and as we age we become less adaptable and then begin to experience the consequences of a limb difference.

Various authors offer up what they consider pathological limb length discrepancy. I have seen some claim that differences of as little as 6 mm particularly in athletes should be treated. Personally, I think there are too many variables involved to actually measure a difference that small.

It seems there may somewhat of a consensus that limb discrepancy of 1 to 1.5 cm in difference may be enough to cause gait issues and thus require treatment. The greater the difference in limb length, the greater the compensation needed to "equalize" the gait cycle.

HOW DO WE MEASURE LIMB LENGTH DISCREPANCY



Measuring the lower limbs can have a fair amount of error and inaccuracies and differ between two clinicians measuring the same patient. The most accepted method is for the patient to be lying supine (on their back). Using a steel tape measure, the length from the anterior superior iliac spine (the bony lump in front of your pelvis) to the lower part of the medial malleolus (the lowest part of the inside of your ankle) is measured. This is done on both limbs and any difference in length is noted.

A second method is to measure from the umbilicus (belly button) to the medial malleolus of each ankle.

The problem with each of these measurements is that they do not account for any discrepancy in the ankle joint itself or the foot.

An alternate method is to take radiographs of each limb, with the patient standing, and measure the difference on the x-ray itself.

The last consideration is whether or not the pelvis is level. Conditions such as scoliosis or severe muscle spasms can "lift" one side of the pelvis and create a relative limb length difference.

TYPES OF LIMB LENGTH DISCREPANCY



There are two main types of limb length discrepancies.

Structural or anatomical type. This is a true difference in length of either the femur (upper leg bone) or the tibia (lower leg bone) on one leg compared to the other. This difference may be congenital or post surgical such is the case in hip surgery where the operated side becomes shorter compared to the other limb. Trauma such as severely broken bones particularly where hardware has to be inserted may create an inequality.

short left leg

Functional As the name implies, this is due to a malfunction usually at the level of any of the joints from the hip down to the foot. A typical example would be someone whose one foot excessively flattens out resulting in a situation where that limb may appear shorter.

Both types of discrepancies may occur together making the actual cause more difficult.

Some authors refer to a third type of discrepancy known as environmental. This is the result of walking or running on uneven surfaces such as runners who run in the street which in most cases tend to be slightly "banked" for improved water drainage. A shoe that is more worn out on one foot compared to the other would also be another source of environmental limb length discrepancy. This type of diagnosis may be made in individuals who complain of foot or leg pain when doing certain activities, eg: running.

HOW DOES LIMB LENGTH DISCREPANCY CAUSE PAIN IN THE FOOT, ANKLE OR LEG



In anyone with a discernible limb length discrepancy this creates an abnormal placement of the foot when it hits the ground in the gait cycle which will lead to an abnormal motion in the pelvis. The body then tries to compensate resulting in movement that is not "normal" and this may lead to pain. Typical types of compensation may include excessive plantarflexion of the ankle (the foot pointed downwards) on the shorter limb. The foot on the shorter leg may also supinate in an effort to try and functionally lengthen the leg. This excess supination may lead to pain on the outside of the heel as well as the outside of the foot.

The foot on the longer leg will tend to pronate to functionally decrease the length of the limb. Also noted is forward displacement of the tibia forcing excessive knee flexion. A foot that excessively pronates causes more internal rotation in the lower leg compared to the uppper leg and the result is excessive torquing of the knee joint. Excessive pronation will cause excess pressure on the inside portion of the heel bone potentially creating conditions such as plantar fasciitis and tarsal tunnel syndrome.

Compensation is not limited to just the foot, but it all starts from there. Depending on the position of the foot as it plants itself on the ground other compensation may take place at the ankle, knee and hip joints as well as the lower back. The degree and nature of compensation varies from individual to individual and is affected by not only the degree limb length difference, but also age, sex, individual flexibility, body type including weight along with lesser variables.

Limb length abnormalities not only adversely affects gait, but can be evident in posture when simply standing primarily on the musculature of the lower extremity. Some of the conditions that may be the result of limb length discrepancy include the following:



HOW DO WE TREAT LIMB LENGTH DISCREPANCY



A person can exhibit a discrepancy in their limbs, either structural or functional and it may be nothing more than an incidental finding and as such may not require treatment, while others will have discrepancy and will be part of the source of their musculo-skeletal complaint. Unfortunately, there is no consensus as to how much limb length discrepancy is "too much" and so there are limited guidelines when to treat, other than when there is pain related to the condition.

People who are athletic as well as older individuals with a multitude of anatomical limiting conditions such as arthritis, previous hip surgery, or muscle weakness, where in essence they stress their bodies more, will tend to have lower tolerances to the amount of discrepancy they can get away with. In these situations the energy expended to perform even simple tasks such as walking is increased which makes these humans inefficient machines. Obviously, for an athlete that can be the difference between success and failure in their particular sport, while for an older individual it can make simple walking, going from point A to point B an arduous task.

Treating this condition, in most cases becomes one of trial and error. From an anatomical standpoint treatment may include:

  • stretching of tight muscle groups
  • strengthening of weak muscle groups
  • increasing range of motion in restrictive joints, both done with exercises and perhaps physical therapy.
  • heel lift- Once all anatomical deficiencies are addressed and resolved as well as possible, the next step is to add a heel lift to the shorter limb. This should be done in increments starting with a small heel lift possibly 1/8 inch. After a short period of time, perhaps two weeks, if symptoms have not resolved, adding another 1/8" would be advised. Continuing to add height until symptoms begin to resolve. Keep in mind, the added heel lift is usually done in conjunction with treatment on the actual painful area.

If the actual discrepancy is greater than 3/4 inches, a simple heel lift to accommodate the difference may not be the best option and in these cases a tapered heel lift or even an orthotic with a heel lift built into it may be necessary. Tapering the lift through the foot leads to better accommodation of the large difference in each limb.

The final point worth mentioning is that particularly in functional limb length discrepancies, ongoing evaluation is imperative because over time as the body "adjusts" itself from a combination of heel lift therapy and treatment of any anatomical defects, the size of the heel lift will need to be adjusted to reflect those changes as the limbs become closer to symmetrical.

Herman Tax DPM. Podopediatrics. Williams and Wilkins, Baltimore, MD, 1980

David Edward Marcinko DPM. Medical and Surgical Therapeutics of the Foot and Ankle. Williams and Wilkins, Baltimore, MD, 1992

REFERENCES

OrthoInfo

Children's Hospital of Philadelphia

Pediatric Orthopedic Society of North America



Want more information? CLICK HERE




translate page

ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


redithotics





I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis. Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown



Recent Articles

  1. Vitamin D impact on health

    Feb 06, 23 07:17 PM

    Researchers are suggesting that the effectiveness of Vitamin D in fighting and preventing disease is predicated on a persons body mass index (BMI). The thinner the person the greater the positive impa…

    Read More

  2. Foods to speed up healing

    Feb 01, 23 02:41 PM

    One of the best ways to help yourself heal faster after surgery is to eat well. Getting the proper nutrition will provide your body with the essentials it needs to promote healing. Here is a suggestio…

    Read More

  3. Cancer and Type 2 Diabetes

    Jan 25, 23 04:52 PM

    An article revealing that older type 2 diabetics have a higher incidence of cancer then non-diabetics. It is suggested that cancer may surpass CVD as the number one cause of death in older diabetics.

    Read More

  4. Does glucosamine or MSM reduce arthritis pain?

    Jan 22, 23 01:41 PM

    A good review of the possible benefits to taking glucosamine, chondroitin or MSM for arthritis. Always beware of the possible side effects of over the counter supplements.

    Read More

  5. shin splints

    Jan 18, 23 05:12 PM

    A great review on the various causes of shin splints, along with treatment options.

    Read More

  6. Whats new in skin cancer?

    Jan 15, 23 08:32 PM

    A presentation of newer skin protection combinations in an effort to better protect the skin from the hazards of sun exposure.

    Read More

  7. Causes and risk factors of warts

    Jan 14, 23 05:02 PM

    A good review of the causes of warts and protective measures you can take to prevent developing them.

    Read More

  8. Do chronic wounds need to be dressed daily?

    Jan 11, 23 02:18 PM

    Because of supply chain shortages as well as staffing shortages particularly during the pandemic, many institutions extended the time between dressing changes for chronic wounds. Is this really the be…

    Read More

  9. Food choices that raise your risk of type 2 diabetes

    Jan 08, 23 10:07 AM

    A good review of how blood sugars can become elevated and the harm that can do. Certain food groups have a tendency to raise your blood sugars and should be avoided.

    Read More

  10. Outcome stats from Scarf bunionectomy

    Jan 03, 23 03:04 PM

    The Journal of Foot and Ankle Surgery recently reported a meta analysis of outcomes in 1583 Scarf bunionectomies that met their inclusion criteria. Adverse events did not seem to be any better or wors…

    Read More