Both legs are not always exactly the same length. A difference in length between the right and left leg is sometimes barely visible or noticeable. Nevertheless, this has consequences for the musculoskeletal system.
Here you will find further information as well as selected specialists and centers for the diagnosis and treatment of a leg length difference.
Leg length discrepancy (ICD code: Q72.9) is the medical term for a difference in the length of the legs. The diagnosis and treatment falls under the treatment area of orthopaedics. The difference refers to the length of the legs from the hip to the foot.
It is estimated that 10 - 30 % of people have such a difference.
Normally proportioned skeleton with leg bones without a difference in length. This keeps the pelvis and spine in their physiological alignment and statics. Alexandr Mitiuc / Fotolia
As long as it is only slightly pronounced, there is no need for therapy. If the difference is only 1 to 2 millimeters, the body can easily compensate for the difference on its own.
Therapy is necessary if the difference between the legs exceeds a certain value. The following applies
Leg length differences in children often change in the course of their development. Nevertheless, they must be observed and checked regularly.
Many people are affected by a difference in leg length. No symptoms are to be expected with mild forms. The body can then still compensate for the difference.
With more severe forms, it is important to initiate the correct treatment quickly to avoid long-term damage.
The skeleton and musculoskeletal system with
are individual to each person. However, they always follow physiological, i.e. naturally healthy, principles. This includes the structure of the body via
Changes in joint positions, axial alignment and asymmetries have consequences for the entire system.
The effects can be serious, especially on the spine. With legs of different lengths, the pelvis shifts to the shortened side. It tilts from its horizontal position and a difference in leg length usually results in a pelvic obliquity. The pelvis is slightly higher on the longer leg side.
This also affects the spine. It curves sideways, resulting in mild or severe scoliosis(curvature of the spine).
Legs of different lengths can have various causes. There is a congenital and an acquired difference in leg length. A distinction can be made between two categories:
If a corresponding underlying disease is already present in the newborn, this is referred to as a congenital leg length difference. Examples of this are
Joint diseases or restrictions in joint mobility can also trigger the disorder
An acquired leg length discrepancy develops in the course of life. Causes can be
Leg fractures during growth can affect the cartilaginous growth plates of the broken bones.
Special bone cells are responsible for bone growth. Disorders can lead to the bone cells responsible for growth being more active in one of the legs than in the other. Excessive length growth can also result in different leg lengths. However, these often balance each other out spontaneously in the course of development.
Once length growth is complete, the organism no longer corrects the different leg lengths spontaneously. The habitual adjustments or misalignments of the spine and joints then continue.
The musculoskeletal system is under increased strain if there is a greater difference in leg length. The body has to compensate for the differences in length. This causes the hip area and the spine to shift. The tilt and rotation of the pelvis is compensated for by an increased forward curvature of the spine (lordosis).
In many cases, a shoulder tilt occurs on the side of the body on which the leg is longer. The head also often leans sideways towards the short leg.
Pain often occurs at the transition from the lumbar spine to the sacrum. Other possible complaints are
On the right a healthy spine, on the left a laterally curved spine (scoliosis) due to a leg length discrepancy © Koterka Studio | AdobeStock
A serious consequence of a leg length discrepancy can be the development of scoliosis (curvature of the spine). It develops when the hip bone is displaced due to the leg length discrepancy. The spine must curve to the left to allow the head to stand up straight.
This process can have serious consequences. There are small joints between the bony vertebral processes. These can become misaligned if the vertebrae bend against each other. This is referred to as a facet joint blockage. Possible consequences are
The sacroiliac joints are located in the pelvic area. These are the two joints to which the sacrum is attached in the pelvic ring. These can become misaligned. This severely impairs mobility in the pelvic area.
The two pubic bones can also be painfully affected.
Anatomical structure of the hip joint © Henrie / Fotolia
A large and permanent difference in leg length leads to changes in posture. The spine is permanently impaired. The vertebrae and intervertebral discs wear out more quickly due to the curvature and the risk of osteoarthritis is increased.
The doctor uses a physical examination to determine whether the pelvis and spine are crooked. To do this, he palpates the iliac crests and the spine.
The doctor also measures the length of the legs with a measuring tape. He places it on a palpable bump on the bone of the thigh at hip level. The length is measured up to the outer ankle.
An X-ray or ultrasound(sonography) provides a more precise picture. An exact analysis can be carried out using three-dimensional spine measurement. This allows the extent of the spinal curvature and pelvic misalignment to be determined. A special video procedure is used for this.
A computer can then be used to calculate the height at which the foot orthosis needs to be made. This foot orthosis is used to compensate for the difference in leg length.
The diagnostic process must identify whether there is an actual difference in leg length or whether it is a functional form. In principle, a functional difference in leg length is treated differently to an anatomical leg length difference.
Depending on the form and cause of the leg length discrepancy , treatment approaches are either
Functional leg length discrepancy is often treated with physiotherapy and intensive soft tissue treatment. In some cases, soft tissue surgery is also indicated.
In the case of anatomical leg length discrepancy, orthopaedic insoles are often sufficient for correction. The earlier the diagnosis is made, the greater the chances of success in correcting the leg length discrepancy. Insoles raise the shorter leg and allow the pelvic obliquity to be straightened.
The effect of orthopaedic shoes is due to the heel elevation, which can compensate for up to 12 cm.
If the difference is very pronounced, various orthopaedic interventions can be used.
In adolescents in the growth phase, for example, the growth of the longer leg can be slowed down with a minimal intervention. The growth plate in the leg must still be open, so this method is no longer possible once growth is complete.
There is another effective methodonce length growth is complete. Using a special surgical technique, the shorter leg can be slowly lengthened. This lengthens it by around one millimeter per day.
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