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

BackgroundLeg-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.MethodsOnline 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 DiscussionUsing 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 ~ 20 mm (~3/4").ConclusionAnatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

[1]  J. Travell,et al.  The lower extremities , 1993 .

[2]  G. Cummings,et al.  Effect of simulating leg length inequality on pelvic torsion and trunk mobility. , 2000, Gait & posture.

[3]  J. Scholz,et al.  The Effect of Imposed Leg Length Difference on Pelvic Bone Symmetry , 1993, Spine.

[4]  B T Bates,et al.  Biomechanical implications of mild leg length inequality. , 1991, British journal of sports medicine.

[5]  J. Guichet,et al.  Lower limb-length discrepancy. An epidemiologic study. , 1991, Clinical orthopaedics and related research.

[6]  M. Cornwall,et al.  Leg-length discrepancy: effect on the amplitude of postural sway. , 1991, Archives of physical medicine and rehabilitation.

[7]  Specht Dl,et al.  Anatomical leg length inequality, scoliosis and lordotic curve in unselected clinic patients. , 1991 .

[8]  T O'Brien,et al.  Leg length discrepancy--an experimental study of compensatory changes in three dimensions using gait analysis. , 1999, Gait & posture.

[9]  L. Mol.  [Leg length inequality]. , 1977, Nederlands tijdschrift voor geneeskunde.

[10]  J. Kenwright,et al.  The influence on the spine of leg-length discrepancy after femoral fracture. , 1983, The Journal of bone and joint surgery. British volume.

[11]  R. Brand,et al.  Effects of leg length discrepancies on the forces at the hip joint. , 1996, Clinical orthopaedics and related research.

[12]  R H Gross,et al.  Leg length discrepancy in marathon runners , 1983, The American journal of sports medicine.

[13]  C. B. Burns,et al.  Reliability and validity of rigid lift and pelvic leveling device method in assessing functional leg length inequality. , 1998, The Journal of orthopaedic and sports physical therapy.

[14]  O. Friberg,et al.  Leg length asymmetry in stress fractures. A clinical and radiological study. , 1982, The Journal of sports medicine and physical fitness.

[15]  C. Goldsmith,et al.  Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial. , 1996, Journal of manipulative and physiological therapeutics.

[16]  D. Kushner,et al.  Determination of leg length discrepancy. A comparison of weight-bearing and supine imaging. , 1988, Investigative radiology.

[17]  E. R. Mansfield,et al.  The validity of the prone leg check as an estimate of standing leg length inequality measured by X-ray. , 1995, Journal of manipulative and physiological therapeutics.

[18]  J. L. Rau,et al.  Effect of Leg Length Discrepancy on Trunk Muscle Fatigue and Unintended Trunk Movement , 1997 .

[19]  J. Taylor,et al.  Lumbar Spine Structural Changes Associated With Leg Length Inequality , 1982, Spine.

[20]  V. Kapoor,et al.  Surgical treatment of limb-length discrepancy following total hip arthroplasty. , 2004, The Journal of bone and joint surgery. American volume.

[21]  M. Ylikoski,et al.  Leg-length inequality has poor correlation with lumbar scoliosis , 1989, Archives of Orthopaedic and Trauma Surgery.

[22]  J P Gofton,et al.  Studies in osteoarthritis of the hip. II. Osteoarthritis of the hip and leg-length disparity. , 1971, Canadian Medical Association journal.

[23]  U. Kujala,et al.  Lower limb asymmetry and patellofemoral joint incongruence in the etiology of knee exertion injuries in athletes. , 1987, International journal of sports medicine.

[24]  O. Friberg,et al.  Clinical Symptoms and Biomechanics of Lumbar Spine and Hip Joint in Leg Length Inequality , 1983, Spine.

[25]  角島 元隆,et al.  The effect of leg length discrepancy on spinal motion during gait : three-dimensional analysis in healthy volunteers , 2004 .

[26]  P. Komi,et al.  Gait asymmetry in patients with limb length discrepancy , 2004, Scandinavian journal of medicine & science in sports.

[27]  V. Hoikka,et al.  Leg-length inequality and low-back pain after Perthes' disease: a 28-47-year follow-up of 96 patients. , 1992, Journal of spinal disorders.

[28]  K. Hassanein,et al.  Joint moments in minor limb length discrepancy: a pilot study. , 1997, American journal of orthopedics.

[29]  S. White,et al.  Asymmetric Limb Loading with True or Simulated Leg-Length Differences , 2004, Clinical orthopaedics and related research.

[30]  U. Kujala,et al.  Factors predisposing Army conscripts to knee exertion injuries incurred in a physical training program. , 1986, Clinical orthopaedics and related research.

[31]  Gofton Jp.  Persistent low back pain and leg length disparity. , 1985 .

[32]  D. Specht,et al.  Anatomical leg length inequality, scoliosis and lordotic curve in unselected clinic patients. , 1991, Journal of manipulative and physiological therapeutics.

[33]  J. Taylor,et al.  Low-Back Pain Associated With Leg Length Inequality , 1981, Spine.

[34]  J. Travell.  Myofascial pain and dysfunction , 1983 .

[35]  Mannello Dm,et al.  Leg length inequality. , 1992, Journal of manipulative and physiological therapeutics.

[36]  J. Gofton.  Persistent low back pain and leg length disparity. , 1985, The Journal of rheumatology.

[37]  H. Sutton.  AN EPIDEMIOLOGICAL STUDY , 1937 .

[38]  Stuart L. Weinstein,et al.  Lovell and Winter's Pediatric Orthopedics , 1996 .

[39]  Burke Gurney,et al.  Leg length discrepancy. , 2002, Gait & posture.

[40]  P. Levangie.  The association between static pelvic asymmetry and low back pain. , 1999, Spine.

[41]  R. Siffert.  Lower limb-length discrepancy. , 1987, The Journal of bone and joint surgery. American volume.

[42]  L. Giles.  Lumbosacral facetal "joint angles' associated with leg length inequality. , 1981, Rheumatology and rehabilitation.

[43]  S. Subotnick.  Limb length discrepancies of the lower extremity (the short leg syndrome). , 1981, The Journal of orthopaedic and sports physical therapy.

[44]  M. N. Smith-Petersen,et al.  ARTHROPLASTY OF THE HIP , 1939 .

[45]  D. Riddle,et al.  Validity of derived measurements of leg-length differences obtained by use of a tape measure. , 1990, Physical therapy.

[46]  T. White,et al.  Arthroplasty of the hip. Leg length is not important. , 2002, The Journal of bone and joint surgery. British volume.

[47]  J. Parvizi,et al.  Surgical treatment of limb-length discrepancy following total hip arthroplasty. , 2003, The Journal of bone and joint surgery. American volume.

[48]  J. Juhl,et al.  Prevalence of Frontal Plane Pelvic Postural Asymmetry—Part 1 , 2004, The Journal of the American Osteopathic Association.

[49]  G. A. Knutson.  Incidence of foot rotation, pelvic crest unleveling, and supine leg length alignment asymmetry and their relationship to self-reported back pain. , 2002, Journal of manipulative and physiological therapeutics.

[50]  P. Sharkey,et al.  Clinical significance of leg-length inequality after total hip arthroplasty. , 1995, American journal of orthopedics.

[51]  Fisk Jw,et al.  Clinical and radiological assessment of leg length. , 1975 .

[52]  S Orava,et al.  Risk Factors for Recurrent Stress Fractures in Athletes , 2001, The American journal of sports medicine.

[53]  K R Kaufman,et al.  Gait asymmetry in patients with limb-length inequality. , 1996, Journal of pediatric orthopedics.

[54]  I Stokes,et al.  Scoliosis associated with limb-length inequality. , 1982, The Journal of bone and joint surgery. American volume.

[55]  Robert Robergs,et al.  Effects of Limb-Length Discrepancy on Gait Economy and Lower-Extremity Muscle Activity in Older Adults , 2001, The Journal of bone and joint surgery. American volume.

[56]  G. Cummings,et al.  Short-term effect of correcting leg length discrepancy on performance of a forceful body extension task in young adults. , 1998, Hiroshima journal of medical sciences.

[57]  G. Andersson.  Epidemiological features of chronic low-back pain , 1999, The Lancet.

[58]  J. W. Fisk,et al.  Clinical and radiological assessment of leg length. , 1975, The New Zealand medical journal.

[59]  G. R. Clarke,et al.  Unequal leg length: an accurate method of detection and some clinical results. , 1972, Rheumatology and physical medicine.

[60]  K. Tallroth,et al.  Leg‐Length Inequality in People of Working Age: The Association Between Mild Inequality and Low‐Back Pain Is Questionable , 1991, Spine.

[61]  A. Fann.  The prevalence of postural asymmetry in people with and without chronic low back pain. , 2002, Archives of physical medicine and rehabilitation.

[62]  K. Zabjek,et al.  Acute systematic and variable postural adaptations induced by an orthopaedic shoe lift in control subjects , 1999, European Spine Journal.