Leg length discrepancy: not always implicate a shorter leg!

Leg length discrepancy: not always implicate a shorter leg!

Numerous articles and comments have been written on leg length discrepancy (LLD).  How to measure it, how to test it, how to treat it.

I have often been consulted by patients who, according to their physician or therapist, should have a leg length discrepancy. Which was not seen before or even ignored. The majority had no medical history of broken legs or complicated fractures. Testing them  both laying and standing I measured indeed this LLD.

Seeing  back  many of them the before measured length  not only seemed to be changed, but also the leg itself!  At that time we made so-called podograms on which you could see the pressure of the feet. Today this registration is all ict.

These length changes  were so frequent that there must be a pattern. As manual therapist and posturologist I am used to think 3 D (threedimensional).

laying

In many cases I then noticed a pelvis rotation around the longitudinal body axis. I asked the laying patient to bend both knees, resting the feet, leaving the knees free to move. Almost always one or both knees moved to one side.   A lumbar support under the loins towards the pelvis was rotating, made, nine out of ten times, makes the LLD disappear. In my experience this was not a ‘real’ LLD but a ‘physiological’. Many professionals, for instance hairdressers, stand their whole working life most on one leg. The muscles of the foot/leg/hip at that side contract and a ‘created LLD’ is born! Do not start to treat this as a shorter leg by means of heel orthotics because the pelvis will rotate even more!! the pelvis has to be corrected by a contra-rotation.

June, 2019.

PRONATION  really understood?

Imagine,

  • you walk barefoot on, for example, sand
  • you leave visible footprints of the heelstrike and caput metatarsalia behind
  • you expect a (pronation) impression at the medial length arch 
  • you see the opposite, the lateral impression is deeper
  • the medial arch is most of the time not even visible at pronation 
  • pronation is a natural and therefore normal phenomenon and no illnes
  • that the anti-pronation does not make sense and may even be a contra-indication