January 20

Limb Length Discrepancy

Are you a runner, walker, or person who is on their feet throughout the day?  Do you sometimes experience lower back pain, hip or knee discomfort, tightness of lower limb muscles or cramping?  It could be you are living with a condition called limb length discrepancy.

 Limb length discrepancy, simply put, is when you have one leg or arm longer than the other.  Limb length discrepancy affects 25% to 32% of the population, with findings of 1/5 to 3/5 of an inch difference between the lengths of their legs.  With this high percentage of incidences, one wonders why people do not have more symptoms.  Well, it all depends on how big of a difference in the length of a person’s legs and the cause of the problem.  Limb length discrepancy is often undiagnosed and goes untreated for years.

What are the symptoms?

The finding of limb length discrepancy is often coincidental and without symptoms.  However, when I do find this condition in patients through a thorough examination, patients will provide me with a more detailed subjective finding of pain or discomfort with other joints above their ankle, not necessarily pain in their feet.

The longer side usually takes more pressure and weight on the body, which could lead to foot conditions like plantar fasciitis.  Visual signs include a limp during the gait cycle, a drop in the shoulder and pelvis on the shorter side, and the curvature of the spine.  An article that I read reports that the shorter side with shortening of bones may lead to osteoarthritis at the knee or hip level over time.  Moreover, the shorter side, which is caused by the tightening of the lower back muscles, leads to an outside pelvic tilt and shortening of the flexor muscles group.

And when people do have symptoms, they seek help from many professionals, and ancillary services like physical therapy, chiropractic care and massages to relieve their pain.  People just do not connect symptoms of the same-side joint pain to their unequal limb length.

What should you do if you think you have a limb length discrepancy?

Treatment of the condition is geared towards treating the symptoms.  Of course, a heel lift is a good starting point for the shorter side of the legs.  In this scenario, custom orthotics are indicated.  A permanent heel lift can be added to the custom inserts to address the shortening.  However, a heel lift of only half an inch is allowable in the shoe.  In the case of a higher discrepancy, if more correction is needed, it has to be mounted on the outer sole of the shoe.  A shoe repair shop could help the patient in this scenario.  Chiropractic care should help in the adjustment of the spine and pelvis to get them back in alignment.  Massage therapy is able to relax the muscles and pull the joints out of position through manipulation.  In severe cases where there is a great difference in height with more chronic pain, surgical intervention is indicated. Stretching exercises on a day-to-day basis will help increase a person’s functional level as well.

In summary, an assessment by a podiatrist could give a person with symptoms of knee, hip, and lower back pain the diagnosis and the correct measurement of how much height to address.  Following a healthcare provider on a regular basis could help a person living with limb length discrepancy by minimizing the pain and preventing the long-term effects of the condition.

Dr. Dang H. Vu, DPM is a Baltimore Podiatrist with more than 17 years of experience. He completed his residency at Sinai Hospital of Baltimore, where he furthered his surgical expertise. He now holds privileges at Northwest Hospital. He offers services from three Baltimore Locations in Reisterstown, Towson and in the Rotunda Building in Hampden. You can find directions and request an appointment on his website FamilyPodiatryofMD.com.


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