We come across leg length imbalances quite frequently here at the clinic, and they can have quite a significant effect on cases of back pain or leg pain as the body tries to compensate for this imbalance. Often patients have heard from other sources if they have a leg length imbalance, but without thorough examination this can easily be misinterpreted. Unfortunately, we have come across cases where leg length has been miscalculated in the past, with orthotics prescribed and the patient has ended up in more pain. This is because there is actually two main types of leg length differences. There can be a structural difference in the legs actually being measurably different lengths, but there may be cases where the legs are actually measuring the same length but due to dysfunction in the pelvis there may be one hip that is holding one leg higher than the other.

Causes of Leg Length Imbalance

The effects of a leg length imbalance can vary greatly from person-to-person, as it will also depend on when the discrepancy manifested itself. Sometimes leg length imbalances can be caught early in childhood as a toddler begins to crawl and walk – especially later in childhood as they may have difficulty in running or playing, but in other cases it can go unnoticed if there are no symptoms initially. A very small imbalance – for example just a couple of millimetres – would be unlikely to cause any side-effects or impact the patient’s quality of life in any way. These imbalances can be caused due to the way longer bones in the body grow. The femur and the tibia (thigh and shin bone, respectively) grow around areas of cartilage in the bone itself, called a growth plate, if anything happens to disturb these areas – physically or neurologically – then an imbalance may develop. Common causes of leg length imbalances can be: previous injuries to the leg – such as if it was broken, bone infections if one occurs during infancy or childhood, dysplasia, or an underdevelopment that is present at birth.

Studies have shown that people with a leg length imbalance are more likely to experience lower back pain, as a more significant leg length difference will cause the patient to compensate through their walking which can affect their spine over time. They may also be more susceptible to injury, and may tire quickly when walking because it takes more physical effort to compensate for an imbalance.

How to Measure A Leg Length Imbalance

If an imbalance is found, invariably it has been found with patients lying down, with the leg being measured between the bony part of your leg at the front of your pelvis and the ankle. However, this can be quite an ineffective and inaccurate measurement, especially as these bones can become rotated in any way which can potentially give you an artificially false treading. Leg length imbalances can also be detected through shoulder height imbalances, but this can also show cases of scoliosis so would only signal that further investigation is needed.

The best, and most accurate, way to measure leg length imbalance is in fact through X-ray imaging, although the patient will need to show clinical relevance that an X-ray is required. Usually a practitioner will conduct a preliminary examination  to examine any foot involvement. Sometimes the arches of your feet can have an effect on the accuracy of the reading – so the practitioner should assess this first. If an X-ray is clinically indicated (usually the potential benefits of having the X-ray outweighs the risks), the patient ideally should have their heels together to get the most accurate reading. The practitioner should then examine the hip angles, at the top of the leg bone. The difference is then usually an accurate representation, and can be quantified so that a resolution to the problem can be found.

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How To Treat A Leg Length Imbalance

Although in rare cases it may be recommended the patient undergoes surgery, this may only occur in very extreme cases. Usually, the problem can be addressed using insoles placed in a shoe to equal out the difference in height. An insole, also known as an orthotic or a heel lift, can improve a patient’s walking almost instantly as it immediately levels out the discrepancy. Obviously this is also a much quicker and non-invasive approach compared to surgery, so may be ideal for most people who do suffer from an imbalance. In severe cases, surgeries to correct imbalances can often be unpleasant and require a huge amount of rehabilitation work due to the invasiveness of the procedures. Lengthening and shortening of the bones can be done if the leg length has been discovered after a patient has stopped growing, but if it’s present in a child then bone growth restriction could be performed during adolescence.

Overall, leg length imbalances are something that we come across regularly at the clinic, although in most cases they can be too minor to be noticeable to the patient or see any side-effects from. If you have been told you have a leg length issue, but you’re still experiencing pain in your spine then it may be worth visiting a professional who might be able to give you some more specific guidance and a thorough examination to see if your imbalance has been measured correctly. If you’re based in the London area, we can offer an examination with treatment specifically targeted towards the back pain that you may experience if you do have a leg length imbalance. Call our team today on 0203 947 3222 to find out more on how we can help, or to book your first appointment.

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