Management of Leg Length Inequality

James J. McCarthy, MD, and G. Dean MacEwen, MD


J South Orthop Assoc. 2001;10(2) 

In This Article

Functional Effects

The functional effects of leg length inequality on gait have been studied by several authors. Gait asymmetry requires a leg length inequality of at least 2 cm (3%).[7,8] Minor leg length inequalities (<2 cm) do not seem to alter the kinematics or kinetics of gait.[9] Larger inequalities are associated with greater mechanical work,[10] and equalizing limb length improves the symmetry of gait.[11]

The effect of gait asymmetry on back pain, scoliosis, and knee and hip arthrosis is less clear. The association between leg length inequality and back pain has not been established.[12,13,14,15] There does not appear to be an increase in the incidence of back pain in patients with small leg length inequalities,[12,14] though Tjernstrom and Rehnberg[16] have reported improvement in back pain in patients who have had lengthening for correction of large (3 to 14 cm) leg length inequalities. Before resorting to a limb equalization procedure, we suggest a trial of a shoe lift in a patient with a leg length inequality and back pain to determine whether equalizing limb length will improve the back pain.

It has been reported that the incidence of scoliosis is higher in patients with leg length inequality.[17,18] If the leg length inequality caused the scoliosis, it would be expected that the scoliosis would compensate for the inequality (with the convex of the curve toward the short leg), but in one third of the cases the opposite is true.[19]

The effects of leg length inequality on the lower limbs are largely speculative. Tjernstrom and Rehnberg[16] reported few lower extremity complaints in patients with a leg length inequality. The longer limb will place the hip in slight adduction, about 4° to 5° for a 2 cm leg length inequality, but only with equal weight on each limb and symmetric joint positions. There is no evidence that leg length inequality leads to early hip or knee arthrosis.[20]


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