Many people present to a chiropodist with a leg length discrepancy. The vast majority are asymptomatic. However, when a patient presents with unilateral symptoms, a leg length discrepancy is worthy of consideration. Sometimes the difference is congenital, sometimes post-surgical after hip or knee replacement(s). Sometimes it is functional due to an inability to fully straighten a leg due to arthritis or flexion contractures at the hip or knee, or because of ankle equinus.
Nevertheless, in these cases, the role of the chiropodist is to identify when and if the LLD is making a contribution to the presenting condition.
Often the link to a patient’s chief complaint is not obvious. For example, cases of metatarsalgia can actually be exacerbated on the shorter limb. Intuitively, many will surmise that there is less forefoot pressure on the short side. However, in cases where the calf muscle is tight, contraction of the muscle – raising the calcaneus and consequently plantarflexing the forefoot – increases forefoot pressure. A heel raise on the shorter side reduces the contribution of the calf to the forefoot pressure and is therefore one component of treatment of the problem. History and examination will help identify any other measures that need to be taken to address the patient’s problem.
Leg length discrepancies have also been linked to cases of plantar fasciitis, ankle, knee, hip and back pain. There have even been cases in which a primary diagnosis of scoliosis was actually a compensation for a leg length discrepancy.