A leg length difference is the general term for two different leg lengths. There is an anatomical leg length difference, in which one leg is shorter than the other due to bone growth, and the functional leg axis, in which one leg is more loaded than the other due to a muscular difference. The anatomical leg length difference can be corrected by insoles, the functional leg length difference by mobilization and muscle techniques. A leg length difference can lead to pelvic obliquity, which affects the entire statics of the body. The difference in leg length usually only becomes apparent through accompanying symptoms such as back pain, hip pain, knee or foot pain or through an uneven gait pattern with corresponding wear and tear on the shoes.
Physiotherapy
In physiotherapy for a leg length difference, the type of leg length difference is determined first. If the patient has not received a detailed examination from the doctor, the type of leg length difference can be determined in physiotherapy by measuring the lengths. For the anatomical leg length, the therapist measures from the trochanter major of the thigh to the malleolus lateralis (outer ankle).
For the functional leg length, the therapist measures from the anterior superior iliac spine (anterior prominent point on the pelvic bone) to the medial malleolus. However, a difference of more than 6 mm can only then be considered a leg length difference. If there is an anatomical difference in leg length, nothing can be done in therapy except for insoles.
The situation is different with functional leg length differences. By lifting both heels, the therapist can compare the length between the feet. In doing so, he is guided by the problem side of the patient.
If this indicates pain in the area of the pelvis on the left side, the therapist looks to see whether the left side is shorter or longer than the right side. If it is shorter, he mobilizes the hip to maximum flexion, adduction and external rotation, and pulls the leg into extension over a maximum external rotation position. The therapist then checks the leg length again.
If the leg lengths have been compensated, further therapy can be performed by mobilizing the pelvis. If the shortening continues, the pelvis must be manipulatively straightened. If the leg is longer on the pain side, the therapist mobilizes the leg into maximum extension, abduction and internal rotation and, while holding the internal rotation, pulls the leg next to the other leg.
The result is the same as with leg shortening. As the procedure progresses, the pelvis is mobilized and possibly manipulated. The mobilization can be done in a lateral position or in a prone or supine position, then with the help of the hip.
The overall statics of the patient should also be taken into account and improved by mobilization of the knee, foot and spine. If scoliosis is present, it should be trained by specific exercises. For this purpose the weak side should be strengthened and the strong side stretched.
If an increased tonus (muscle tension) is seen in the leg and back muscles, this should be released. The tonus can be improved by soft tissue techniques, fascial solution or massage grips. If there is a muscle imbalance also in the area of the legs, this should be corrected by specific exercises.
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