Structural Vs. Functional Leg Length Discrepancy

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Overview
The field of leg length inequalities or leg length discrepancy often abbreviated as LLD is well documented and understood. There are two types of short legs; functional (functional LLD) and structural (true LLD). A functional short leg occurs as a result of muscle imbalances, pelvic torsion or other mechanical reasons. The millimeters of ?appearing? short are typically less than 10, and are do not appear on Xray. This article is about structural or anatomical short legs.Leg Length Discrepancy

Causes
Leg length discrepancies can be caused by: hip and knee replacements, lower limb injuries, bone diseases, neuromuscular issues and congenital problems. Although discrepancies of 2 cm or less are most common, discrepancies can be greater than 6 cm. People who have LLD tend to make up for the difference by over bending their longer leg or standing on the toes of their shorter leg. This compensation leads to an inefficient, up and down gait, which is quite tiring and over time can result in posture problems as well as pain in the back, hips, knees and ankles.

Symptoms
Faulty feet and ankle structure profoundly affect leg length and pelvic positioning. The most common asymmetrical foot position is the pronated foot. Sensory receptors embedded on the bottom of the foot alert the brain to the slightest weight shift. Since the brain is always trying to maintain pelvic balance, when presented with a long left leg, it attempts to adapt to the altered weight shift by dropping the left medial arch (shortening the long leg) and supinating the right arch to lengthen the short leg.1 Left unchecked, excessive foot pronation will internally rotate the left lower extremity, causing excessive strain to the lateral meniscus and medial collateral knee ligaments. Conversely, excessive supination tends to externally rotate the leg and thigh, creating opposite knee, hip and pelvic distortions.

Diagnosis
The only way to decipher between anatomical and functional leg length inequalities (you Can better posture make you taller? have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.

Non Surgical Treatment
To begin a path torwards a balanced foundation and reduce pain from leg length discrepancy, ask your doctor about these Functional Orthotics and procedures. Functional Orthotics have been shown to specifically reduce pain from leg length inequality, support all three arches of the foot to create a balanced foundation, maximize shock absorption, add extra propulsion, and supply more stability, enable posture correction and long-term preventive protection. Will improve prolonged effectiveness of chiropractic adjustments. Shoe or heel Lifts, Correct the deficiencies that causes imbalances in the body.
LLL Shoe Insoles
Surgical Treatment
Surgery is another option. In some cases the longer extremity can be shortened, but a major shortening may weaken the muscles of the extremity. In growing children, lower extremities can also be equalized by a surgical procedure that stops the growth at one or two sites of the longer extremity, while leaving the remaining growth undisturbed. Your physician can tell you how much equalization can be attained by surgically halting one or more growth centers. The procedure is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the LLD will gradually decrease as the opposite extremity continues to grow and “catch up.” Timing of the procedure is critical; the goal is to attain equal length of the extremities at skeletal maturity, usually in the mid- to late teens. Disadvantages of this option include the possibility of slight over-correction or under-correction of the LLD and the patient?s adult height will be less than if the shorter extremity had been lengthened. Correction of significant LLDs by this method may make a patient?s body look slightly disproportionate because of the shorter legs.