Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

For Online Access

Best Paper Award Selection - Editorial Board Site

2001, Volume13

Issue 1

94 pages

Issue price - $163.00

Edwin Hanada, M.D.
Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

D. Casey Kerrigan, M.D.
Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA

Leg-length discrepancy (LLD) is a common disorder, with important clinical implications, including for gait. There are many controversial clinical issues involving LLD that can make it challenging for the clinician. The extent of LLD that is clinically significant is up for debate, although this is now more commonly expressed as a percentage of the longer limb leading to, for example, compensatory strategies in gait. There is some evidence to suggest that LLD has an association with low back pain, and is linked with degenerative arthritis of the longer-leg hip and knee, although the strength of these associations are a contentious issue. Evaluation of LLD should involve a thorough history and physical examination, including clinical measurement through the "iliac crest palpation book correction" technique, and quantitative gait analysis. Finally, treatment should involve stretching, and strengthening exercises for the hip abductors/adductors, and extensors, as well as for the back. For LLD between 20 and 5O mm, conservative management should involve a trial of a heel with or without a shoe lift. Larger LLD should be managed by prostheses if surgical management is not being considered. Leg-length discrepancy remains a fascinating clinical entity and an important one, with which clinicians should be familiar, and be able to manage effectively.

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