Clinical assessment and treatment of leg length inequalities

Controversy persists regarding the significance of leg length inequality, the diagnostic approach to the use of heel lifts, and the implementation of proper orthopedic support in treatment of anatomical leg length inequalities. The purpose of this paper is to review the literature and formulate a sequential examination for a patient with leg length discrepancy, then outline a formula for the treatment of the patient. The initial problem a practitioner faces in examining a patient with leg length inequality is to determine if a true (anatomical) leg deficiency exists. Through a series of measurements and pelvic assessments, an effective screening process can be accomplished before radiography (scanogram) is required. An understanding of the mechanics along the kinetic chain, anywhere from the foot to the lumbar spine, coupled with the information gained from radiographs, can provide a treatment plan detailing the size of the lift and location.