Functional and structural limb length discrepancies: evaluation and treatment

The examining physician should have a high index of suspicion when evaluating patients with lower extremity and/or back pain so that the diagnosis of leg length inequality is not overlooked. If an organized and systematic physical examination is performed, the practioner will become more comfortable and competent in the diagnosis of limb asymmetry. Once the diagnosis of limb length asymmetry is made the further classification of functional versus structural limb length discrepancy will dictate what treatment will be indicated. The structural asymmetries are evaluated by the indirect method of measurement and treatment with a heel lift approximately half the measured asymmetry initially. The functional asymmetries are evaluated by the flexion and pronation tests and treated with a properly posted orthotic.