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A New Method for Measuring Structural Limb-Length Discrepancy: A Quasi-Experimental Study.

Huthaifa Atallah1, Titeana Qufabz1, Mahmoud Alfatafta1

  • 1Prosthetics and Orthotics Department, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan.

Journal of Clinical Medicine
|June 12, 2026
PubMed
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This summary is machine-generated.

A new Paired Medial Malleolus Level Test (PMMLT) accurately measures limb-length discrepancy (LLD) using malleoli and a ruler. This simple, cost-effective method offers a radiation-free alternative to imaging for LLD assessment.

Area of Science:

  • Orthopedics
  • Radiology
  • Biomedical Engineering

Background:

  • Limb-length discrepancy (LLD) is a common orthopedic condition.
  • Existing clinical and radiological methods for assessing structural LLD have limitations.
  • A novel, non-imaging method using malleoli is proposed.

Purpose of the Study:

  • To introduce and validate a new method, the Paired Medial Malleolus Level Test (PMMLT), for measuring structural LLD.
  • To compare the accuracy and reliability of PMMLT against established methods and radiography.
  • To provide a practical, cost-effective, and radiation-free alternative for LLD assessment.

Main Methods:

  • A quasi-experimental study involving 18 participants with structural LLD.
  • Four assessment methods were employed: PMMLT, measuring tape method (ASIS to MM), standing-block test, and long bone radiography.
Keywords:
clinical measurementlimb-length discrepancymalleolusradiography

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  • Validity was determined by comparing measurements against full-length standing radiography.

    • Main Results:

    • All tested methods showed strong correlations with radiography (r > 0.990, p < 0.001).
    • The PMMLT demonstrated high accuracy (mean LLD 2.98 ± 1.69 cm) with negligible bias (-0.01 cm) and the narrowest limits of agreement.
    • No significant differences were found among the four measurement techniques.

    Conclusions:

    • The Paired Medial Malleolus Level Test (PMMLT) is an accurate, practical, and simple method for assessing limb-length discrepancy.
    • PMMLT is cost-effective and avoids radiation exposure, making it suitable for diverse clinical settings.
    • This novel technique offers a valuable alternative, particularly where imaging is unavailable or contraindicated.