We’ve been having a run on patients presenting with “hip pain” at C1 which turns out to be leg-length inequality (LLI) rather than true hip joint pain.
Leg length inequality is common, with a staggering 90% of us having some inequality and 23% of the general population having a discrepancy of 1 cm or more – which is a fair discrepancy. Treatment aims for LLI must include obtaining leg length equality, producing a level pelvis, and improving function.
Guidelines set out by James J. McCarthy, MD, and G. Dean MacEwen, MD for treatment of leg length inequality are: <2 cm — no treatment or a lift in the shoe; 2 to 6 cm — an epiphysiodesis or shortening procedure is considered; 6 to 15 cm — a lengthening procedure is considered. A leg length inequality of 15 to 20 cm — may require a staged lengthening, lengthening combined with epiphysiodesis, or amputation. Numerous complications of limb lengthening procedures occur frequently, even in experienced hands.
Management of Leg Length Inequality
from Journal of the Southern Orthopaedic Association
James J. McCarthy, MD, and G. Dean MacEwen, MD
Now, few and far between, are those who have a LLI of 2 – 6 cm and rare as hen’s teeth are those who have greater but the less than 2 cm are pretty common.
What causes LLI – well it is is uncommon for your limbs just to grow to different lenghts so an anatomical LLI is usually something to do with trauma – breaking a leg or ankle being the most likely cause. If this hasn’t happened that we’d look at the arch of the foot and see if they are symetrical as a collapsed arch can lower a hip height. However, the most common cause of LLI we have seen at the clinic is caused by pelvic rotation at the sacroiliac joint. This is usually treatable depending just on how much movement you can back into the joint and they have a tendency to resolve well if they can be moved.
I’d resist a heel lift as they are a real pain, since they have to be moved between shoes and, on philisophical grounds, as they treat a sign and not a cause in many cases.
