Subtle clues to an LLD?

Leg length discrepancies, whether their functional anatomical, have biomechanical consequences north of the foot. This low back pain patient exhibited 2 signs. Can you tell what they are?

can you see the difference ?

how about now?

compare right to left

compare right to left

can you see the difference in the Q angles?

Look at the first picture and noticed how the left knee is hyper extended compared to the right. Sometimes we see flexion of this extremity. This is to "functionally shorten" that extremity.

Now look at the Q angles. Can you see how the left QL angle is greater than the right? This usually results from a long-term leg length discrepancy where the body is attempting to compensate by increasing the valgus angle of that knee, effectively shortening the extremity.

Dr Ivo Waerlop, one of The Gait Guys

#subtle #clues #LLD #leglengthdiscrepancy #leglengthinequality #thegaitguys #gaitabnormality

So, what kind of shoes do I put this guy in?

The answer is, well…it depends.

This gentleman has a large Q angle (need to know more about Q angles? click here). The second photo is taken from above looking down at his knee.

If he has medial (inside) knee pain (possibly from shear forces), you would want to unload the medial knee, so a more flexible shoe that would allow more pronation of the foot and INCREASE the amount of valgus would open the medial joint space and probably be more appropriate.

If he had lateral (outside) knee pain (possibly from compressive forces), then a shoe with more support (like a motion control shoe) would help to unload the lateral knee and create more space may be appropriate. And that just covers the local knee issue. What if he has a pes planus and needs more than a “more stable” shoe ? And, what if that pes planus is rigid and won’t accept a more rigid arch supporting device ? What are you gonna do then ?

The caveat?

There are no hard and fast rules AND there is no substitute for examining the person and asking LOTS of questions BEFORE putting them in a shoe. You must approach each case on a case-by-case basis with all factors brought into the fold to make the best clinical decision.  Simply watching them walk, as you have heard it over and over again here on The Gait Guys, will lead you into wrong assumptions much of the time. Sometimes the obvious fix is not possible or won’t be tolerated by the person’s foot, knee, hip or body.  So, sometimes you have to settle with something in-between. 

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