More subtle clues..LLD's

This gentleman presented to the office with left-sided knee pain at the medial collateral ligament following a cutting injury, moving from right to left with the left foot planted. As you can see, he has an anatomical leg length discrepancy with tibial and probable femoral length deficiencies on the left side. Can you see the subtle, increased tone of the long flexors of the toes on the left hand side as it evidenced by the increased prominence of the long extensor tendons to a greater degree on the shorter side? This is a common compensation seen in true leg length discrepancies with clawing of the toes in attempt to create stability on the shorter leg side. Often times, the progression angle on the shorter side will be increased as well.

Subtle clues to flexor dominance

Take a close look at these photographs. Compare the prominence of the extensor tendon‘s left to right. What do you see? Do you notice the deeper furrowing of the extensor tendons on the left? Do you see the subtle increased extension of the metatarsophalangeal and requisite increased flexion of the inter-phalangeal articulations, left versus right? What about the height of the arches?

Keep a keen eye out for subtle signs. They can make a real difference in your clinical diagnosis and results…