leg length inequality

truisms

·      aims in erect stance are

·      bipedal stance

·      level pelvis

·      hip contracture in coronal plane not compatible with level pelvis

·      tilted pelvis accompanied by scoliosis

·      apparent shortening achieved

·      in coronal plane by hip adduction

·      in sagittal plane by knee flexion

·      apparent lengthening achieved

·      in coronal plane by hip abduction

·      in sagittal plane by ankle equinus

·      lower limb is sagittal intercalated segment

·      hip, knee and ankle flexion are obligatory movements

steps

·      attempt to obtain symmetrical stance

·      assess levels of ASIS

scenarios
Symmetrical stance with level pelvis

= leg length equality

·      components equal with no deformity

·      components equal with bilateral symmetrical deformity

·      components equal with compensated deformity

·      components unequal but sum equal

Symmetrical stance with tilted pelvis

= leg length inequality

·      compensated with hip attitude in coronal plane

Asymmetrical stance with level pelvis

= fully compensated leg length inequality

·      flexed contralateral knee

·      equinus ipsilateral ankle

= sagittal deformity with ipsilateral sagittal compensation

·      fixed flexion of knee with ankle equinus (and flexion of hip)

·      fixed ankle equinus with flexion of knee (and flexion of hip)

·      fixed flexion of hip with equinus of ankle (and flexion of knee)

= coronal deformity with contralateral coronal deformity

·      valgus of knee with contralateral varus of knee

Asymmetrical stance with tilted pelvis

= partly compensated leg length inequality

·      partly flexed contralateral knee

·      partly equinus of ipsilateral ankle

= coronal deformity with sagittal compensation

·      fixed abduction of hip with ipsilateral flexion of knee

·      fixed abduction of hip with contralateral equinus of ankle

·      fixed adduction of hip with contralateral flexion of knee

·      fixed adduction of hip with contralateral equinus of ankle

= sagittal deformity with coronal compensation

·      fixed flexion of knee with ipsilateral hip abduction

·      fixed equinus of ankle with ipsilateral hip adduction