Leg length and asymmetry

Leg-length discrepancy and asymmetry: assess before compensating

A difference or asymmetry does not always require the same response. First we need to understand its real functional relevance.

Call +34 628 342 080 What to bring

Assessment of pelvis, legs and loading where asymmetry is suspected

MEDIPIE approach

Not every difference should be compensated in the same way

A leg-length discrepancy or asymmetry may be structural, functional, already compensated or of little relevance to the reason for consultation. It is therefore not sensible to add lifts or compensation without understanding the case.

At MEDIPIE we consider clinical history, loading, gait, posture, footwear, tolerance and symptoms. If compensation is considered, it should be introduced cautiously and followed up.

How posture, loading and gait are integrated in the assessment

What we relate before compensating

Reason for consultation and associated symptoms.
Gait, support, pelvis, posture and possible compensation.
Footwear and available space for any proposed compensation.
Previous tests or measurements when available.
Tolerance to changes in height, support or materials.

When compensation may make sense

When indicated, a lift or orthosis may improve tolerance or reduce a specific overload. It is not applied automatically simply because a difference is found.

Follow-up is important to check adaptation and avoid excessive change.

How we decide whether an orthosis or compensation makes sense

Before using a lift

Three decisions should not be automated

One isolated measurement does not determine the height or automatically mean compensation is needed.

Confirm what was measured

We distinguish a possible structural difference from functional asymmetry and review the reliability and context of available measurements.

Relate it to function

We check whether the difference relates to symptoms, gait and real compensation or is already well tolerated.

Test progressively

When appropriate, compensation can be partial, compatible with footwear and reviewed before it is maintained or increased.

Evidence and limits

There is no universal threshold that automatically requires compensation

A systematic review of shoe lifts in adults with leg-length discrepancy and musculoskeletal conditions found signals of possible improvements in pain and function, but overall evidence quality was low or very low and studies described poorly how much and how to compensate.

The review concluded that higher-quality studies are needed to define which differences should be treated and which correction strategy to use. One number therefore does not automatically become a prescription: at MEDIPIE we relate it to symptoms, function, gait, footwear, available measurements and tolerance.

Source: Campbell T.M. et al. Shoe Lifts for Leg Length Discrepancy in Adults With Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature. Arch Phys Med Rehabil. 2018. View on PubMed.

Frequently asked questions

Common questions

Does every leg-length discrepancy need a lift?

No. First we need to assess whether the difference is structural, functional, compensated or even of little relevance to the reason for consultation. The decision depends on available measurements, symptoms, gait, footwear, the patient's adaptations and expected tolerance.

How do you decide how much to compensate?

It is not decided by simply copying one measurement. Available evidence does not establish one universal threshold or correction strategy. We relate the difference to posture, gait, shoe space, symptoms and adaptability; when appropriate, compensation may be partial and progressive and should be reviewed.

Do you have a measurement or previous lift?

See which reports, X-rays, footwear and previous devices are useful to bring so they can be interpreted in context.

See all questions

Appointments by phone

Assess the asymmetry in context

Bring reports, X-rays, lifts or previous orthoses if you have them. We will review their origin, usefulness and tolerance before considering compensation.

Clinical content reviewed by Juan Bautista Calero Márquez, podiatrist registered no. 115 in the Region of Murcia.

+34 628 342 080