One Leg Longer Than the Other? Here’s How to Fix It

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Quick Summary: One Leg Longer Than the Other? Here’s How to Fix It

• Leg length discrepancy can be structural (bone) or functional (muscle/joint related).
• Common symptoms include hip pain, back discomfort, and uneven gait patterns.
• Treatment ranges from heel lifts and orthotics to physical therapy or surgery.
• Clinical measurement and imaging help determine the appropriate treatment approach. Need an evaluation? Contact Elizabeth E. Auger, DPM.

Fun fact most people don’t know about the human body: about 90% of people have one leg longer than the other. Most of us just don’t notice because for the majority of cases, these differences are tiny, capping out at under half an inch.

It does, however, lead to some struggles most people don’t realize are tied to it. Have you ever noticed one shoe wears out faster than the other, or that one side of your hip tires out starts to hurt much earlier in the day?

Dr. Elizabeth Auger, DPM, has information that can help you if leg asymmetry is affecting your lifestyle.

Why Is One of My Legs Longer Than the Other?

Again, it really isn’t as uncommon as you might think. Perfect symmetrical features are incredibly rare in people, and that applies to your limbs just as much as it does to faces.

This means people just tend not to notice… up to a certain point. If a leg length discrepancy goes past the half-inch mark, that’s when issues start to become noticeable.

The problem is that the body actually tries to account for uneven lengths by adjusting the rest of the body to compensate for it. You can see this with things like a passive head tilt, or with posture where one shoulder is naturally higher. Most commonly, you can test this by resting your weight on your back leg when standing.

The greater the discrepancy, the more your body adjusts. The more your body adjusts, the worse the long-term effects are on the joints picking up the slack.

Structural vs. Functional Leg Length Discrepancy

There is a second kind of leg length discrepancy besides a natural (structural) leg length difference. In the medical field, we call this a functional leg length discrepancy.

Functional difference means your legs are the same or close to the same length, but you have other mechanical issues that make them function as if one were significantly shorter than the other. Usually, this is related to common conditions such as muscle tightness or pelvic tilt.

Functional discrepancies can also be directly tied to the mechanics of your feet. If you’re flat-footed only on one side of the body, for example, then naturally, one side of your body will end up pressing closer to the ground, and every other problem with your posture follows downstream from that.

Common Causes of Leg Asymmetry

Besides being born with unusually uneven lengths, one way or another, uneven legs are often tied to medical history.

• Childhood Development: Kids getting hurt is an expected part of growing up. However, because the skeleton is still growing, any injuries sustained at a young age can lead to long-term structural oddities as adults.

• Mechanical Trauma: Things like a damaged hip or knee surgery can lead the body to shift its posture over time to avoid pain in injured joints. Unfortunately, this means offloading your weight somewhere else where it isn’t meant to be.

• Medical Conditions: Some medical cases can contribute to uneven legs either by messing with the skeletal structure itself, or through interrupting clean signals traveling through the nerves (as in the case of polio).

How Do I Tell if One Leg is Longer Than the Other?

It sounds like a silly question, but as we’ve pointed out, it’s not always immediately obvious, given how good the body is at trying to perform as close to baseline as possible. There’s also the fact that a lot of symptoms people struggle with because of uneven leg lengths can be misattributed to other causes.

Because of this, outside of directly measuring your limbs, the first signs of asymmetry are typically indirect observations.

• Uneven gaits
• One-sided fatigue
• Exclusively using one side of the body for physical tasks
• Uneven wear on shoes and pants

Observations like these are usually hard to pin on uneven limbs on their own, and a podiatrist will usually have to compare them side by side with other typical symptoms like pains or aches in your body.

How to Measure Leg Length Discrepancies

Generally speaking, you probably shouldn’t do it yourself at home. Unless you have a significant difference between your legs, you’re probably not going to get an accurate measurement with just a tape measure.

You don’t know if it’s the thighs or shins that have an extra length. You don’t know if they’re the same length and they only appear different because of tight tendons or misaligned joints.

Podiatrists use standardized clinical assessments to determine whether a gap exists. Diagnosis usually starts with an examination of your posture, and, if asymmetry isn’t ruled out (or confirmed) by both standing and supine (lying down) assessments, doctors move on to imaging technology.

If you must measure your leg length at home, follow these tips:

• Have a partner.
• Loosen your hips with hip rotations for 1 minute.
• Lie down on the floor with your legs straight, and feet together.
• Instruct your partner to check that your heels are aligned.

If your heels are not aligned, then you may have a leg length discrepancy.

Leg Length Discrepancy Treatment by Severity

Once you’ve been diagnosed with a leg length discrepancy, your doctor will have to come up with a personal treatment plan. What this plan includes will depend on the nature of the asymmetry as well as the extent of it.

Mild Discrepancies

For the majority of cases, usually with under a quarter of an inch difference, treatment is usually non-invasive and can be limited to pain and discomfort management. The simplest solutions include thick pads called heel lifts, which are essentially shoe inserts that support the shorter leg.

Because the difference between the legs is so small, it usually doesn’t take too much effort for the body to adjust, though patients may feel odd when walking, at least for a few days. In cases of functional leg asymmetry (not structural), the body may be able to permanently correct its posture over time, especially with a good exercise program.

Moderate Cases

Patients might not see improvement with basic lifts between a quarter of an inch to half an inch of difference. In fact, there have been cases where lifts to this degree lead to an unnatural forward angle that eventually leads to new discomfort along the forefoot.

It’s a little like the physics of being forced to walk in heels all day.

For moderate cases, podiatrists will often start to recommend special inserts called orthotics. Custom orthotics in Salt Lake City are manufactured specifically to fit the patient and distribute weight evenly across the surface of the foot.

Over-the-counter devices are also available, but it’s still best to consult with a podiatrist to understand how custom orthotics compare to store-bought inserts before spending your money.

Severe Cases

The worst cases of asymmetrical leg lengths can reach and sometimes exceed a difference of 1 inch. At this point, inserts might not work at all without causing the heel to slip out of the shoe while walking.

Podiatrists may refer patients to orthopedic surgeons for advanced medical procedures like limb lengthening, or growth plate surgery. This is often a last resort, however.

Uneven Leg Length FAQ

How much leg length discrepancy is normal?

Most medical experts agree on a leg length of ⅕ of an inch or less to be normal, requiring no treatment at all. Between a fifth and a fourth of an inch, patients may or may not experience symptoms depending on their lifestyle.

Patients will usually experience issues when the discrepancy reaches just under half an inch.

Can leg length discrepancy correct itself?

Yes, if the discrepancy is functional. Physical therapy and exercise programs can target poor posture and musculoskeletal form over time. Done consistently enough, improvements may last for years or even be permanent.

Structural leg length discrepancy, however, can only be corrected at a young age before growth plates at the ends of the leg bones fuse. Outside of surgical procedures, treatment for structural asymmetry is mostly limited to management.

Heel lift vs custom orthotics: Which is right for me?

That depends on the size of the discrepancy. Heel lifts suffice for smaller differences, and custom orthopedic inserts are generally recommended for larger differences, or for differences caused by other conditions such as plantar fasciitis.

Does insurance typically cover leg length discrepancy evaluation? 

The answer heavily varies with your plan and with the nature of the discrepancy. For the most part, diagnostic testing and imaging can be considered as medically necessary, and are covered by medical insurance, but shoe modifications and inserts may be covered only partially or not at all.

When to See a Podiatrist

Generally speaking, podiatrists are the medical specialists to speak with when looking to diagnose mechanical issues with the feet and legs. In Salt Lake City, Dr. Elizabeth Auger, DPM regularly assists patients with gait and posture issues that might point toward true limb length differences.

Call (801) 396-9743 today for your appointment.