LLD Exam

Four Physical Outcomes


1.  Symmetrical Stance & Level Pelvis 


A.  LL Equality

- Components equal with no deformity


B.  Components equal with bilateral symmetrical deformity

- eg Bilateral varus knees


2.  Symmetrical Stance with Oblique Pelvis 


Uncompensated LLD


3.  Asymmetrical Stance & Level Pelvis 


A. Fully Compensated LLD

- Flexed contralateral knee 

- Equinus ipsilateral ankle


B. Sagittal deformity with ipsilateral sagittal compensation

- FFD knee with Equinus & hip flex OR

- Fixed Equinus with flex knee & hip OR

- FFD hip with equinus & flex knee


C.  Coronal deformity with contralateral coronal deformity

- Valgus of knee & contralat varus of knee


4. Asymmetrical Stance with Oblique Pelvis 


A.  Partly compensated LLD

- Partly flexed contralateral knee

- Partly equinus of ipsilateral ankle


B. Coronal hip deformity with sagittal compensation

- Fixed hip adduction with contralateral knee flexion / ipsilateral equinus

- Fixed hip abduction with ipsilateral knee flexion / contralat equinus


C.  Sagittal def c coronal compensation

- FFD knee c ipsilateral hip abduction

- Fixed equinus c ipsilateral hip ADD


Leg length Examination


1.  Look



- flexed knee


Signs hemihypertrophy

- NF
- haemangiomas / lipomas (Proteus, Klippel-Trenau-Weber, Beckwith)



- trauma, infection


Aids / Shoes

- heel inserts / raises


2.  Gait




Compensate well 

- Walk on toes short leg usually / equinus

- Flexion long knee uncommon as energy++




Compensate less well

- Walk with bilateral heel-toe gait

- Vaults over long leg

- Excess Sagittal head motion


3.  Measure LLD

A.  Functional LLD

- on blocks

- heels flat, nil knee FFD (if able)

- correct pelvic tilt

- should correct scoliosis



- if can make pelvis stable

- ASIS equal

- blocks are a quantitative measure of functional LLD


B.  Apparent LLD


Lying on bed

- measure from xiphisternum to medial malleolus

- no correction for contractures


C. Real / True LLD


Must correct for deformity in coronal and sagittal plane



- hip adduction / abduction contracture

- hip FFD

- knee FFD



1.  Hip FFD

- pillow under both thighs

2.  Knee FFD

- pillow under both knees

3.  Hip adduction contracture won't correct to neutral

- measure each leg crossed over the other

4.  Hip abduction contracture won't correct to neutral

- place both legs in similar position


If there is a contracture, perform the above measures

- then meaure the intercalated segments

- from ASIS to medial joint line

- medial joint line to medial malleolus


4.  Identify site of shortening



- must not forget can have small foot / old calcaneal fracture / wasted buttock

- hips and knees flexed

- side by side

- look for tibial / femoral shortening


If shortening above knee, find out if shortened above greater trochanter

- i.e. hip deformity


Bryant's triangle

- line perpendicular to GT and ASIS

- distance between

- quantify in fingerbreadths


Nelaton's line

- line from ischial tuberosity to ASIS

- GT should be on or below line


Klisics line

- GT to ASIS

- should aim to umbilicus

- will be more parallel


5.  Other


Examine Knee stability

- can have problems lengthening femur if ACL deficient

- i.e. fibula hemimelia