BIOMECHANICAL COMPENSATION IN AN INDIVIDUAL WITH LEG LENGTH DISCREPANCY: A CASE REPORT

Enrico Leonarto; Nani Cahyani Sudarsono

doi:10.20884/1.mandala.2026.19.2.21881

Enrico Leonarto Department of Community Medicine, Faculty of Medicine, Indonesia University, Indonesia
Nani Cahyani Sudarsono Department of Community Medicine, Faculty of Medicine, Indonesia University, Indonesia

DOI: https://doi.org/10.20884/1.mandala.2026.19.2.21881

Abstract

Leg length discrepancy (LLD) is a structural asymmetry that may lead to biomechanical compensations, including pelvic tilt and gait asymmetry, and may increase the risk of injury, particularly in physically active individuals. Management often requires a functional approach in addition to anatomical correction. Case: A 37-year-old woman presented with discomfort and aching in her left ankle and calf, particularly when wearing thin-soled footwear. She was diagnosed with a 3-cm structural LLD, with the left leg being shorter, and aimed to participate in long-distance running events of up to 10 km. Clinical examination confirmed bilateral iliotibial band syndrome (ITBS) and right-sided patellofemoral pain syndrome (PFPS). The patient underwent a conservative exercise program supervised 2–3 times per week, with each session lasting 60 minutes. The program emphasized lumbopelvic strengthening, particularly of the gluteal muscles, to improve postural stability, along with load management and footwear modification. Anatomical correction using a personalized insole was recommended through referral to an orthotist-prosthetist; however, this intervention had not been implemented at the time of this report. Following the exercise program, pain intensity decreased from a visual analog scale (VAS) score of 5 to 2. In addition, pelvic drop during the mid-swing phase was no longer observed on gait assessment. Adherence to the exercise program was 100%. Conclusion: A biomechanical management strategy combining functional rehabilitation with anatomical correction using an insole may be important in managing concomitant injuries associated with LLD, such as ITBS and PFPS. In physically active individuals, management should incorporate a comprehensive approach aimed at restoring movement efficiency and reducing the risk of further musculoskeletal injury.

References

Altiok, H. et al. (2024) “The Effect of Knee Height Asymmetry on Gait Biomechanics,” Journal of Pediatric Orthopedics, 44(7), pp. e598–e603. Available at: https://doi.org/10.1097/BPO.0000000000002704.
Applebaum, A., Nessim, A. and Cho, W. (2021) “Overview and Spinal Implications of Leg Length Discrepancy: Narrative Review,” Clinics in Orthopedic Surgery, 13(2), pp. 127–134. Available at: https://doi.org/10.4055/cios20224.
Assogba, T.F. et al. (2018) “The effects of real and artificial Leg Length Discrepancy on mechanical work and energy cost during the gait,” Gait & Posture, 59, pp. 147–151. Available at: https://doi.org/10.1016/j.gaitpost.2017.10.004.
Azizan, N.A. et al. (2018a) “Leg Length Discrepancy: Dynamic Balance Response during Gait,” Journal of Healthcare Engineering, 2018, p. 7815451. Available at: https://doi.org/10.1155/2018/7815451.
Fazreena Othman, N. et al. (2019) “The effect of leg length inequality on joint contact forces of lower limbs during walking,” Acta of Bioengineering and Biomechanics, 21(1), pp. 55–62.
Hamada, T. et al. (2022) “Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs,” Strategies in Trauma and Limb Reconstruction, 17(3), pp. 144–147. Available at: https://doi.org/10.5005/jp-journals-10080-1566.
Kamis, S., Leisman, G. and Carmeli, E. (2017) “Detecting the presence of leg length discrepancy based on gait deviations and functional measurement of leg length during walking,” BMJ Case Reports, 2017, p. bcr2017219645. Available at: https://doi.org/10.1136/bcr-2017-219645.
Khamis, S. and Carmeli, E. (2017) “A new concept for measuring leg length discrepancy,” Journal of Orthopaedics, 14(2), pp. 276–280. Available at: https://doi.org/10.1016/j.jor.2017.03.008.
Korontzi, M., Kafetzakis, I. and Mandalidis, D. (2023) “Effects of Artificially Induced Leg Length Discrepancy on Treadmill-Based Walking and Running Symmetry in Healthy College Students: A Lab-Based Experimental Study,” Sensors, 23(24), p. 9695. Available at: https://doi.org/10.3390/s23249695.
Michalik, R. et al. (2022) “Biomechanical evaluation and comparison of clinically relevant versus non-relevant leg length inequalities,” BMC musculoskeletal disorders, 23(1), p. 174. Available at: https://doi.org/10.1186/s12891-022-05113-2.
Siebers, H.L. et al. (2021) “Changes in muscle activities and kinematics due to simulated leg length inequalities,” Biomedizinische Technik. Biomedical Engineering, 66(5), pp. 437–447. Available at: https://doi.org/10.1515/bmt-2020-0266.
Tallroth, K., Ristolainen, L. and Manninen, M. (2017) “Is a long leg a risk for hip or knee osteoarthritis?,” Acta Orthopaedica, 88(5), pp. 512–515. Available at: https://doi.org/10.1080/17453674.2017.1348066.