Full-limb standing X-rays with the emitter at 3m, centered on knees.
CT scanograms.
Family history: Take a detailed family history.
Examination of a Leg Length Discrepancy
Standing
Look
Discrepancy: Check for any obvious discrepancy.
Trunk/Pelvis: Look for pelvic tilt or trunk lean.
Posture: Observe for flexion posture in the long leg or equinus in the short leg.
Spine: Assess for scoliosis using a forward bend test and note correction (compensatory).
Feet: Check for fusions or deformities.
Other signs: Look for scars, swellings, or angular deformities.
Feel
Place fingers on ASIS with knees extended and feet flat to assess difference.
Perform a block test until the pelvis is square (functional discrepancy).
Move
Gait:
Observe and comment on gait patterns, such as short leg gait, ipsilateral knee flexion, contralateral ankle equinus, circumduction, hip hitching, or trunk bending.
Lie Down
Look
Observe for any additional findings.
Feel
Square up the pelvis and palpate the ASIS.
Measure true and apparent discrepancy.
Move
Perform:
Thomas test: Assess hip flexion contractures.
Hip ROM: Evaluate for contractures.
Galleazzi test: Determine femoral or tibial discrepancy.
If femoral: Use Nelaton’s line and Bryan’s triangle for further assessment.