Leg length inequality, pelvic obliquity

Leg length inequality is present in almost one in every three people. It only requires treatment if the difference is 0.5 cm in children or over 1 cm in adults. The causes can be idiopathic (unknown origin), post-traumatic (such as damage to growth plates), or connected to an underlying disorder (congenital malformations). Leg length inequality can occur in the context of joint disorders (such as Legg-Calve-Perthes disease) or functionally during joint mobility impairment.

Definition

Medicine defines leg length inequality as the possible difference in the length of the legs, defined as the lower limbs from the hips to the feet. Minor differences do not require treatment; most people have slight leg length inequality and experience no symptoms. Therapy should only be considered if the difference is 7–10 mm. Leg length inequality in children must be monitored and, in some circumstances, treated. The inequality often disappears as the child grows.

There is a fundamental difference between anatomical and functional leg length inequality.

Pelvic obliquity usually results from leg length inequality. The pelvis is higher on the side of the longer leg. Pelvic obliquity causes scoliosis (sideways curvature of the spinal column) in various degrees of severity.

Causes

Anatomical leg length inequality

True leg length inequality resulting from differing lengths of the upper and/or lower legs: Possible causes:

• sometimes results from a hip TEP operation (artificial hip joint)
• congenital: club foot, congenital hip dislocation, coxa vara, for example
• infection-related: Osteomyelitis, septic coxitis
• paralysis-related: cerebral palsy, poliomyelitis
• Traumatic: the result of bone fractures or injuries to the epiphyseal plate
• tumour-related:
• miscellaneous: leg malalignment (valgus malalignment, varus malalignment, Legg-Calve-Perthes disease)

functional leg length inequality

Without anatomical length difference, resulting from:

• arthrotic hip joint
• Hip contracture (increased inclination, adduction or abduction)
• Contractures in the knee
• Drop foot

Long-term consequences

Because the legs form the foundation of our statics, a great leg length inequality can cause changes in posture and in the spinal column, as well as secondary drop foot. Pelvic obliquity causes scoliosis (sideways curvature of the spinal column) in varying degrees of severity. The human body does have ways of compensating, but most great leg length inequality leads to painful changes. Compensation can occur in two ways:

• Tiptoeing: Walking on the toes of the short leg reduces the influence of the difference in length. Many women do this even in pumps.
• Raised shoes

Conventional therapy

Depending on the difference in leg length:

• orthopaedic shoe alteration (raised heels with sole adjustment and insoles)
• custom-made orthopaedic shoes or custom-made shoes with inner shoes or foot bedding orthesis
• Elevated shoes or orthopaedic leg orthesis, or in extreme cases and on physician recommendation, surgery

The kybun principle of operation – being proactive

When walking on the soft, elastic material of the kyBoot sole/the kyBounder, the impact from hard surfaces (such as asphalt) is pleasantly absorbed. This is particularly important for those suffering from joint or soft tissue pain and provides relief when walking.

Since the foot can move freely in all directions, the core stabilizing foot musculature is strengthened. The feet become stronger and can absorb forces (when walking, jogging, etc.) better, protecting the joints higher up from overtaxation and deterioration.

The unstable walking experience in the kyBoot/standing on the kyBounder strengthens the entire body. Joint stability and posture are automatically improved. An upright posture, in turn, relieves the joints and reduces pain.

The positive effect of the kyBoot on posture and the natural rollover relax tense muscles (such as back tension) and well-being is significantly improved.

The kyBoot’s soft, elastic sole can compensate for leg length inequality to a certain degree (up to approx. 1 cm). If the leg length inequality is greater, there are several ways to adapt the kyBoot. To achieve perfect results and minimise waiting time, contact your local kybun dealer. They will be able to arrange the modifications.

Initial reactions

Specific initial reactions with leg length inequality:

The elastic material of the kyBounder/kyBoot sole changes your posture. For those with a more or less severe leg length inequality or who have worn special orthopaedic shoes or insoles for years, the change in body statics in the kyBoot/on the kyBounder can cause reactions such as strain, pain and fatigue in the beginning. Give your body time to adjust to the new way of walking in the kyBoot and read the recommendations under ‘Application tips’.

Click here for the general initial reactions experienced by kyBounder and kyBoot beginners: Initial reactions

kybun exercises

For information about the special kyBoot exercises or the basic kyBounder exercises , please click here: kybun exercises

The following adaptations to the standard implementation of interval walking are important in case of pelvic obliquity :

Anatomical pelvic obliquity:

1. If possible, seek a solution before interval walking: Differences of up to 1 cm can be compensated for by the soft, elastic material; greater differences require consultation with kybun.
2. Always look straight ahead (improves posture)
3. During slow exercises, imagine a thread attached to your head, pulling it upwards
   - Upper body straightening
4. During fast exercises: Clasp your hands in front of your stomach
   - more energetic rotation of hips, back and shoulders

Functional pelvic obliquity:

1. During fast exercises: Clasp your hands in front of your stomach
   - more energetic rotation of hips, back and shoulders so that the pelvic posture is changed as consciously as possible
2. conduct both exercises with a focus on the changeover
   - long-term: Musculature must adapt to the new posture
3. Always look straight ahead (improves posture)
4. During slow exercises, imagine a thread attached to your head, pulling it upwards
   - Upper body straightening

Application tips

• Do not make your steps too long
• Everyday/leisure: Walk with the kyBoot or use the kyBounder as much as possible. Take note of fatigue > perform the kybun exercises regularly and take a short break if needed.
• Walk upright
• Job: Sit as little as possible. Alternate sitting and standing in the beginning, and take along replacement shoes to change into
• If you feel unsafe/too unstable in the kyBoot even after a test walk, we recommend a second generation kyBoot model. These have a somewhat wider sole in the area of the midfoot, providing added stability. Seek advice from your local kyBoot expert.
• If you find the second generation kyBoot model too unstable for you as well, we recommend the kyBounder. You can choose the thickness you are comfortable with (the thicker, the less stable, the more intensive the training). You can easily compensate for leg length inequality by standing with each leg on a kyBounder of a different thickness. You can also hold on to a fixed object to gain more security.
• Initial reactions such as back pain or an increase in your existing back pain when using the kyBoot or the kyBounder may be due to various reasons (e.g. tense muscles, movements that are unfamiliar for the back). The body should have progressively fewer initial reactions if the dosage is adjusted correctly (increase duration of wear at your discretion).
• If you do not feel comfortable in the kyBoot despite following the ‘Application tips’, we advise you to consult a local kybun dealer.