Comparison of Supine and Prone Methods of Leg Length Inequality Assessment

Abstract

Objective: The primary objective of the current study was to determine the reliability between methods of supine and prone leg length inequality (LLI) assessment. The secondary objective was to determine if the degree of examiner confidence affected the degree of intermethod agreement. Methods: Two experienced doctors of chiropractic assessed 43 participants for LLI, one using a prone and the other a supine method. They stated whether they were confident or not confident in their findings. Results: Kappa values for intermethod agreement were 0.16 for the full data set; 0.00 for the n = 20 subgroup with both examiners confident; 0.24 for the n = 18 subgroup with 1 examiner confident; and 0.55 for the n = 5 subgroup with neither examiner confident. Supine and prone measures exhibited slight agreement for the full data set, but no agreement when both examiners were confident. The moderate agreement with both examiners not confident may be an artifact of small sample size. Conclusions: This study found that supine and prone assessments for leg length inequality were not in agreement. Positioning the patient in the prone position may increase, decrease, reverse, or offset the observed LLI that is seen in the supine position. (J Chiropr Med 2017;16:103-110)

Leg length discrepancy: A systematic review on the validity and reliability of clinical assessments and imaging diagnostics used in clinical practice

“…Thirteen studies on the validity of clinical assessments [ 22 , 23 , 25 , 31 , 33 – 35 , 41 , 42 , 44 , 46 , 48 , 55 ] had a low risk of bias and low concerns regarding applicability for all domains using QUADAS-2 tool ( Table 1 ). One study on the reliability of clinical assessments [ 27 ] had low risk of bias using the QAREL- checklist ( Table 3 ). Six studies on the validity of imaging diagnostics [ 59 – 61 , 67 , 70 , 71 ] had a low risk of bias and low concerns regarding applicability for all domains using QUADAS-2 tool ( Table 2 ).…”

“…The method was also used in a further study, however, without placing shims beneath the shoe sole [ 26 ]; 4.) assessment of leg length discrepancy in prone position by visually comparing the level of the medial malleoli [ 27 ]; 5.) determination of LLD with the participant in prone position with the knees extended and then flexed to 90° [ 30 , 38 , 51 , 52 ]; 6.)…”

“…The assessment of leg length discrepancy in prone position was predominantly considered reproducible and accurate [ 26 , 28 , 29 , 38 , 45 , 49 , 51 , 53 ]. In a few studies, reliability was reported poor to fair [ 27 , 30 , 52 ]. The studies investigating validity of the prone leg check showed contradictory results, with one reporting good validity [ 48 ], and the other reporting poor validity [ 49 ].…”

Clinical Relationship Between Cervicogenic Headache and Leg Length Discrepancy

“…Leg length discrepancy (LLD) greater than or equal to 15mm [44] to 20mm [45] has been shown to alter lumbar posture [45][46][47][48], has been associated with cervical pathology [49], and has been referenced as a risk factor for CGH [50], yet no studies to date have specifically studied the existence of a relationship between LLD and CGH. Therefore, the purpose of this study was to assess if a relationship existed between CGH and clinically relevant LLD ≥20 mm.…”

The Question of Short Lower Limb and Long Lower in Manual Therapy: An Overview

“…Manoeuvre: The patient is in a supine position with their legs stretched out; therapist performed an ankle dorsiflexion, compare lengths of internal malleolus. cervical segmental misalignment[18]. Abnormal pronation patterns we quantified using the Foot Posture Index (FPI) in a modified stance position: arms extended, forward lean against the wall, knees sufficiently bent to load the forefoot, score FPI < 2 from abnormal pronation for misalignment leg length (Figure 5).The relative position of the posterior superior iliac spines.…”