Leg Length Discrepancy and Scoliosis: A Complete Guide for Parents and Patients

Leg Length Discrepancy and Scoliosis: A Complete Guide for Parents and Patients

A family enjoys a sunny day by the water, with children playfully splashing and carefree moments shared, illustrating the importance of understanding leg length discrepancy and scoliosis for a healthy spine.

Leg length discrepancy (LLD) – a condition where one leg is shorter than the other – can have a noticeable impact on posture. In growing children and even adults, a significant difference in leg lengths can tilt the pelvis and spine, sometimes leading to a curved spine. Is this real scoliosis or just a postural adaptation? In this comprehensive guide, we’ll demystify the connection between leg length differences, pelvic obliquity (uneven hips), sacral slanting (tilt of the base of the spine), and spinal curvature.

Our aim is to educate parents, patients, and even professionals (physios, osteopaths, chiropractors) in plain language with technical clarity. You’ll learn how to recognize signs of leg-length-related curvature, how it’s assessed (visually and via imaging like X-rays or EOS scans), and evidence-based management options – from simple heel lifts to bracing – all based on the latest research. We’ll also discuss the risk of misdiagnosis (pelvic tilt vs. true LLD) and when to seek further evaluation.

Throughout this guide, keep in mind that every spine is unique. While we’ll talk about functional scoliosis (sometimes called “pseudo-scoliosis”) caused by leg length discrepancy, we’ll also clarify how this differs from idiopathic scoliosis (a structural curvature with no relation to leg lengths). Our tone is warm and trustworthy, aligned with Australian health guidelines, so you can feel informed but not alarmed. Let’s start by understanding the basics of how a short leg can affect the spine.

Model of a spine illustrating the impact of a short leg on spinal alignment, highlighting the potential for imbalance and strain.

How Leg Length Discrepancy Leads to Pelvic Tilt and Scoliosis

When one leg is shorter than the other (even by a small amount), the body will often compensate to keep you balanced. Typically, the pelvis tips down on the side of the shorter leg – this is called pelvic obliquity, and it causes the base of the spine (the sacrum) to slant. Because the spine attaches to the pelvis, a tilted sacrum forces the spine to curve sideways to maintain an upright head and even gazepmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. This sideways curvature of the lumbar spine is a compensatory bend toward the short-leg side, effectively a functional scoliosis (meaning the spine bends due to an outside cause, not because of an inherent spinal disease). Research shows that limb length inequality commonly results in a lumbar scoliosis with the convexity (outward bulge) toward the shorter limbpmc.ncbi.nlm.nih.gov. In fact, 40–60% of children with a lumbar scoliosis have some pelvic tilt presentpmc.ncbi.nlm.nih.gov – often linked to a leg length difference.

Left: Without compensation, a shorter right leg causes the pelvis to tilt and the spine to curve. Right: Using a lift under the short leg helps level the pelvis and spine, reducing the curvaturepmc.ncbi.nlm.nih.gov.

This type of spinal curvature from LLD is sometimes termed a postural scoliosis or pseudo-scoliosis, because the spine itself is structurally normal – it’s just bending due to the uneven foundation. If you correct the uneven leg length (for example, by standing on a small block or heel lift on the short side), the pelvis can level out and the spine straightens up. In medical literature, it’s well documented that equalizing a leg length discrepancy can eliminate the scoliosis caused by itpmc.ncbi.nlm.nih.gov. One study of 369 children with LLD-related curves found that after giving them appropriate shoe lifts, over 83% showed correction of the spinal curve within weekspmc.ncbi.nlm.nih.gov. In other words, fix the leg length difference, and the spine goes back to normal alignment. This confirms that the curvature was functional (driven by posture) and not a fixed deformity.

It’s important to note that even a small leg length difference can matter. Sacral slanting – the tilt of the sacrum – does not have to be extreme to influence the spine. Recent research by Cho et al. (2024) found that even minor sacral slanting can affect the alignment of the upper spine and shoulderspubmed.ncbi.nlm.nih.gov. Think of the sacrum as the foundation of a building: if the foundation tilts a bit, the structure above will compensate. An unlevel sacral base indeed contributes to lumbar scoliosis and overall spinal imbalancepubmed.ncbi.nlm.nih.gov.

However, not every spinal curve is caused by a short leg. This brings us to a critical distinction: functional vs. structural scoliosis.

A professional consultation delves into the nuances of functional vs. structural scoliosis, emphasizing that not all spinal curves result from limb length discrepancies.

Functional (Leg-Length) Scoliosis vs. Structural (Idiopathic) Scoliosis

Not all scoliosis is created equal. Functional scoliosis refers to a curvature that is caused by something outside the spine – like a leg length discrepancy, muscle spasm, or bad posture habits. If you remove the cause, the spine can straighten. In contrast, structural scoliosis refers to an inherent curvature of the spine itself (often due to vertebrae that have rotated or developed abnormally). The most common form of structural scoliosis in kids and teens is idiopathic scoliosis, meaning it arises spontaneously from unknown causes, not due to leg inequality or other obvious factors.

How can you tell the difference? One key clue is flexibility. A functional scoliosis from LLD is generally non-structural and non-progressive – the spine’s structure is normal and the curve doesn’t get worse on its ownpmc.ncbi.nlm.nih.gov. If the person lies down or the leg lengths are equalized, the curvature diminishes or disappears. By contrast, in idiopathic scoliosis, the spine has a fixed twist; the curve often remains even when lying flat or bending to the side (and it may progress as the child grows if not treated). On an X-ray, a structural scoliosis will usually show vertebral rotation (the bones have twisted), whereas a purely functional curve shows little to no rotation.

Another tip: have the person sit down. In a true leg length discrepancy, the uneven hip height vanishes when sitting (since the legs aren’t bearing weight), and any scoliosis caused by it should also reduce. If the curvature is still evident while sitting, that suggests an intrinsic spinal curve not dependent on leg lengths.

Pelvic obliquity (uneven height of the hip bones) is the common link between LLD and spinal curvature. When one leg is shorter, pelvic obliquity occurs, and the spine curves to compensate. If the scoliosis is purely compensatory, it’s often called a postural scoliosis, and it “regresses totally or partially when its cause, that is LLD, is removed”pmc.ncbi.nlm.nih.gov. In plain terms: it’s reversible by fixing the leg length difference.

Idiopathic scoliosis, on the other hand, is not caused by pelvic tilt – often the pelvis may actually tilt because of the spinal curve. In some cases of long-standing scoliosis, one leg may appear functionally shorter as the body adapts (for example, the spine’s curve can shift weight distribution, causing one hip to sit higher). As one study notes, occasionally the scoliosis can cause an LLD (rather than the other way around), due to asymmetrical loading and growthpmc.ncbi.nlm.nih.gov. This is why careful assessment is needed – we don’t want to mistake a pelvic tilt due to scoliosis for a true leg length discrepancy.

It’s also worth noting that most children with idiopathic scoliosis do not have a significant anatomical leg length difference. A 2018 study by Ploumis and colleagues looked at adolescents with idiopathic thoracic or thoracolumbar scoliosis and found LLD > 1 cm in only 8.2% of casespmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. They concluded that meaningful LLD is uncommon in idiopathic scoliosis patientspmc.ncbi.nlm.nih.gov. So if a child has a sizable scoliosis, the odds are that it developed for reasons other than a short leg (since idiopathic scoliosis affects ~2% of kidspmc.ncbi.nlm.nih.gov, whereas significant LLD isn’t present in most of those cases). In those with idiopathic curves and a minor LLD, the leg difference tends to remain stable over time and is not the main driver of the scoliosis – the spinal curvature can progress during growth even if the leg discrepancy stays the samepmc.ncbi.nlm.nih.gov. This means treating an idiopathic scoliosis usually involves addressing the spine (bracing, exercises, etc.) rather than just adding a heel lift, especially if the leg length difference is small.

Summary: Functional scoliosis due to LLD is flexible and correctable by leveling the legs, while structural idiopathic scoliosis is a fixed curvature that comes from within the spine. Next, let’s explore how you might notice a leg-length discrepancy and related scoliosis in the first place.

A healthcare professional assesses leg length and flexibility to evaluate potential functional scoliosis due to leg-length discrepancy.

Signs and Diagnosis of Leg Length Discrepancy Scoliosis

Clinical signs of an LLD-related scoliosis can sometimes be subtle. Parents might notice that their child consistently stands with one hip higher than the other, or one shoulder looks lower. The child’s pants legs might always seem uneven in length, or shoe soles wear out asymmetrically. In cases of a pronounced leg length difference, the person might have a slight limp or gait asymmetry – they may dip down on the short leg side with each step. Chronic lower back pain in adults can also be a sign, as the uneven pelvic alignment puts strain on the lumbar spine and discspmc.ncbi.nlm.nih.gov. However, back pain is less common in children. In a purely functional scoliosis from LLD, when the person bends forward (Adams forward bend test), there is usually no significant rib hump (since the vertebrae aren’t rotated), unlike in structural scoliosis where a rib hump is a tell-tale sign.

When a healthcare professional evaluates suspected leg length discrepancy, they will typically do both a visual exam and precise measurements:

• Standing examination: The patient stands straight, ideally with legs shoulder-width apart. The examiner checks if the pelvis is level – often by palpating the iliac crests (top of the hip bones) on both sides. If one side is higher, they may then place thin blocks under the shorter leg until the pelvis levels out (this is called the block test). This indirect standing method incorporates foot and ankle mechanics and mimics how a lift would correct the discrepancypmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. For example, if a 1 cm board under the left foot evens the hip heights, it suggests an approximate 1 cm LLD on the left side. This method also immediately shows if the spinal curve straightens when the pelvis is level – a strong indicator of functional scoliosis.

  
  

• Supine measurement (direct method): The patient lies down flat. The practitioner may measure from fixed bony points (like the anterior superior iliac spine ASIS to the medial malleolus at the ankle) with a tape measure. This gives an idea of the true anatomical leg lengths. However, this supine tape measurement has limitations – studies have shown it can be quite inaccurate and inconsistentpmc.ncbi.nlm.nih.gov. Soft tissue thickness, difficulty in finding the exact landmarks, and the possibility that lying down removes pelvic tilt (masking a functional difference) all contribute to error. In fact, observer error of 5–10 mm is common with tape measurements, and one study reported that more than half of manual leg length measurements were wrong by over 5 mm when compared to radiographic standardspmc.ncbi.nlm.nih.gov. In over 10% of cases, the clinician even misjudged which leg was actually longerpmc.ncbi.nlm.nih.gov. Thus, while a supine tape measure can provide a rough estimate, it should be interpreted with caution.

  
  

Given these limitations, if a significant leg length discrepancy or scoliosis is suspected, imaging is often recommended for accurate assessment. The gold standard is a standing X-ray that includes the entire spine and the pelvis/hipsscolicare.com. This can be a plain radiograph (often a standing PA scoliosis X-ray) or an EOS image (a special low-dose biplanar X-ray). The imaging allows for precise measurements:

• On a standing full-spine X-ray, the radiologist can measure the height difference between the right and left femoral heads (the ball of the hip joints). This is essentially the functional LLD – how much one side of the pelvis is lower than the other in standingscoliosisjournal.biomedcentral.comscoliosisjournal.biomedcentral.com. They can also measure the tilt of the sacral base (sacral slant angle) and the difference in iliac crest heights, which quantify pelvic obliquityscoliosisjournal.biomedcentral.com.

  
  

• Advanced systems like EOS imaging even provide 3D measurements. In one study using EOS, researchers distinguished functional vs. structural LLD by reconstructing the actual bone lengths: they found that structural LLDs (true bone length differences) were usually very small – on average only 0.2 mm difference – while functional LLDs (as seen on standing posture) averaged about 5.6 mmscoliosisjournal.biomedcentral.comscoliosisjournal.biomedcentral.com. Remarkably, in that group of 82 scoliosis patients, 18 had an apparent leg difference of 10 mm or more when standing, yet none had an actual bony difference of ≥10 mmscoliosisjournal.biomedcentral.com. The disparity means those leg length differences were due to spinal/pelvic alignment, not because the bones were unequal. The authors noted “functional LLDs were caused by scoliosis” in those casesscoliosisjournal.biomedcentral.com – a crucial insight to avoid treating a phantom leg length problem in a primarily scoliosis case.

  
  

 Example of EOS standing full-spine imaging for scoliosis, showing the frontal (left) and lateral (center) X-ray views, and a 3D reconstruction of the spine and pelvis (right)hss.edu. Such imaging allows precise measurement of spinal curves and any pelvic tilt or leg length differences.

The X-ray will also quantify the spinal curvature via the Cobb angle, and check for vertebral rotation. According to radiographic criteria, a Cobb angle of 10° or more on the standing film confirms a true scoliosisscolicare.com. If that curve disappears when the short leg is lifted (sometimes separate X-rays are taken with a lift in place, known as a modified Ferguson view), it indicates a functional cause. If the curve persists and shows vertebral rotation, it’s a structural scoliosis. Standard practice is to get two views for scoliosis: a PA (frontal) and a lateral view, both done standing, to fully assess the spine’s alignmentscolicare.com. These should include the hips, as mentioned, to evaluate leg lengths. If scoliosis is suspected clinically (e.g. a notable asymmetry or a scoliometer reading above a threshold), an X-ray is warranted to confirm the diagnosis and determine if the curve is structuralscolicare.com.

In summary, combination of clinical examination (standing block test, visual inspection) and imaging (standing X-rays or EOS scans) provides the full picture. The clinical exam might tell us “the left hip looks lower and a 1 cm pad evens it out” while the X-ray might reveal “there’s a 12° lumbar curve and a 5 mm pelvic tilt.” Together, this information guides appropriate treatment. But first, one must ensure we’re treating the right problem – which leads us to avoiding misdiagnosis.

Medical professionals collaborate over patient X-rays and data to ensure accurate diagnosis and avoid misdiagnosis.

Avoiding Misdiagnosis: Pelvic Tilt or True Leg Length Discrepancy?

One of the biggest pitfalls in managing these cases is mistaking a pelvic tilt from another cause for a true leg length discrepancy, or vice versa. For instance, a child might have a mild idiopathic scoliosis that causes them to lean slightly on one side; on quick exam it might appear they have a short leg, when in fact their leg lengths are equal and the spine is the primary issue. If a practitioner assumed a short leg and slapped a heel lift on the “short” side, they could actually worsen the situation by tilting the child further. Similarly, if a child does have a true LLD but it’s written off as “just their scoliosis,” you might miss a chance to correct something that could be fixed easily.

To avoid these errors, clinicians follow a systematic approach:

• Examine in different positions: Check alignment when standing, then sitting, then lying. A real LLD will show up when standing (pelvic tilt) but not when sitting (since the legs aren’t a factor). A pelvic tilt that remains when sitting likely points to a spinal or structural issue.

  
  

• Assess flexibility of the curve: If the child bends to the side of the high hip and the curve reduces, it might be functional. If not, it may be structural.

  
  

• Imaging confirmation: As discussed, an X-ray can directly measure if the femurs and tibias differ in length (with EOS 3D or dedicated leg length X-rays) and simultaneously show the spine and pelvis alignment. This removes the guesswork. It’s far better to rely on imaging for any discrepancy beyond a trivial amount, given how unreliable visual/tape methods can be for small differencespmc.ncbi.nlm.nih.gov.

  
  

Healthcare providers are also taught to look for other causes of apparent LLD:

• Tight muscles or joint contractures can make one leg functionally shorter (for example, a tight hip flexor or knee bent slightly). This isn’t a true bony LLD but can mimic onepmc.ncbi.nlm.nih.gov.

  
  

• Foot biomechanics: a severely flat foot on one side can drop that side down a few millimeters; conversely a high arch on one side can make that leg effectively shorter. Custom orthotics might fix those, not a lift.

  
  

• Pelvic anomalies: sometimes a rotated pelvis or asymmetric hip development can give the illusion of LLD.

  
  

Given the complexity, referral for imaging is recommended in scenarios such as:

• Suspected leg length difference of more than about 5–10 mm that could be contributing to posture issues.

• Any scoliosis signs in a child (e.g. uneven shoulders or a rib hump on forward bend) – an X-ray is needed to measure the curvescolicare.com.

• Unclear cases where it’s not obvious what’s causing the asymmetry.

  
  

Using tools like a scoliometer can also help. A scoliometer is a small level device placed on the back (often over the spine or the sacrum) that measures the tilt. If placing the scoliometer over the lower back (sacrum) shows a significant tilt that corrects with a small lift underfoot, it’s a good hint that a leg length issue is presentpmc.ncbi.nlm.nih.gov.

The risk of misdiagnosis is a big reason why you shouldn’t rush into treatment without thorough assessment. As a parent, if you’re ever advised to get a heel lift or a brace, it’s fair to ask: “How do we know this is the right approach? Was the leg length measured accurately? Did we confirm with X-ray?” A careful clinician will appreciate those questions and ensure the root cause is identified before proceeding.

Exploring evidence-based treatment options with colorful heel lifts and orthotic inserts in athletic shoes for improved comfort and foot support.

Evidence-Based Treatment Options: Heel Lifts, Orthotics, and Bracing

Once a leg length discrepancy and any related scoliosis are properly evaluated, a tailored treatment plan can be made. Management options typically include:

• Heel Lifts / Shoe Inserts: This is the simplest and often most effective treatment for a functional scoliosis caused by a true leg length discrepancy. A heel lift is a wedge or platform added under the heel (or entire foot) of the shorter leg to raise it up. By leveling the sacral base, the spine no longer needs to curve to compensate. Research strongly supports this approach in the right situations: equalizing leg lengths has been shown to eliminate the scoliosis in a majority of cases where the curve was due to LLDpmc.ncbi.nlm.nih.gov. For example, Raczkowski et al. reported correction of the spinal curvature in over 80% of children after using lifts, usually within weekspmc.ncbi.nlm.nih.gov. Another study on adults found that using a heel lift to level the sacrum significantly reduced a mild lumbar scoliosis anglepubmed.ncbi.nlm.nih.gov.

  
  

• How much lift to use? Generally, the goal is to compensate for the measured difference, but not always 100% immediately. If one leg is 10 mm shorter, a 5–10 mm lift is considered (some clinicians will correct the full amount, others slightly under-correct initially to let the body adapt). Lifts can be placed inside the shoe up to a certain height (usually around 5–8 mm comfortably, sometimes up to ~12 mm with special insolesscolicare.com). If more height is needed, an external shoe build-up or orthopaedic shoe may be required. It’s often wise to start with a smaller lift and increase gradually – abruptly adding a large lift can cause temporary back pain as muscles adjustpmc.ncbi.nlm.nih.gov. In the study of 369 kids, those with bigger discrepancies sometimes took months for “real equalization” as they increased lift height over time, averaging about 11 months to fully correct the differencepmc.ncbi.nlm.nih.gov.

  Importantly, heel lifts are usually recommended for true, structural LLDs or significant functional ones that clearly affect alignment. If the leg length difference is very small (e.g. 3–5 mm), many practitioners won’t treat it at all, since such minor asymmetry is common (up to half the population has a slight inequalityscolicare.com) and within the body’s adaptive capacity. On the flip side, differences of >1.5–2 cm are quite substantial and often need interventionpmc.ncbi.nlm.nih.gov. There is some debate in the literature on what size discrepancy is “clinically significant” – some authors suggest even 5–10 mm can matter for the spinepmc.ncbi.nlm.nih.gov, while others argue that only very large differences (20–30 mm) truly impact long-term outcomespmc.ncbi.nlm.nih.gov. The consensus is to treat the patient, not just the number: if a 7 mm difference is causing a noticeable pelvic tilt and discomfort, a small lift is justified.

  
  

• Custom orthotics might be used in conjunction if foot mechanics are part of the issue. For example, a custom insole can both include a heel lift and also correct arch issues, providing a more comprehensive postural supportscolicare.com. ScoliCare (a scoliosis specialty group) notes that heel lifts and foot orthotics can aid in treating cases where leg length or pelvic tilt is causing spinal imbalancescolicare.com. Essentially, the lift addresses the leg length, while orthotic support ensures the foot is stable (preventing unequal pronation from mimicking a short leg).

  
  

• Scoliosis Bracing: If a patient has a structural scoliosis (idiopathic) that is moderate or progressing (typically Cobb angle > 20–25° in a growing child), a brace is indicated regardless of any leg length issues. Modern scoliosis braces, like the custom 3D ScoliBrace® used by ScoliCare clinics, are designed to halt curve progression and even correct the deformity over time. When a leg length discrepancy coexists with scoliosis, the approach may combine therapies. For instance, if a child has a 30° idiopathic curve and a 1.5 cm true LLD, they might wear a scoliosis brace to treat the curve and use a shoe lift to level the pelvis. Bracing and LLD correction are not mutually exclusive – they address different aspects (spine vs. base). In one case series, all scoliosis patients with >1 cm LLD were put in braces for their curves, but only those with the largest LLD (around 2 cm) got a heel lift as well, because without it the brace made them imbalancedpmc.ncbi.nlm.nih.gov. In fact, one teen with a 20 mm discrepancy started to “fall with the scoliosis brace on” until a lift was added to stabilize himpmc.ncbi.nlm.nih.gov. Once the lift leveled his foundation, the brace could do its job on the spine effectively. This underscores that for significant LLD, a lift might be needed to enable other treatments like bracing or exercise to work properly.

  
  

• It’s worth emphasizing that correcting leg length is not always appropriate in structural scoliosis cases, especially those with complex curves. In an idiopathic scoliosis with a double curve (an “S” curve balancing the spine), the pelvis might already be relatively level. Introducing a heel lift here could actually throw off that balance. As an example, if a patient has a double major curve and stands evenly balanced (no big pelvic tilt), but we measure a 5 mm difference in leg length on X-ray, you wouldn’t reflexively put a 5 mm lift – the spine has already compensated and is in equilibrium. Adding the lift might create a new imbalance (making one hip too high) and increase the curvature on one side. Scoliosis specialists caution that each case must be individualized: sometimes the spine drives the posture, and forcing a level pelvis isn’t helpful. In the EOS study mentioned earlier, none of the patients had a large true LLD, yet many had an apparent LLD from their scoliosisscoliosisjournal.biomedcentral.com. The take-home point is, if the scoliosis is primary (idiopathic) and the leg length difference is minimal or just functional, treating the scoliosis (e.g. bracing, therapy) is the priority, not adding lifts. Conversely, if there is a clear anatomical LLD contributing to a curve, addressing that asymmetry is crucial for long-term success.

  
  

• Physical Therapy and Scoliosis Exercise: In both functional and structural cases, targeted exercises can help. For LLD-related issues, therapy might focus on stretching tight muscles (e.g. the calf and hamstrings on the short leg side can tighten, and the hip flexors on the long leg side can become tightpmc.ncbi.nlm.nih.gov) and strengthening the core to support the spine. For structural scoliosis, Schroth method exercises or other scoliosis-specific rehab can improve posture and muscular balance. It’s important that any exercise program takes into account a leg length difference – for instance, therapists will often have a patient do exercises with a small lift under the short leg so they are training in a balanced position.

  
  

• Observation: If the leg length difference is mild and the scoliosis is mild, sometimes the plan is simply to monitor growth and posture. Many children with a small LLD (e.g. 5–9 mm) and a mild curvature (say 10°) might just be rechecked periodically. As Ploumis et al. noted, those small anisomelias tend not to worsen with growthpmc.ncbi.nlm.nih.gov. However, if a child is still growing and has a structural curve, frequent monitoring is needed because idiopathic scoliosis can progress rapidly during growth spurtspubmed.ncbi.nlm.nih.gov.

In all cases, the overarching goal is to provide a level foundation (when needed) and address the spine appropriately. That leads us to the concept of the sacral base in scoliosis treatment.

Why a Level Sacral Base Matters in Scoliosis Therapy

Imagine trying to build a tower on a crooked base – you’d have to make compensations as you stack blocks to keep the tower upright. The human spine works similarly. The sacrum – which connects to the pelvis – is the base of the spinal column. If the sacrum is tilted (sacral slanting) due to a leg length discrepancy or pelvic obliquity, the spine above will develop curves to keep the head centered. This is why many clinicians emphasize establishing a level sacral base before or during scoliosis treatment.

Having a level base is particularly important when prescribing things like braces or exercises. For example, a corrective scoliosis brace applies forces to de-rotate and straighten the spine. If one leg is significantly shorter and uncorrected, the brace might straighten the spine relative to the pelvis, but the person could end up leaning to one side because the whole pelvis is tipped – undermining the effectiveness of the brace. As mentioned, one case had to incorporate a heel lift with a brace to prevent the patient from toppling over due to the unaddressed pelvic tiltpmc.ncbi.nlm.nih.gov. Once the sacral base was leveled, the brace could maintain proper alignment and the patient’s balance improved.

Even in therapy, say a patient is doing side planks or other exercises to improve a lumbar curve – if their pelvis is tilted during those exercises, they might be strengthening a compensated position. By first using a small lift to level them, the exercises can be done in a more neutral alignment, leading to better outcomes.

There is evidence supporting that leveling the sacral base can directly reduce curvature. We saw that in Dr. Irvin’s study where adding heel lifts in adults with mild lumbar curves reduced the lateral bending angle of the spinepubmed.ncbi.nlm.nih.gov. The results “suggest that an unlevel sacral base contributes to lumbar scoliosis” and correcting it can be beneficialpubmed.ncbi.nlm.nih.gov. Another study in kids found that when LLD was corrected, both the pelvic tilt and the scoliotic curve regressed in most casespmc.ncbi.nlm.nih.gov.

However, caution is warranted: leveling the sacral base is a means to an end, not always an end in itself. In idiopathic scoliosis with established structural curves, the sacrum might be tilted as part of the spine’s overall balance strategy. If you forcibly level it without addressing the spinal curves, you might see some unintended shifts. Therefore, practitioners will level the base when it clearly improves alignment and is needed (particularly in functional curves or unbalanced single-curve scoliosis). In complex curves, they might partially level or carefully test the effects (e.g., do an X-ray with a trial lift to see if the overall alignment improves or not before making it a permanent addition).

In summary, a level sacral base often provides the optimal foundation for any further scoliosis correction – it’s easier to straighten a spine that’s not also balancing on a slant. Achieving that may be as simple as a shoe insert, and it can make therapies like bracing or exercises significantly more effectivepubmed.ncbi.nlm.nih.gov. It’s all about giving the body the best mechanical advantage to heal or correct itself.

Youthfulness and resilience: A young boy stands with a soccer ball, embodying strength and positivity in the journey of managing scoliosis and limb length discrepancy.

Conclusion: Caring for Scoliosis and LLD – Your Next Steps

Dealing with posture issues in your child or for yourself can be challenging – there’s often a puzzle to solve, and you want to get it right. The key takeaways from this guide are: (1) leg length discrepancy can cause a real but functional scoliosis (a curved spine that can straighten when the inequality is fixed); (2) thorough assessment is crucial to distinguish this from structural scoliosis; and (3) evidence-based interventions like heel lifts, when appropriate, can dramatically improve alignment, while structural scoliosis may require bracing or other therapies. The goal is always to treat the whole person – leveling the framework (legs and pelvis) and addressing the spine itself so that everything works in harmony.

If you’re in the Melbourne area (or specifically Glen Waverley), and you’re concerned about your or your child’s posture, uneven hips, or a scoliosis diagnosis, we’re here to help. At Posture Blueprint Glen Waverley, our approach is holistic and research-informed. We start with a comprehensive posture assessment – checking leg lengths, spine alignment, and overall balance. We use the latest imaging standards (including low-dose options) when needed, and we collaborate with you to create a custom plan, whether that’s monitoring, providing a gentle heel lift, exercise therapy, or referring for bracing if necessary. Our team is warm, caring, and mindful of Australian health guidelines, so you’ll get honest advice without any hype.

Colorful beach huts line the sandy shores, capturing the vibrant spirit of the Melbourne area. If you're in Glen Waverley, visit Posture Blueprint for care in posture and scoliosis.

Ready to take the next step? We offer a free posture assessment for new patients, so you can get clarity on what’s going on and peace of mind about the best path forward. If you’re in Glen Waverley or nearby, you can easily book your complimentary assessment through our website. Visit Posture Blueprint and click on “Book a Free Posture Assessment,” or give us a call. We’ll be happy to answer your questions and set up a time that works for you.

Remember: A small difference today can make a big difference in the future – leveling a foundation, guiding a spine’s growth, or simply easing your worries with expert guidance. With the right knowledge and support, you can help ensure your child stands tall and confident, on an even footing, and with a healthy spine. We’re here to provide that blueprint for better posture and a thriving life.

References:

1. Raczkowski, J. et al. (2010). Functional scoliosis caused by leg length discrepancy. Annals of Agricultural and Environmental Medicine, 17(2), 249-252. pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov

2. Ploumis, A. et al. (2018). Progression of idiopathic thoracic or thoracolumbar scoliosis and pelvic obliquity in adolescent patients with and without limb length discrepancy. Journal of Orthopaedic Surgery and Research, 13(1), 192. pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov

3. Cho, J.H. et al. (2024). Does Sacral Slanting Affect Postoperative Shoulder Balance in Lenke Type 2A Adolescent Idiopathic Scoliosis? Neurospine, 21(1), 286-292. pubmed.ncbi.nlm.nih.gov

4. Kim, H. et al. (2010). Scoliosis Imaging: What Radiologists Should Know. RadioGraphics, 30(7), 1823-1842. pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov

5. ScoliCare (2023). What Are the Correct Scoliosis X-rays to Request? scolicare.comscolicare.com

6. ScoliCare (n.d.). Foot Orthotics and Heel Lifts – Pro Products. scolicare.com

7. Sekiya, T. et al. (2018). Evaluation of functional and structural leg length discrepancy in patients with adolescent idiopathic scoliosis using the EOS imaging system. Scoliosis and Spinal Disorders, 13:3. scoliosisjournal.biomedcentral.comscoliosisjournal.biomedcentral.com

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