title: Distance Between the Malleoli and the GroundA New Clinical Method to Measure Leg-Length Discrepancy.
abstract: BACKGROUND
  The aim of this work is to introduce a useful method for the clinical diagnosis of leg-length inequality: distance between the malleoli and the ground (DMG).
  
  
  METHODS
  A transversal observational study was performed on 17 patients with leg-length discrepancy. Leg-length inequality was determined with different clinical methods: with a tape measure in a supine position from the anterior superior iliac spine (ASIS) to the internal and external malleoli, as the difference between the iliac crests when standing (pelvimeter), and as asymmetry between ASISs (PALpation Meter [PALM]; A&D Medical Products Healthcare, San Jose, California). The Foot Posture Index (FPI) and the navicular drop test were also used. The DMG with Perthes rule (perpendicular to the foot when standing), the distance between the internal malleolus and the ground (DIMG), and the distance between the external malleolus and the ground were designed by the authors.
  
  
  RESULTS
  The DIMG is directly related to the traditional ASIS-external malleolus measurement (P = .003), the FPI (P = .010), and the navicular drop test (P < .001). There are statistically significant differences between measurement of leg-length inequality with a tape measure, in supine decubitus, from the ASIS to the internal malleolus, and from the ASIS to the external malleolus.
  
  
  CONCLUSIONS
  This new method (the DMG) is useful for diagnosing leg-length discrepancy and is related to the ASIS-external malleolus measurement. The DIMG is significantly inversely proportional to the degree of pronation according to the FPI. Conversely, determination of leg-length discrepancy with a tape measure from the ASIS to the malleoli cannot be performed interchangeably at the level of the internal or external malleolus.
authors.forename: Estela Gomez
authors.initials: EG
authors.lastname: Aguilar
authors.forename: Águeda Gómez
authors.initials: ÁG
authors.lastname: Domínguez
authors.forename: Carolina
authors.initials: C
authors.lastname: Peña-Algaba
authors.forename: José M
authors.initials: JM
authors.lastname: Castillo-López
mesh_terms: D000293:Adolescent; D000328:Adult; D064386:Ankle Fractures; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007870:Leg Length Inequality / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D010173:Palpation / Q000295:instrumentation* / Q000379:methods; D056888:Patient Positioning / Q000379:methods; D010808:Physical Examination / Q000379:methods*; D011032:Podiatry / Q000379:methods; D011859:Radiography / Q000379:methods*; D018709:Statistics, Nonparametric; D016683:Supine Position; D013639:Tarsal Bones / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D055815:Young Adult