Structural Leg Length Difference
A structural leg length difference (LLD) is when one leg is physically longer than the other because of an actual difference in bone length — most often in the femur (thigh) or tibia (shin). This differs from a functional leg length difference, where the legs are the same length but appear uneven due to muscle imbalance, joint stiffness or pelvic alignment.
What causes a structural leg length difference?
A structural LLD can develop for several reasons, including:
- Differing growth rates in childhood, sometimes linked to disease or treatments such as chemotherapy that interfere with the bone growth plates.
- Injury or surgery to a bone or joint that alters its length.
- Changes in pelvic alignment, which can be influenced by factors such as scoliosis of the spine or damage to spinal discs, creating an imbalance so that one leg sits shorter on standing.
What symptoms can it cause?
When one leg is shorter, your body compensates — and those compensations can flow up the chain. Common symptoms may include:
- Foot, ankle, knee, hip or lower back pain
- An uneven or altered walking and running pattern
- One foot rolling in (pronating) more than the other
- Fatigue or discomfort that worsens with standing, walking or running
Because the body adapts in subtle ways, a structural LLD is sometimes only identified once these compensatory aches appear.
How does Blueprint Podiatry assess and treat it?
Our podiatry team takes the time to work out whether a true structural difference is present, how much it measures, and how it is affecting you — rather than treating the symptom in isolation.
Assessment may include a detailed history, a standing and weightbearing examination, and a thorough gait and running analysis. As every one of our podiatrists is a certified Level 1 Running Coach, we look closely at how your difference plays out in real movement — not just standing still.
Management of a structural LLD often involves a heel raise or a full-foot lift to help even up the body and reduce the compensatory changes that can drive pain. Where appropriate, this can be incorporated into a custom orthotic. At Blueprint Podiatry, orthotics are designed from weightbearing 3D scans and 3D printed in-house, so we can produce patient-matched left and right devices that account for the difference between your two legs — without the delay of an external lab.
Depending on your presentation, your plan may also include footwear guidance, foot mobilisation therapy, a tailored exercise program, and other clinic services such as shockwave therapy or dry needling to help manage related soft-tissue symptoms.
When should you seek help?
It's worth booking an assessment if you've noticed persistent one-sided foot, knee, hip or back pain, an uneven gait, or a noticeable difference in leg length — particularly in a growing child. Early, accurate assessment helps guide the right approach.
Medically reviewed by Matt Shanahan, registered podiatrist (AHPRA POD0001603396), Blueprint Podiatry.
Last reviewed: 21 June 2026.
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Frequently asked questions
How do you know if my legs are actually different lengths or just uneven?
A true structural difference comes from a genuine difference in bone length, while a functional difference comes from muscle, joint or alignment factors. Our podiatrists assess this through history-taking, weightbearing examination and gait analysis to determine which type you have and how it's affecting you.
Will I need orthotics or a heel lift for a leg length difference?
Sometimes. A structural LLD often benefits from a heel raise or full-foot lift to help balance the body and reduce compensations that cause pain. Where suitable, this can be built into a custom orthotic — 3D scanned and printed in-house at our Tuggerah clinic — though your plan depends on your individual assessment.
Can a leg length difference be checked in children?
Yes. Differing growth rates can contribute to a leg length difference in childhood, so it's reasonable to have a growing child assessed if you've noticed an uneven gait, one-sided complaints or an apparent difference. We see children's podiatry presentations and can guide you on the appropriate next steps.
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