Weber-Barstow Maneuver | Functional Leg Length Difference

A functional leg length difference is the result of compensation for a change that might have occurred because of positioning rather than due to structure. So this could be the case in spinal scoliosis or excessive foot pronation, for example.

Gomez-Aguilar et al. (2021) evaluated the inter-rater reliability of the Weber-Barstow maneuver and found a Kappa value of 0.52. This means that this test has a moderate agreement.

To perform the maneuver, have your patient in supine position. You can give slight traction to make sure both legs are in the same position. Then, palpate the distal part of the medial malleoli and ask your patient to flex his hip and knee. Then, ask your patient to lift off the pelvis from the treatment table.

Next, passively extend your patient’s knees and bring his feet together. Now you can compare the height of the medial malleoli with your thumbs.

Different levels indicate asymmetry.
It is estimated that about 90% of the population has a leg length inequality with a mean of 5.2mm. The evidence suggests that for most people with anatomic leg length inequality is not clinically significant until the magnitude reaches approximately 20mm or more. (Knutson et al. 2005)

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other parts of basic hip joint assessment are:

• Active Range of Motion (AROM) Assessment of the Hip
• Passive Range of Motion (PROM) Assessment of the Hip

References

Gomez-Aguilar, E., Reina-Bueno, M., Lafuente-Sotillos, G., Montes-Salas, R., Munuera-Martinez, P. V., & Castillo-Lopez, J. M. (2021). Validity of clinical methods in the detection of leg-length discrepancies. HIP International, 31(2), 186-190.

Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & osteopathy. 2005 Dec;13(1):11.