Observation

• Keep both legs together with hips & knees flexed with the medial malleolus together
• Assess if any length discrepancy between the femur & tibia

Leg length measurement

• Overall measurement: Measure leg length from anterior superior iliac spine (ASIS) to medial malleolus
• Femur length: measure from tip of greater trochanter to lateral joint line
• Tibia length: measure from medial joint line to medial malleolus
• Femur head/neck length: measure distance from anterior superior iliac spine to tip of greater trochanter

Assess walking and view alignment with gait pattern

• After standing on both legs observe the pelvis when standing on one leg. If pelvis drops on the unaffected side this is a sign of ipsilateral dysfunctional abductor muscle function
• During walking the same phenomenon occurs where the pelvis drops to one side, hence a Trendelenburg gait pattern

Stand on one leg and assess if pelvis remain parallel to floor

• Flex hip to 90° and rotate internally & externally while measuring the maximum end point angle ROM

Hip internal & external rotation

• Ensure pelvis is stationary and does not move with testing
• Adduction: move leg across & towards opposite leg & measure maximum adduction angle
• Abduction: with stable pelvis move tested leg outwards to maximum abduction & measure maximum abduction angle