Many methods are used to measure the length of both lower extremities. The measurements I will describe will quickly indicate if there is a structural abnormality. If you are unsure if it is structural bilateral lower extremity length or if it is difficult to easily determine, you may recommend that the patient have a CT scan to determine structural or functional bilateral lower extremity length. If there is an imbalance in the structure of the lower extremities, then symptoms around the hip and lumbar regions will be evident. Usually, the structural long lower extremity will have an increased angle of rotation forward. In addition, the patient usually presents with unilateral knee valgus as a surrogate for the structural long lower extremity. Therefore, we need to be keenly observant and examine these structural abnormalities and the associated compensatory mechanisms. It is important to perform a bilateral lower extremity length assessment in the system at this time, as it will alert the physician to look for unilateral anterior rotation as a compensator when the patient is in the closed chain position of NCSP and RCSP. When measuring bilateral lower extremity length, strive to minimize the effects of pelvic opening and torsion a these factors may interfere with the measurement process and findings. Always inform the patient what you are doing and why you are doing it. Use the discussion to obtain any additional information, such as “I will now measure the length of your lower extremities, which may have an effect on the arch pain you are experiencing. Have you had any back or hip pain?” The measurement assessment process I have used in my practice since 1996 involves drawing an ink line just below the medial ankle. Then, an attempt is made to remove any compensatory soft tissue tightening, as well as any “inward spreading” or “outward spreading” of the pelvis. How can the doctor adjust the patient, I recommend that they do so. However, for other physicians who cannot perform a word alignment, a simple pelvic “swing” will help temporarily relax the tense muscles and help maintain proper alignment of the ASIS (anterior superior iliac spine). A higher ASIS combined with a lower ASIS indicates that the patient has pelvic torsion. A slow “hip twist” procedure is enough to “relax” the tense muscles around the hip, allowing you to measure the long bones without soft tissue restrictions. I have found this method to be very reliable – certainly more reliable than the ligature method of measurement. Note that if you use orthopedic therapy and ignore that the patient has structural bilateral lower extremity length problems, then the orthopedic insole will remove the natural long lower extremity pronation compensation and the patient will usually complain of back and hip pain felt in the relative location of the old pain. This step is critical in both simple evaluations as well as more complex evaluations. Functional. Bilateral lower extremity length (i.e., no significant structural . unequal length of both lower extremities) can be treated with orthopedic insoles only, with a combination of structural adjustments to aid treatment, including stretching and deep tissue massage, adjustments, and loosening maneuvers as needed.