Distance Between the Malleoli and the Ground

The aims of the present study were to introduce a useful method for the clinical determination of leg length asymmetry—distance between the malleoli and the ground (DMG)—and to determine whether there is a relationship between the different methods of quantifying leg-length discrepancy and foot position.

A correlational, transversal, and observational descriptive study was performed on 17 patients with leg length discrepancy.

The following variables were determined: 1) the length of each leg, with a tape measure from the most prominent area of the ASIS to the inferior border of

the external malleolus and from the ASIS to the inferior border of the internal malleolus; 2) the difference between the iliac crests, by means of the pelvimeter; 3) asymmetry between the ASIS with the PALpation Meter (PALM); 4) the Foot Posture Index (FPI), to quantify the degree of neutral, pronated, or supine position of the foot; 5) fall in navicular with the patient standing, to quantify the capacity for pronation of the subtalar joint, with the navicular drop test (NDT); and 6) the distance from both external and internal malleoli to the ground (DMG), including the distance between the internal malleolus and the ground (DIMG) and the distance between the external malleolus and the ground (DEMG).

The variable observed to be most related to the remaining variables studied is the DMG.

A direct relationship was found between ASIS–internal and external malleolus distance and the DMG, suggesting that this may be a useful clinical method for studying lower-limb asymmetry.

The DIMG was determined to be significantly inversely proportional to the degree of pronation according to the FPI.

Leg length discrepancy in healthy individuals cannot be measured interchangeably at the level of the internal or external malleolus given that there are statistically significant differences between both methods.


  1. Aguilar, E. G., Domínguez, Á. G., Peña-Algaba, C., Castillo-López, J. M. (2017) Distance Between the Malleoli and the Ground. Journal of the American Podiatric Medical Association: March/April 2017, Vol. 107, No. 2, pp. 112-118

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