[Reprinted from University Medical Magazine, October, 1891.. 
TWO CASES OF A PECULIAR TYPE OF 
PRIMARY CRURAL ASYMMETRY. 
BY 
Henry Ling Taylor, M.D., 
Fellow of the Academy of Medicine, New- York ; Member of the 
New-York County Medical Society, etc., New-York; 
Member of the American Orthopedic 
Association. 
PHILADELPHIA 
UNIVERSITY OF PENNSYLVANIA PRESS 
1891 TWO CASES OF A PECULIAR TYPE OF 
PRIMARY CRURAL ASYMMETRY.1 
Henry Ling Taylor, M.D., 
Fellow of the Academy of Mediate York ; Member of 
the New- York County Medical Society, etc., New- 
York; Member of the American Orthopedic 
Association. 
It has been well known for some eighteen or twenty 
years that the lower extremities of some individuals, 
otherwise normal, differ in length, and that occasional 
cases occur where this difference is considerable. The 
question has been studied with reference to shortening 
after fracture of the femur, and also as to its bearing on 
the etiology and treatment of lateral curvature of the 
spine. In a previous paper2 a simple method of exami- 
nation was described by the writer, and thirty-four cases 
were recorded where the difference in the length of the 
extremities had been found to be more than a quarter of 
an inch ; in six it was an inch or more. The left leg 
was shorter in thirty cases ; the right, in four. About 
half the cases had permanent curvature-that is, a curva- 
1 Read at the fifth annual meeting of the American Orthopedic Asso- 
ciation, Washington, D C , September 22, 1891. 
* Primary Crural Asymmetry, The Medical Reord, April 26, 1884, 4 
TAYLOR, PECULIAR PRIMARY CRURAL ASYMMETRY. 
ture which did not disappear when the pelvis was levelled. 
Considerable stress was laid on the importance of pelvic 
obliquity as an etiological factor in many cases of curva- 
ture. 
In calling attention to these results Dr. F. Beely, 
of Berlin,1 remarked that there was an apparent differ- 
ence in the height of the iliac crests in many early cases 
of true lateral curvature due to rotation of the pelvis and 
shoulders or head, before much spinal deformity was ap- 
parent, and that in such cases as he had examined there 
was no actual difference in the length of the extremities. 
It is certainly true that where there is much rotation 
of the lumbar spine it is often difficult to be sure one is 
levelling from corresponding points on the iliac crests; 
then, if in the standing position the pelvis is rotated on 
a vertical axis passing through or near one acetabulum, 
as it sometimes seems to be, the opposite iliac crest and 
anterior iliac spine will be lower, even if there is no differ- 
ence in the actual length of the legs. In many cases of 
lateral curvature the pelvis is carried obliquely in sitting 
and standing from the effect of the malformed vertebral 
bodies and disks. The patient sits more heavily on one 
buttock, and in walking may carry the knee slightly bent, 
on the side toward which the pelvis slopes. It is cer- 
tainly easy to make mistakes, even if care is taken in the 
observations; and it would be well, as Dr. Beely sug- 
gests, to employ both levelling and the tape for greater 
certainty, as I did in the cases to be related. I am now 
' Centralblatt fur Orthopadische Chirurgie, July,-1885. TAYLOR, PECULIAR PRIMARY CRURAL ASYMMETRY. 
5 
inclined to think, that pelvic obliquity alone is not so often 
the cause of true lateral curvature as I then supposed, 
for the reason, among others, that I have seen cases in 
which the lumbar spine rotated away from the short side 
instead of toward it, and also because one finds cases of 
such large difference in the length of the extremities 
without rotation, as in the examples to be related. 
Case I--A lady, 23 years of age, came from the South in 
March, 1890, to consult me about the shortness of the right leg. 
She said she was in good health and could walk several miles; 
but her physician told me she did not walk far on account of tir- 
ing easily. She knew of no sickness during childhood, except 
measles at the age of 2 years. When she was 8 years old it was 
noticed that her back was not straight, and at 14 that there was 
a slight peculiarity in her walk. Only the past winter had she 
noticed that het right leg was short. This patient was of sallow 
and delicate appearance ; she walked with a slight limp, and the 
pelvis very markedly tilted to the right. She said her short leg 
-the right-was the stronger of the two, and that she was in the 
habit of standing on it, bending her left knee. Examination 
showed complete absence of any trace of present or previous af- 
fection of the joints, muscles or nerves. Joint mobility was nor- 
mal, the knee reflexes active, and the muscles were fairly devel- 
oped, those of the right leg being distinctly larger and firmer. The 
right calf measured 12 inches, the left ujf inches. The dis- 
tance from the anterior superior spine of the ilium to the internal 
malleolus measured on the right side 29 inches, on the left 31-• 
a difference of two inches in favor of the left leg. A part of this 
difference was below the knee, for as the patient sat with the soles 
on the floor there appeared to be a difference of about an inch in 
the height of the knees. Measurement from the head of the tibia 
to the internal malleolus revealed a difference of 1% inch in 
favor of the left; and from the great trochanter to the knee-joint 6 
TAYLOR, PECULIAR PRIMARY CRURAL ASYMMETRY. 
of an inch. Standing with the hips and back exposed, the 
pelvis was seen to be much tilted to the right, and a book two 
inches thick placed under the right foot levelled the pelvis, and 
very nearly straightened the back. There was no abnormal ro- 
tation or deformity of the spine, and no true lateral curvature, but 
merely a natural compensatory bending when the difference was 
not made up. The left foot was smaller and slightly shorter 
than its mate. The arms were apparently equal in length from 
the acromion to the end of the middle finger. I have no note of 
the fact, but I have a distinct impression that this patient was right- 
handed. 
Cas® II.-A large, well-developed girl of 15 was brought to 
me from Western Pennsylvania in June, 1890, for advice in regard 
to her left hip. Between the ages of 6 and 18 months she had 
had four attacks of convulsions attributed to teething. After that 
she was well, except for the ordinary children's diseases and a fall 
on the forehead at 6 years of age. She had never had symptoms 
of paralysis of the eyes, face or limbs, and had never walked lame 
till recently. For six months it had been noticed that the left 
hip was smaller, and she had had a slight limp or peculiarity in 
walking for six months past, especially when fatigued. For two 
months she had had a slight headache and had tired easily ; for a 
month her appetite had been less good than usual. She had no 
backache and slept well. This patient was rather nervous and 
quick in her movements, but was well nourished, and seemed to be 
in good or fair health. Her height was fifty-nine and a half 
inches in her stockings. There was little or no abnormality in her 
gait, but standing with her back exposed the left iliac crest was 
seen and felt to be about an inch lower than the right. A book 
one inch thick placed under the left foot made up the difference and 
straightened the spine, which had no abnorma rotation. The dis- 
tance from the ilium to the internal malleolus measured 30^ inches 
on the right side ; 29^ on the left. When the patient sat, the 
right knee was higher, and the measurement from the top of the 
tibia to the internal malleolus was five-eighths of an inch greater TAYLOR, PECULIAR PRIMARY CRURAL ASYMMETRY. 
7 
on the right side. The left (short leg) was more muscular and 
measured slightly more around the calf and above the knee. The 
knee reflexes were normal. This patient sewed with her left 
hand, but did everything else with her right hand. Her mother 
thought she was originally left-handed ; the girl thought she was 
right-handed. There was no well-established case of left-handed- 
ness in the family. From the tip of the acromion to the end of 
the middle finger, the right arm measured three-quarters of an 
inch more than its mate. 
The cases are of interest because of the large differ- 
ence observed with no assignable cause ; the absence of 
true lateral curvature; the fact that the short leg1 was 
decidedly the larger and stronger, and that rather more 
than half the shortening was demonstrated to be below 
the knee. Both patients experienced relief by using the 
proper amount of cork on the shoe of the short side. 
1 Mr. Chas. Roberts in the Lancet for April 27, 1878, says: " The limb pos- 
sessed of the least muscular development will be found the longer of the two."