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Leg length discrepancy as a rare cause of a piriformis syndrome.

Dere et al. [3] presented two female patients with piriformis syndrome (PS) who had a shorter leg on the effected side. Triamcinolone piriformis injections with equalization of patients’ leg lengths using insoles solved the problems without further recurrence of PS symptoms. The authors concluded that a “short leg” is one of the rarer causes of PS and it can be seen alone or in combination with other causal factors. There was no mention of any articles which presented the issue of leg length discrepancy related to PS in the English medical literature [1,2,4–7,9], and there was no biomechanical explanation of the causal factor. Therefore, we would like to emphasize a few facts pertaining to this issue. To the best of our knowledge, TePoorten [9] was the first to mention shortness of the affected extremity among signs of PS 40 years prior to the publication of Dere et al. [3]. Several years later, Retzlaff et al. [7] emphasized that the leg on the affected side is shortened due to a contracture of the piriformis muscle. In cases where the leg on the opposite side appears shortened, it is probable that some other dysfunction exists and that the condition is not directly related to the PS. On the other hand, Hallin [5] stated that pain and tenderness are most often on the “long side”, but may be bilateral or on the short side only. It should be mentioned that a 1 cm elongation of the affected leg was identified as a