Burch (1989, based on Goodrich 1942) cites New York to North Carolina with potential in South Carolina for the nominal subspecies and Hot Springs in Bath Co., West Virginia for Leptoxis carinata nickliniata as well as other areas in West Virginia nearby (Miller-Way and Way, 1989). Populations inhabiting the Kanawha River and its tributaries (i.e. South Fork New River, Knapp Creek) conventionally have been referred to as Leptoxis dilatata but Dillon and Robinson (2008) could find no significant difference, morphological or otherwise, to distinguish them from Leptoxis carinata. Dillon and Robinson (2008) argue that it represents a living fossil left relictually from the Paleozoic uplift of the Appalachians.