Overview
There are generally two kinds of leg length discrepancies. Structural discrepancy occurs when either the thigh (femur) or shin (tibia) bone in one leg is actually shorter than the corresponding bone in the other leg. Functional discrepancy occurs when the leg lengths are equal, but symmetry is altered somewhere above the leg, which in turn disrupts the symmetry of the legs. For example, developmental dislocation of the hip (DDH) can cause a functional discrepancy. In DDH, the top of the leg bone (femur) that is not properly positioned in the hip socket may hang lower than the femur on the other side, giving the appearance and symptoms of a leg length discrepancy.
Causes
Limb-length conditions can result from congenital disorders of the bones, muscles or joints, disuse or overuse of the bones, muscles or joints caused by illness or disease, diseases, such as bone cancer, Issues of the spine, shoulder or hip, traumatic injuries, such as severe fractures that damage growth plates.
Symptoms
LLD do not have any pain or discomfort directly associated with the difference of one leg over the other leg. However, LLD will place stress on joints throughout the skeletal structure of the body and create discomfort as a byproduct of the LLD. Just as it is normal for your feet to vary slightly in size, a mild difference in leg length is normal, too. A more pronounced LLD, however, can create abnormalities when walking or running and adversely affect healthy balance and posture. Symptoms include a slight limp. Walking can even become stressful, requiring more effort and energy. Sometimes knee pain, hip pain and lower back pain develop. Foot mechanics are also affected causing a variety of complications in the foot, not the least, over pronating, metatarsalgia, bunions, hammer toes, instep pain, posterior tibial tendonitis, and many more.
Diagnosis
On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.
Non Surgical Treatment
Treatment depends on the amount and cause of the leg length discrepancy as well as the age of your child. Typically, if the difference is less than 2 cm we don?t recommend immediate treatment. We may recommend that your child wear a heel lift in one shoe to make walking and running more comfortable. If the leg length discrepancy is more significant, your doctor may recommend surgery to shorten or lengthen a leg. The procedure used most often to shorten a leg is called epiphysiodesis.
shoe lifts for men's shoes
Surgical Treatment
Bone growth restriction (epiphysiodesis) The objective of this surgical procedure is to slow down growth in the longer leg. During surgery, doctors alter the growth plate of the bone in the longer leg by inserting a small plate or staples. This slows down growth, allowing the shorter leg to catch up over time. Your child may spend a night in the hospital after this procedure or go home the same day. Doctors may place a knee brace on the leg for a few days. It typically takes 2 to 3 months for the leg to heal completely. An alternative approach involves lengthening the shorter bone. We are more likely to recommend this approach if your child is on the short side of the height spectrum.
There are generally two kinds of leg length discrepancies. Structural discrepancy occurs when either the thigh (femur) or shin (tibia) bone in one leg is actually shorter than the corresponding bone in the other leg. Functional discrepancy occurs when the leg lengths are equal, but symmetry is altered somewhere above the leg, which in turn disrupts the symmetry of the legs. For example, developmental dislocation of the hip (DDH) can cause a functional discrepancy. In DDH, the top of the leg bone (femur) that is not properly positioned in the hip socket may hang lower than the femur on the other side, giving the appearance and symptoms of a leg length discrepancy.
Causes
Limb-length conditions can result from congenital disorders of the bones, muscles or joints, disuse or overuse of the bones, muscles or joints caused by illness or disease, diseases, such as bone cancer, Issues of the spine, shoulder or hip, traumatic injuries, such as severe fractures that damage growth plates.
Symptoms
LLD do not have any pain or discomfort directly associated with the difference of one leg over the other leg. However, LLD will place stress on joints throughout the skeletal structure of the body and create discomfort as a byproduct of the LLD. Just as it is normal for your feet to vary slightly in size, a mild difference in leg length is normal, too. A more pronounced LLD, however, can create abnormalities when walking or running and adversely affect healthy balance and posture. Symptoms include a slight limp. Walking can even become stressful, requiring more effort and energy. Sometimes knee pain, hip pain and lower back pain develop. Foot mechanics are also affected causing a variety of complications in the foot, not the least, over pronating, metatarsalgia, bunions, hammer toes, instep pain, posterior tibial tendonitis, and many more.
Diagnosis
On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.
Non Surgical Treatment
Treatment depends on the amount and cause of the leg length discrepancy as well as the age of your child. Typically, if the difference is less than 2 cm we don?t recommend immediate treatment. We may recommend that your child wear a heel lift in one shoe to make walking and running more comfortable. If the leg length discrepancy is more significant, your doctor may recommend surgery to shorten or lengthen a leg. The procedure used most often to shorten a leg is called epiphysiodesis.
shoe lifts for men's shoes
Surgical Treatment
Bone growth restriction (epiphysiodesis) The objective of this surgical procedure is to slow down growth in the longer leg. During surgery, doctors alter the growth plate of the bone in the longer leg by inserting a small plate or staples. This slows down growth, allowing the shorter leg to catch up over time. Your child may spend a night in the hospital after this procedure or go home the same day. Doctors may place a knee brace on the leg for a few days. It typically takes 2 to 3 months for the leg to heal completely. An alternative approach involves lengthening the shorter bone. We are more likely to recommend this approach if your child is on the short side of the height spectrum.