Have you noticed that your pants always fit a little weird or that you are always leaning to one leg when standing for awhile? If so, one of your legs may be longer than the other. This is known as a leg length discrepancy. There are two main reasons for a leg length discrepancy. One reason is that one of your leg bones (tibia or femur) is longer on one side. This is referred to as a true leg length discrepancy because the actual length of your bones is different. A second reason is that your pelvic bone may be rotated on one side making it appear that one leg is longer than the other. This is referred to as an apparent leg length discrepancy because the actual length of your leg bones What is the Ilizarov method? not different. In order to figure out if you have a true or apparent leg length discrepancy, your doctor may take an x-ray to measure the length of your leg bones or a simple measurement from your belly button to your ankle can help determine the reason. Over time, the leg length difference can cause stress on your low back, hips and knees, which may cause pain or discomfort.
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.
The patient/athlete may present with an altered gait (such as limping) and/or scoliosis and/or low back pain. Lower extremity disorders are possibly associated with LLD, some of these are increased hip pain and degeneration (especially involving the long leg). Increased risk of: knee injury, ITB syndrome, pronation and plantar fascitis, asymmetrical strength in lower extremity. Increased disc or vertebral degeneration. Symptoms vary between patients, some patients may complain of just headaches.
Infants, children or adolescents suspected of having a limb-length condition should receive an evaluation at the first sign of difficulty in using their arms or legs. In many cases, signs are subtle and only noticeable in certain situations, such as when buying clothing or playing sports. Proper initial assessments by qualified pediatric orthopedic providers can reduce the likelihood of long-term complications and increase the likelihood that less invasive management will be effective. In most cases, very mild limb length discrepancies require no formal treatment at all.
Non Surgical Treatment
Treatment of leg length inequality involves many different approaches, such as orthotics, epiphysiodesis, shortening, and lengthening, which can be used alone or combined in an effort to achieve equalization of leg lengths. Leg length inequality of 2 cm or less is usually not a functional problem. Often, leg length can be equalized with a shoe lift, which usually corrects about two thirds of the leg length inequality. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up. This needs to be done for every shoe worn, thus limiting the type of shoe that the patient can wear. Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift. The shoe looks unsightly, and often the patient complains of instability with such a large lift. A foot-in-foot prosthesis can be used for larger leg length inequalities. This is often done as a temporizing measure for young children with significant leg length inequalities. The prosthesis is bulky, and a fixed equinus contracture may result.
Limb deformity or leg length problems can be treated by applying an external frame to the leg. The frame consists of metal rings which go round the limb. The rings are held onto the body by wires and metal pins which pass through the skin and are anchored into the bone. During this operation, the bone is divided. Gradual adjustment of the frame results in creation of a new bone allowing a limb to be lengthened. The procedure involves the child having an anaesthetic. The child is normally in hospital for one week. The child and family are encouraged to clean pin sites around the limb. The adjustments of the frame (distractions) are performed by the child and/or family. The child is normally encouraged to walk on the operated limb and to actively exercise the joints above and below the frame. The child is normally reviewed on a weekly basis in clinic to monitor the correction of the deformity. The frame normally remains in place for 3 months up to one year depending on the condition which is being treated. The frame is normally removed under a general anaesthetic at the end of treatment.
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