Overview
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 is 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.
Causes
There are many causes of leg length discrepancy. Some include, A broken leg bone may lead to a leg length discrepancy if it heals in a shortened position. This is more likely if the bone was broken in many pieces. It also is more likely if skin and muscle tissue around the bone were severely injured and exposed, as in an open fracture. Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. A break in a child's bone through the growth center near the end of the bone may cause slower growth, resulting in a shorter leg. Bone infections that occur in children while they are growing may cause a significant leg length discrepancy. This is especially true if the infection happens in infancy. Inflammation of joints during growth may cause unequal leg length. One example is juvenile arthritis. Bone diseases may cause leg length discrepancy, as well. Examples are, Neurofibromatosis, Multiple hereditary exostoses, Ollier disease. Other causes include inflammation (arthritis) and neurologic conditions. Sometimes the cause of leg length discrepancy is unknown, particularly in cases involving underdevelopment of the inner or outer side of the leg, or partial overgrowth of one side of the body. These conditions are usually present at birth, but the leg length difference may be too small to be detected. As the child grows, the leg length discrepancy increases and becomes more noticeable. In underdevelopment, one of the two bones between the knee and the ankle is abnormally short. There also may be related foot or knee problems. Hemihypertrophy (one side too big) or hemiatrophy (one side too small) are rare leg length discrepancy conditions. In these conditions, the arm and leg on one side of the body are either longer or shorter than the arm and leg on the other side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This is known as an "idiopathic" difference.
Symptoms
The most common symptom of all forms of LLD is chronic backache. In structural LLD the sufferer may also experience arthritis within the knee and hip are, flank pain, plantar fasciitis and metatarsalgia all on the side that is longer. Functional LLD sufferers will see similar conditions on the shorter side.
Diagnosis
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
The object of treatment for leg length discrepancy is to level the pelvis and equalize the length of the two limbs. Inequalities of 2-2.5 centimeters can be handled with the following. Heel lifts/ adjustable heel lifts can be used inside a shoe where shoes have a full heel counter. Heel lifts may be added to the heel on the outside of the shoe along with an internal heel lift. Full platforms along the forefoot and rearfoot area of a shoe can be added. There are many different adjustable heel lifts available on the market. For treatment of a leg length discrepancy, consult your physician. They may refer you to a Physiotherapist or Chiropractor for determination of the type of LLD. A Certified Pedorthist (Canada) will treat a structural leg length discrepancy with a heel lift or in larger discrepancies a footwear modification.
functional leg length discrepancy treatment
Surgical Treatment
The type of surgery depends on the type of problem. Outpatient procedures may be used to alter the growth of the limb. This is often done through small incisions. If an outpatient procedure is done, your child can continue with most regular activities. Other times, surgery may be very involved and require the use of an external device that is attached to the limb with pins and wires. This device may be left on for months to correct the deformity or lengthen the leg. If this type of surgery is required, your child will be making weekly visits to Cincinnati Children's.
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 is 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.
Causes
There are many causes of leg length discrepancy. Some include, A broken leg bone may lead to a leg length discrepancy if it heals in a shortened position. This is more likely if the bone was broken in many pieces. It also is more likely if skin and muscle tissue around the bone were severely injured and exposed, as in an open fracture. Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. A break in a child's bone through the growth center near the end of the bone may cause slower growth, resulting in a shorter leg. Bone infections that occur in children while they are growing may cause a significant leg length discrepancy. This is especially true if the infection happens in infancy. Inflammation of joints during growth may cause unequal leg length. One example is juvenile arthritis. Bone diseases may cause leg length discrepancy, as well. Examples are, Neurofibromatosis, Multiple hereditary exostoses, Ollier disease. Other causes include inflammation (arthritis) and neurologic conditions. Sometimes the cause of leg length discrepancy is unknown, particularly in cases involving underdevelopment of the inner or outer side of the leg, or partial overgrowth of one side of the body. These conditions are usually present at birth, but the leg length difference may be too small to be detected. As the child grows, the leg length discrepancy increases and becomes more noticeable. In underdevelopment, one of the two bones between the knee and the ankle is abnormally short. There also may be related foot or knee problems. Hemihypertrophy (one side too big) or hemiatrophy (one side too small) are rare leg length discrepancy conditions. In these conditions, the arm and leg on one side of the body are either longer or shorter than the arm and leg on the other side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This is known as an "idiopathic" difference.
Symptoms
The most common symptom of all forms of LLD is chronic backache. In structural LLD the sufferer may also experience arthritis within the knee and hip are, flank pain, plantar fasciitis and metatarsalgia all on the side that is longer. Functional LLD sufferers will see similar conditions on the shorter side.
Diagnosis
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
The object of treatment for leg length discrepancy is to level the pelvis and equalize the length of the two limbs. Inequalities of 2-2.5 centimeters can be handled with the following. Heel lifts/ adjustable heel lifts can be used inside a shoe where shoes have a full heel counter. Heel lifts may be added to the heel on the outside of the shoe along with an internal heel lift. Full platforms along the forefoot and rearfoot area of a shoe can be added. There are many different adjustable heel lifts available on the market. For treatment of a leg length discrepancy, consult your physician. They may refer you to a Physiotherapist or Chiropractor for determination of the type of LLD. A Certified Pedorthist (Canada) will treat a structural leg length discrepancy with a heel lift or in larger discrepancies a footwear modification.
functional leg length discrepancy treatment
Surgical Treatment
The type of surgery depends on the type of problem. Outpatient procedures may be used to alter the growth of the limb. This is often done through small incisions. If an outpatient procedure is done, your child can continue with most regular activities. Other times, surgery may be very involved and require the use of an external device that is attached to the limb with pins and wires. This device may be left on for months to correct the deformity or lengthen the leg. If this type of surgery is required, your child will be making weekly visits to Cincinnati Children's.