Menu

Jonathans Concepts

Reports With Regard To You

Congenital Leg Length Discrepancy

June 29, 2017
Overview

Many children have one leg that is marginally longer than the other. In most cases, the difference is present at birth but may be too slight to be detected. More significant leg length differences (more than 2 cm) often become obvious as your child grows and begins to crawl and walk. We don?t always know what causes these discrepancies. A significant discrepancy can lead to more serious problems including arthritis and difficulty walking. However, with appropriate treatment, most children with this condition can participate in regular activities. Treatment options include heel lifts and, in more severe cases, surgery to either lengthen or shorten a leg.Leg Length Discrepancy

Causes

Sometimes the cause of LLD is unknown, yet the pattern or combination of conditions is consistent with a certain abnormality. Examples include underdevelopment of the inner or outer side of the leg (hemimelias) or (partial) inhibition of growth of one side of the body of unknown cause (hemihypertrophy). These conditions are present at birth, but the limb length difference may be too small to be detected. As the child grows, the LLD increases and becomes more noticeable. In hemimelia, one of the two bones between the knee and the ankle (tibia or fibula) is abnormally short. There also may be associated foot or knee abnormalities. Hemihypertrophy or hemiatrophy are rare conditions in which there is a difference in length of both the arm and leg on only one side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This type of limb length is called idiopathic. While there is a cause, it cannot be determined using currect diagnostic methods.

Symptoms

Children whose limbs vary in length often experience difficulty using their arms or legs. They might have difficulty walking or using both arms to engage in everyday activities.

Diagnosis

The doctor carefully examines the child. He or she checks to be sure the legs are actually different lengths. This is because problems with the hip (such as a loose joint) or back (scoliosis) can make the child appear to have one shorter leg, even though the legs are the same length. An X-ray of the child?s legs is taken. During the X-ray, a long ruler is put in the image so an accurate measurement of each leg bone can be taken. If an underlying cause of the discrepancy is suspected, tests are done to rule it out.

Non Surgical Treatment

Internal heel lifts: Putting a simple heel lift inside the shoe or onto a foot orthotic has the advantage of being transferable to many pairs of shoes. It is also aesthetically more pleasing as the lift remains hidden from view. However, there is a limit as to how high the lift can be before affecting shoe fit. Dress shoes will usually only accommodate small lifts (1/8"1/4") before the heel starts to piston out of the shoe. Sneakers and workboots may allow higher lifts, e.g., up to 1/2", before heel slippage problems arise. External heel lifts: If a lift of greater than 1/2" is required, you should consider adding to the outsole of the shoe. In this way, the shoe fit remains good. Although some patients may worry about the cosmetics of the shoe, it does ensure better overall function. Nowadays with the development of synthetic foams and crepes, such lifts do not have to be as heavy as the cork buildups of the past. External buildups are not transferable and they will wear down over time, so the patient will need to be vigilant in having them repaired. On ladies' high-heel shoes, it may be possible to lower one heel and thereby correct the imbalance.

Leg Length Discrepancy Insoles

deelsonheels

Surgical Treatment

Epiphysiodesis is a surgical option designed to slow down the growth of the long leg over a period of months to years. It is only used in growing children. The operation involves a general anaesthetic. Small incisions are made around the knee near the growth plates of the thigh bone and the shin bone. The growth plates are prevented from growing by the use of small screws and plates (?8 - plates?). The screws are buried beneath the skin and are not visible. Stitches are buried beneath the skin and do not need to be removed. The child is normally in hospital for 2-3 days. The child can weight bear immediately and return back to normal activity within a few weeks. Long term follow up is required to monitor the effects of the surgery. The timing of the surgery is based on the amount of growth predicted for the child. Therefore, this procedure can under- and over-correct the difference in leg length. Occasionally the screws have to be removed to allow growth to continue. This procedure can be used on one half of the growth plate to correct deformity in a limb e.g. knock-knees or bow legs. This is known as hemiepiphysiodesis.

Go Back