Cover image for Leg Length Difference article

Leg length discrepancy: causes and treatment methods

The difference in the length of the legs is the presence of one leg longer than the other due to the difference in the length of the bones in them, due to the difference in growth, where the length in the first leg is average, and the other is deficient.

There are many reasons for the difference in the length of the legs in children. The difference in the length of the legs is not only an aesthetic problem but a significant cause of many other orthopedic diseases, such as: scoliosis (sidway curve in the spine).

There are many ways to treat leg length discrepancy, and surgery is the most prominent of these solutions. The different leg-length surgery techniques and equipment used in it differ depending on the patient’s condition and the extent of his aspirations for treatment results.

Surgery is not the only treatment for the disparity in the length of the legs, as there are many other non-surgical treatments. Follow us in this article to learn all the information about the difference in the length of the legs in detail.

What is leg length discrepancy?

Many people have a problem with different lengths of the upper and lower extremities, but it is minor and unnoticeable. The difference in the length of the arms as a disease is less symptomatic and affects the patient's daily life. Therefore, in these two articles, we will focus on the difference in the length of the lower limbs.

As we mentioned, there is a difference in the length of the legs in many people, but it is not noticed and does not affect the lifestyle. But if the difference in the length of the legs is more than 2 cm, the patient will face a problem in his daily life, especially while walking.

Image showing the difference in the length of the legs
Leg length discrepancy

What are the causes of leg length discrepancy?

There are many causes of leg length discrepancy, but mainly they are divided into four groups of causes that lead to the cessation of bone growth on one side while the other remains normal. (Some diseases may lead to excessive limb growth, not stopping its growth).

Congenital leg length difference

A halt in the growth of one of the two limbs may occur during fetal life for unknown reasons, and the child is born with one leg shorter than the other (developmental defect). Some congenital diseases also lead to discrepancies in the length of the legs, such as Evolutionary hip dislocation (natal) and the hip varus Coxa Vara.

Traumatic Leg length difference

The difference in the length of the legs also occurs through the injury of the leg with complex bony fractures that do not heal quickly, especially in the area of the growth disc (growth cartilage), where the fracture in this area leads to its early ossification. Hence, the growth of the leg stops while the other leg continues to grow normally, which causes a difference in the length of the legs.

Special mention is made of the femur and tibia since a severe fracture may cause them to stop increasing in length. Some fractures of the femur may lead to overgrowth of the bone, leading to an increase in the length of the leg and the occurrence of leg length discrepancy.

leg length discrepancy due to orthopedic diseases

Orthopedic diseases in some people lead to a lack of bone growth and, thus, a shortened bony length in the affected limb. Among the most important of these diseases that lead to leg length discrepancy:

  • Osteomyelitis: It is a severe inflammatory disease that occurs due to inflammation and infection of the bone with germs and may lead to amputation of the limb if it is not treated promptly.
  • bone tumors;
  • bone cysts

And the reason for the last two diseases may be a result of the treatment of these two diseases in the first place because the therapy here is either surgical removal or exposing the bone to radiation, or giving the patient chemical drugs to treat cancer. Still, at the same time, they lead to slowing down or stopping bone growth.

leg length discrepancy for other reasons

Some other diseases may cause weakness in the limb or the inability to use it, causing a deficiency in its growth. Others may form inflammation around the growth disc, thus disrupting its functioning and generating a difference in the length of the legs. Among these diseases:

  • Cerebral Palsy
  • Juvenile arthritis

Leg length discrepancy Symptoms

Symptoms of length difference in the legs occur according to the severity of this difference. When the bone length difference is significant, the signs will be apparent, the most important of which are:

  • Lameness: Because of the height difference, the patient will limp while walking, as one hip will be higher than the other, or he will bend the knee of the extended leg to be able to walk, and he may walk on tiptoes on short feet.
  • Back pain: due to the abnormal way of walking.
  • Fatigue: the result of excessive effort to walk.

Leg length discrepancy Treatment in Turkey

Previously, the treatment of leg length discrepancy was difficult and not possible, but recently Bimaristan Medical Center Provides The latest methods of treating leg length discrepancy.

The treatment is done for the height difference based on the patient’s condition, desires, and aspirations, in addition to the advice of the specialist doctor, as there is a non-surgical treatment if the patient does not wish to undergo surgery.

Surgery provides many treatment solutions in many cases, as it restores the limb to its average length and achieves equality in the length of the feet, either by shortening the long limb or lengthening the short limb (with the same principle of Stature Lengthening surgery). The choice is made according to the patient's desire to gain a little height or lose a few centimeters of his height for his gait to return to normal.

Non-surgical treatment of leg length discrepancy

If the difference in length between the legs is not significant (less than 2 cm), then surgery is not recommended. A non-surgical solution is preferred because the benefit from surgery here is small compared to the risk of undergoing it, in addition to the use achieved from non-surgical treatment in the few differences. Among the non-surgical methods of treatment:

Physiotherapy

Physical therapy relies on stretching exercises for the muscles, and this treatment may be helpful if the length of the legs is slightly different. Still, this type of treatment must be done under the supervision of a physiotherapist who knows which exercise to follow. Contact us To reserve your seat for Physiotherapy in Turkey.

Shoe brace

The length difference in the legs may be treated simply by placing a lever or support for the patient's shoe in the short foot so that the height of this support is equal to the difference between the length of the legs and thus the problem of the difference in the length of the legs is solved.

prosthetics

The difference in the length of the legs may be due to a bone disease that eventually leads to amputation of the limb, and here it is functional. Prosthetics fitting In order for the patient's life to return to normal.

Leg length discrepancy surgery

It is divided into two main parts: the leg-shortening and the leg-lengthening processes. The appropriate surgery is chosen according to the patient’s age and the degree of difference in length between the legs.

Leg shortening in Turkey

This type of surgery is used when the difference in the length of the legs is of medium severity (between 2 and 6 cm) and is divided into two types of surgeries according to the age of the patient (if he is an adult and full of growth or in the stage of growth and height increase). One of the disadvantages of this type of operation is that the patient loses some centimeters of his height. However, one of its advantages is that it is a simple operation and not a significant surgery like leg lengthening operations.

Leg shortening in children

Since children are in the stage of growth and increase in height, it will be beneficial to treat the difference in the length of their legs by stopping bone growth in the normal limb so that the limb that is short in length can join the length of the first limb and thus recover from the leg length discrepancy. There are two types of surgeries here:

  • Epiphysiodesis: The doctor fuses the epiphyseal bone at the long limb to stop it from growing temporarily or permanently. The timing here is the most critical factor in the success of this treatment.
  • Epiphyseal Stapling: It is done by inserting staples into the bone epiphysis of the longer leg by the orthopedist to stop it from growing temporarily until the short leg catches up with it and they become the same length, then the staples are removed.
Leg shortening in adults

Since bone growth is complete in adults, the only solution to the difference in the length of the legs is to remove part of the bone in the short leg by the surgeon so that the two sides of the bone heal after removing a piece of it and the length of the legs are equal.

A radiograph showing the removal of a piece of bone from the femur in order to treat the difference in the length of the legs through the process of shortening the leg
Removing a piece of bone from the thigh bone to treat Leg length discrepancy through the process of shortening the leg

Leg lengthening surgery in Turkey

It is the most extended operation among the surgeries for leg length discrepancy. It is performed for patients in adolescence and the beginning of puberty and is based on the principle of healing fractures in the bones. This operation is done in Turkey by removing a piece of the bone to be lengthened, and a bone-lengthening device is placed. After installing this device in a surgical operation, the doctor recommends the child or family members increase the distance between the two pieces of bone by adjusting the length of the device placed between these two pieces daily by rotating a small arm placed on the leg and connected to the intraosseous device.

Image showing a bone lengthening device
Internal and external bone lengthening device

This procedure continues for several months because the daily increase in length does not exceed a few millimeters until we reach the required length of the leg; then, we remove the device with another surgery, and the patient recovers from the leg length discrepancy. There are two types of bone-lengthening devices: an external device and an internal device. The inner bone lengthening device is the latest technology in treating leg length discrepancy due to its high accuracy and reduced risk of infection in the leg bones.

Image showing two internal and external bone lengthening devices for the treatment of leg length discrepancies
Bone lengthening device to treat different legs length

The difference in the length of the legs is a real problem for a person that hinders him from walking and causes various bone diseases in the knee, ankle, and spine, in addition to the tilt of the shoulders and damage to the hip joint or anywhere else in the skeletal structure due to the abnormal gait. There are many reasons for the leg length discrepancy, but in any case, treating the leg length discrepancy is necessary for the patient to practice his life typically.


Sources:

  1. Boston Children's Hospital
  2. OrthoInfo - AAOS
  3. Physiopedia

Frequently Asked Questions:

Leg length discrepancy happens due to many reasons, including what is unknown. It comes with the child's birth (congenital deformity), including what is related to injuries and fractures in the bones or bone diseases such as tumors and bone cysts.

Suppose the difference in the length of the legs is noticeable or more than 2 cm. In that case, it is abnormal and must be treated either by surgical methods or without resorting to surgery, according to the recommendation of the specialist doctor. There is a slight difference in some people in length between the legs, but it is small, and unnoticed differences do not affect their daily life.

The treatment of shortness of the foot varies according to the degree of difference between the length of the feet.

If the child suffers from a difference in the length of the legs, then monitoring must be done here to see whether the difference between the legs increases or remains constant. Legs. Either way, fixing leg length discrepancy is indicated and will be done at the best time, according to the surgeon.

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