Leg Length Discrepancy Treatment in Boone, NC
What Is Leg Length Discrepancy?
Leg length discrepancy is a condition defined by a difference between the lengths of the legs and is a form of limb length discrepancy (LLD). It is typically discovered in adolescence, particularly when a child begins to crawl or walk. Leg length discrepancy can be caused by injury, disease, or birth defect. There are three main kinds of leg length discrepancies; structural, functional or environmental.
- Structural (anatomical): A difference in the lengths of the femurs or tibias
- Functional: A malfunction of any of the joints from the hip to the foot
- Environmental: The result of constantly walking or running on an uneven surface
Leg length discrepancy is a very common condition; as much as one-third of the population might have a leg discrepancy of 1cm or less. However, the discrepancy can become serious if the there is a difference of approximately 3cm or more, and can lead to conditions such as scoliosis and osteoarthritis if not addressed.
To schedule a consultation with a healthcare practitioner in Boone who specializes in leg length discrepancy treatment, call (843) 492-4884 or contact Dr. Dalal Akoury online.
Leg Length Discrepancy Causes
There are many different leg length discrepancy causes, and they fall into three main groups: congenital, developmental, and posttraumatic. However, in some cases the cause of a leg length discrepancy is unknown. Congenital leg length discrepancy occurs from birth defects. These conditions may not become notable until later in childhood and can include:
- Developmental dysplasia of the hip
- Proximal femoral focal deficiency
Developmental leg length discrepancy is due to a childhood disease or injury that slows or damages the growth plates in leg bones, including:
- Diseases like Ollier disease, neurofibromatosis, and multiple hereditary exostoses
- Tumors or surgeries to remove tumors, both of which affect growth in nearby body parts
- Infections that affect the growth plates of the bone
- Neurological disorders, such as cerebral palsy and spasticity
Posttraumatic leg length discrepancy is due to an injury or trauma to the bone. For instance, if there is a fracture in the bone, the bone could heal in a shortened condition. This improper healing is more likely to happen from physis disruption, in which compound fractures occur near or in the growth plates.
Leg Length Discrepancy Symptoms
Parents are typically the first to notice abnormalities in their child's walk. However, they may not notice a visual difference in the length of their child's legs because the discrepancy can be so small. Addition leg length discrepancy symptoms you may notice in you or your child include:
- Limping or toe-walking
- Poor posture
- Hip, knee, or lower back pain
- Low stamina
The first step in diagnosing a leg length discrepancy is a review of you or your child's medical history, symptoms and a leg length discrepancy test such as a gait analysis (an evaluation of the way you or your child walks). Your healthcare provider may recommend the block method in which you stand on a series of blocks, allowing your healthcare practitioner to visually measure the difference between each leg length. The block method is more reliable and accurate than using a tape measure.
Additional imaging tests to see the bones are ordered to confirm a discrepancy, create a baseline measurement of each leg, and develop a treatment plan. These imaging tests can include:
- EOS imaging
- CT scan
Leg Length Discrepancy Treatment
Correcting leg length discrepancy can involve using a shoe lift on the shorter leg, shortening the longer leg, or lengthening the shorter leg. The kind of treatment chosen will depend on the size of the discrepancy, its cause, and your age.
In children, it might be recommended that their growth is observed until they reach skeletal maturity. If the discrepancy is not severe, a shoe lift may be worn to improve the patient's gait. Shoe lifts are an inexpensive way for patients of all ages to improve their mobility and relieve back pain.
If it is determined that surgery is needed to fix leg length discrepancy, there are several different operations that can be performed.
Shortening the Leg
Epiphysiodesis is a procedure to slow down or stop the growth plates in the longer leg. It can be accomplished by drilling or scrapping the growth plates or by inserting metal staples around the growth plates to slow their progression. While the operation is relatively simple, it requires perfect timing, as the goal is to reach equal leg length by mid to late teenage years.
Operations to shorten a leg are usually discussed for patients who have finished growing. A section of a bone is removed from the longer limb; in the femur, a maximum of 3 inches can be removed, while 2 inches can be removed in the tibia. Metal screws, plates, or rods are used to hold the bone together while it heals. This surgery cannot be used in major discrepancy cases, as too much shortening can weaken the leg muscles.
Lengthening the Leg
For severe limb discrepancy cases, internally or externally lengthening the shorter limb is recommended. Both procedures require regular follow-ups with the medical professional and physical therapy with home exercise.
In internal lengthening, an incision is made in the shorter bone, and an expandable metal rod is inserted into the cut. The rod gradually lengthens in response to your normal movements. As the rod lengthens, bone grows in the space it creates. While there is a lower risk of infection, it is harder to control the rate of lengthening
External lengthening requires a scaffold-like frame that connects the bones with wires and/or pins outside the body. Your healthcare practitioner cuts the shorter leg bone into two separate sections, and the external fixator frame holds the bones in place while the leg is healing. The rate of lengthening is controlled manually, as you or a family member use the dial on the fixator to lengthen the bone 1mm per day. As a result, the bone slowly grows in the empty space. The fixator is removed when your bones are strong enough to support themselves.
Leg length discrepancy can affect your mobility in very significant ways. To schedule an appointment with a LLD specialist in Boone, call (843) 492-4884 or contact Dr. Dalal Akoury online.
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