Leg length discrepancy (LLD) affects about 70% of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ? 0.07 BW) at the shorter limb compared to the longer limb (0.56 ? 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.
Leg discrepancy can develop from a medical issue in any portion of the femur or tibia. One leg may lengthen, but leg shortening is much more common. Factors that can cause leg length discrepancy include inherited growth deficiencies. Infections. A bone infection can cause delayed growth in the affected limb. Injury. If your child breaks a leg, it may be shorter once it heals. This is most likely to happen if the fracture or break was complicated, an open fracture, or an injury that affected the growth plate near the end of the bone. Alternatively, a break can cause bones to grow faster after healing, making a leg longer. Tumors. Legg-Calve-Perthes disease. This is a condition that affects the ball (femoral head) of the hip joint. The femoral head may be friable and damage easily, sometimes leading to shortening of the thigh bone. Hemihypertrophy. In children with this condition, one side of the body grows more quickly than the other. Vascular malformations. These are abnormal clusters of veins and arteries that can form close to the bone and stimulate growth. Juvenile arthritis. Inflammation from arthritis can stimulate growth in the affected leg and cause discrepancy.
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.
The evaluation of leg length discrepancy typically involves sequential x-rays to measure the exact discrepancy, while following its progression. In addition, an x-ray of the wrist allows us to more carefully age your child. Skeletal age and chronological age do not necessarily equal each other and frequently a child's bone age will be significantly different than his or her stated age. Your child's physician can establish a treatment plan once all the facts are known: the bone age, the exact amount of discrepancy, and the cause, if it can be identified.
Non Surgical Treatment
Heel lifts Raise the heel on the shorter leg. It is applied either to the heel of the custom orthotic or to the inside of the shoe under the insole at the heel. Generally if the discrepancy is greater than 3/8 of an inch, the modification is applied externally on the footwear. Custom made orthotics help to provide proper support and alignment to the foot, controlling conditions such as over pronation. Orthopedic Footwear, properly fitted, to which a lift might be applied inside or out.
height increase medicine
Surgery to shorten the longer leg. This is less involved than lengthening the shorter leg. Shortening may be done in one of two ways. Closing the growth plate of the long leg 2-3 years before growth ends (around age 11-13), letting the short leg catch up. This procedure is called an epiphysiodesis. Taking some bone from the longer leg once growth is complete to even out leg lengths. Surgery to lengthen the shorter leg. This surgery is more involved than surgery to shorten a leg. During this surgery, cuts are made in the leg bone. An external metal frame and bar are attached to the leg bone. This frame and bar slowly pull on the leg bone, lengthening it. The frame and bar must be worn constantly for months to years. When the frame and bar are removed, a leg cast is required for several months. This surgery requires careful and continued follow-up with the surgeon to be sure that healing is going well.