Overview
Surgeries for LLD are designed to do one of three general things ? shorten the long leg, stop or slow the growth of the longer or more rapidly growing leg, or lengthen the short leg. Stopping the growth of the longer leg is the most commonly utilized of the three approaches and involves an operation known as an epiphysiodesis , in which the growth plate of either the lower femur or upper tibia is visualized in the operating room using fluoroscopy (a type of real-time radiographic imaging) and ablated , which involves drilling into the region several times, such that the tissue is no longer capable of bone growth. Because the epiphyseal growth capabilities cannot be restored following the surgery, proper timing is crucial. Usually the operation is planned for the last 2 to 3 years of growth and has excellent results, with children leaving the hospital within a few days with good mobility. However, it is only appropriate for LLD of under 5cm.
Causes
Leg length discrepancies can be caused by poor alignment of the pelvis or simply because one leg is structurally longer than the other. Regardless of the reason, your body wants to be symmetrical and will do its best to compensate for the length difference. The greater the leg length difference, the earlier the symptoms will present themselves to the patient. Specific diagnoses that coincide with leg length discrepancy include: scoliosis, lumbar herniated discs, sacroiliitis, pelvic obiliquity, greater trochanteric bursitis, hip arthritis, piriformis syndrome, patellofemoral syndrome and foot pronation. Other potential causes could be due to an injury (such as a fracture), bone disease, bone tumors, congenital problems (present at birth) or from a neuromuscular problem.
Symptoms
Back pain along with pain in the foot, knee, leg and hip on one side of the body are the main complaints. There may also be limping or head bop down on the short side or uneven arm swinging. The knee bend, hip or shoulder may be down on one side, and there may be uneven wear to the soles of shoes (usually more on the longer side).
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
Treatment depends on what limb has the deformity and the amount of deformity present. For example, there may be loss of function of the leg or arm. Cosmetic issues may also be a concern for the patient and their family. If there are problems with the arms, the goal is to improve the appearance and function of the arm. Treatment of leg problems try to correct the deformity that may cause arthritis as the child gets older. If the problem is leg length, where the legs are not "equal," the goal is equalization (making the legs the same length). Treatment may include the use of adaptive devices, prosthesis, orthotics or shoe lifts. If the problem is more severe and not treatable with these methods, then surgery may be necessary.
leg length discrepancy test
Surgical Treatment
Differences of an inch-and-a-half to two inches may require epiphysiodesis (adjusting the growth of the longer side) or acute shortening of the other side. Differences greater than 2.5 inches usually require a lengthening procedure. The short bone is cut and an external device is applied. Gradual lengthening is done over months to allow the muscles and nerves accommodate the new length.
Surgeries for LLD are designed to do one of three general things ? shorten the long leg, stop or slow the growth of the longer or more rapidly growing leg, or lengthen the short leg. Stopping the growth of the longer leg is the most commonly utilized of the three approaches and involves an operation known as an epiphysiodesis , in which the growth plate of either the lower femur or upper tibia is visualized in the operating room using fluoroscopy (a type of real-time radiographic imaging) and ablated , which involves drilling into the region several times, such that the tissue is no longer capable of bone growth. Because the epiphyseal growth capabilities cannot be restored following the surgery, proper timing is crucial. Usually the operation is planned for the last 2 to 3 years of growth and has excellent results, with children leaving the hospital within a few days with good mobility. However, it is only appropriate for LLD of under 5cm.
Causes
Leg length discrepancies can be caused by poor alignment of the pelvis or simply because one leg is structurally longer than the other. Regardless of the reason, your body wants to be symmetrical and will do its best to compensate for the length difference. The greater the leg length difference, the earlier the symptoms will present themselves to the patient. Specific diagnoses that coincide with leg length discrepancy include: scoliosis, lumbar herniated discs, sacroiliitis, pelvic obiliquity, greater trochanteric bursitis, hip arthritis, piriformis syndrome, patellofemoral syndrome and foot pronation. Other potential causes could be due to an injury (such as a fracture), bone disease, bone tumors, congenital problems (present at birth) or from a neuromuscular problem.
Symptoms
Back pain along with pain in the foot, knee, leg and hip on one side of the body are the main complaints. There may also be limping or head bop down on the short side or uneven arm swinging. The knee bend, hip or shoulder may be down on one side, and there may be uneven wear to the soles of shoes (usually more on the longer side).
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
Treatment depends on what limb has the deformity and the amount of deformity present. For example, there may be loss of function of the leg or arm. Cosmetic issues may also be a concern for the patient and their family. If there are problems with the arms, the goal is to improve the appearance and function of the arm. Treatment of leg problems try to correct the deformity that may cause arthritis as the child gets older. If the problem is leg length, where the legs are not "equal," the goal is equalization (making the legs the same length). Treatment may include the use of adaptive devices, prosthesis, orthotics or shoe lifts. If the problem is more severe and not treatable with these methods, then surgery may be necessary.
leg length discrepancy test
Surgical Treatment
Differences of an inch-and-a-half to two inches may require epiphysiodesis (adjusting the growth of the longer side) or acute shortening of the other side. Differences greater than 2.5 inches usually require a lengthening procedure. The short bone is cut and an external device is applied. Gradual lengthening is done over months to allow the muscles and nerves accommodate the new length.