Leg Length Discrepancy And Hip Pain

Overview

Differences between the lengths of the upper and/or lower legs are called leg length discrepancies (LLD). A leg length difference may simply be a mild variation between the two sides of the body. This is not unusual in the general population. For example, one study reported that 32 percent of 600 military recruits had a 1/5 inch to a 3/5 inch difference between the lengths of their legs. This is a normal variation. Greater differences may need treatment because a significant difference can affect a patient's well-being and quality of life.Leg Length Discrepancy

Causes

A number of causes may lead to leg length discrepancy in children. Differences in leg length frequently follow fractures in the lower extremities in children due to over or under stimulation of the growth plates in the broken leg. Leg length discrepancy may also be caused by a congenital abnormality associated with a condition called hemihypertrophy. Or it may result from neuromuscular diseases such as polio and cerebral palsy. Many times, no cause can be identified. A small leg length discrepancy of a quarter of an inch or less is quite common in the general population and of no clinical significance. Larger leg length discrepancies become more significant. The long-term consequences of a short leg may include knee pain, back pain, and abnormal gait or limp.

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

A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.

Non Surgical Treatment

The key to treatment of LLD in a child is to predict what the discrepancy is at maturity. If it is predicted to be less than 2 cm., no treatment is needed. Limb length discrepancies of up to 2 or 2.5 cm. can be compensated very well with a lift in the shoe. Beyond 2.5 cm., it becomes increasingly difficult to compensate with a left in the insole. Building up the shoe becomes uncosmetic and cumbersome, and some other way of compensating for the discrepancy becomes necessary. The treatment of LLD is long-term treatment, and involves the physician and patient?s family working together as a team. The family needs to weigh the various options available. If leg lengthening is decided on, the family needs to understand the commitment necessary to see it through. The treatment takes 6 months to a year for completion, and complications can happen. But when it works, the results are gratifying.

Leg Length Discrepancy Insoles

Surgical Treatment

Your child will be given general anesthetic. We cut the bone and insert metal pins above and below the cut. A metal frame is attached to the pins to support the leg. Over weeks and months, the metal device is adjusted to gradually pull the bone apart to create space between the ends of the bones. New bone forms to fill in the space, extending the length of the bone. Once the lengthening process is completed and the bones have healed, your child will require one more short operation to remove the lengthening device. We will see your child regularly to monitor the leg and adjust the metal lengthening device. We may also refer your child to a physical therapist to ensure that he or she stays mobile and has full range of motion in the leg. Typically, it takes a month of healing for every centimeter that the leg is lengthened.

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