Limb Length Discrepancy: Causes and Treatments
Do you have different leg lengths?
Limb Length Discrepancy: From Causes to Treatment!
Hello, I am Kwak Yoon-hae from the Department of Orthopedic Surgery at Asan Medical Center in Seoul. Many patients, from newborns to adults, are referred to our orthopedic clinic due to suspected differences in leg length. I will explain the causes, when treatment is necessary, and how our orthopedic department provides surgical treatment.
Causes and Symptoms of Perceived Leg Length Difference
1. Developmental Dysplasia of the Hip (DDH) in Newborns
The most common case we see in babies is when the leg lengths appear different. While often there is no specific cause and it is only a visual difference, in rare cases of DDH, the leg on the side of the dislocated hip may appear shorter. Therefore, a physical examination and simple X-ray may be needed to differentiate.
2. Compensatory Gait in Children and Adolescents
When children with a slight leg length difference start walking, they often develop a compensatory gait on their own. For example, they might walk on tiptoes on the shorter leg or bend the knee or ankle of the longer leg. You may not notice it because they don't limp significantly, but it can be detected by foot deformities, standing with uneven weight distribution, or tiptoe walking on one leg. As they grow older, they may start to limp noticeably. The goal of maintaining symmetrical leg length is to prevent hip dysplasia and spinal deformities due to pelvic height differences.
3. Scoliosis
In some cases, pelvic asymmetry due to scoliosis can be the cause of perceived leg length difference, rather than an actual difference in leg length. In these instances, we often collaborate with professors from our Scoliosis Center.
4. Traumatic Limb Length Discrepancy
In children and adolescents, trauma is a common cause of actual leg length differences. Fractures in the long bones of the leg during growth can lead to overgrowth as the body focuses on rebuilding the injury. Fractures involving the growth plate can cause growth disturbances and leg length differences. Overgrowth or growth plate damage does not occur in all fractures during growth; it depends on the child's age, the severity of the injury, and the location of the injury.
5. Syndromic Overgrowth and Undergrowth
Another cause is limb length discrepancy due to syndromic overgrowth or undergrowth associated with underlying diseases. Asan Medical Center's Medical Genetics Center treats many children nationwide, and we collaborate with them in pediatric orthopedics. In some cases, patients who have received treatment for hemangiomas or tumors at other hospitals are found to have underlying conditions at our hospital. In other cases, one arm or leg may be disproportionately larger without a clear cause, and we evaluate for underlying causes of unilateral overgrowth while treating the leg length difference.
Treatment Methods for Limb Length Discrepancy
A leg length difference of 1.0cm to 1.5cm can occur even in healthy adults. Textbook guidelines generally do not recommend surgical treatment for differences less than 2.0cm. However, it is difficult to apply a uniform standard to growing children. Depending on the gait pattern and for balanced muscle development, we may consider conservative treatments such as shoe inserts or sole modifications in consultation with pediatric rehabilitation specialists.
In orthopedics, we perform surgical procedures to equalize leg length. In children and adolescents with remaining growth potential, we can temporarily arrest the growth plate of the longer leg using staples or pins, allowing the shorter leg to catch up. This is a relatively simple procedure compared to other methods, but it may be difficult to perfectly match the lengths, so the goal is usually to achieve a difference of less than 1.5cm.
In adults or adolescents with little remaining growth, we can lengthen the shorter leg using an external fixator. This is considered when the length difference is greater than 2.5cm. This procedure has potential complications, and it is essential for the patient or caregiver to actively participate in stretching and strengthening exercises during the lengthening process. However, this is not cosmetic limb lengthening; the surgery aims to correct limb length discrepancy and maintain long-term hip and spinal health.
If a child exhibits asymmetrical gait, has a history of trauma, or has one leg that appears thicker than the other, it is important to evaluate for limb length discrepancy and consider appropriate treatment based on the degree of difference.
- Professor Kwak Yoon-hae, Department of Orthopedic Surgery, Asan Medical Center -
Source :https://blog.naver.com/amc_seoul/224017008004
No comments yet.