External Shoe Lifts For Leg Length Discrepancy

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Overview

Leg length discrepancy is the difference in lengths of an individual?s legs. This difference may be anatomical or may be due to scoliosis, trauma/injury, arthritis, overpronation (collapse) of one foot, bowing of one leg or unequal bowing, surgery (hip or knee replacement), pelvic tilting or ageing. The difference can also be functional caused by differing forces of the soft tissues, such as weakness in muscle tissue on one side, or a weakness/tightness in joint tissue. A difference in leg lengths also results when running on indoor banked tracks, beaches and banked streets and side walks (for drainage). Many people have a measurable difference in their leg lengths which is compensated for by their bodies. As we age this compensation does not work as well. An x-ray and physical measurements will define the discrepancy and the adjustment needed.Leg Length Discrepancy

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

If your child has one leg that is longer than the other, you may notice that he or she bends one leg. Stands on the toes of the shorter leg. Limps. The shorter leg has to be pushed upward, leading to an exaggerated up and down motion during walking. Tires easily. It takes more energy to walk with a discrepancy.

Diagnosis

On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.

Non Surgical Treatment

A personalized approach to leg length discrepancy treatment works best for each patient. Your child's doctor will consider many factors when deciding on a course of treatment for this condition. Such factors can include your child's age, extent of the leg length discrepancy, medical history, how your child tolerates certain treatments and procedures, your child's health and prognosis, growth rate, and parental preferences. There is no cookie cutter treatment for each child, or even each centimeter of leg difference. Once all of these factors have been carefully considered, your child's physician will come up with an appropriate course of care. In situations of a very small leg length discrepancy, no treatment, only periodic medical evaluation, may be necessary.

LLD Shoe Inserts

Surgical Treatment

Surgery is another option. In some cases the longer extremity can be shortened, but a major shortening may weaken the muscles of the extremity. In growing children, lower extremities can also be equalized by a surgical procedure that stops the growth at one or two sites of the longer extremity, while leaving the remaining growth undisturbed. Your physician can tell you how much equalization can be attained by surgically halting one or more growth centers. The procedure is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the LLD will gradually decrease as the opposite extremity continues to grow and "catch up." Timing of the procedure is critical; the goal is to attain equal length of the extremities at skeletal maturity, usually in the mid- to late teens. Disadvantages of this option include the possibility of slight over-correction or under-correction of the LLD and the patient?s adult height will be less than if the shorter extremity had been lengthened. Correction of significant LLDs by this method may make a patient?s body look slightly disproportionate because of the shorter legs.

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