Leg Length Discrepancy (LLD) is a condition characterised by an inequality in the length of the lower extremities, specifically the legs. This can occur due to a variety of reasons, including developmental issues, trauma, or medical conditions affecting bone growth.
It is important to know that many people have an LLD but the pelvis’ ability to compensate results in no signs or symptoms and has no long term consequences. It is when the discrepancy is over 15mm that some people will feel a difference.
The reasons for LLD are vast and the majority of time there is no known cause. Some known factors include:
1. Developmental Factors: Some individuals may naturally have one leg longer than the other due to differences in bone growth during childhood and adolescence.
2. Injury or Trauma: Fractures or injuries to the leg bones, such as the femur or tibia, can lead to unequal limb length during the healing process or if the growth plate us damaged.
3. Medical Conditions: Certain conditions like congenital anomalies (present at birth), infections, or skeletal dysplasias can disrupt normal bone growth, resulting in LLD.
4. Surgical Interventions: Surgeries involving the lower limbs, such as joint replacements or corrective procedures for deformities, can sometimes lead to leg length inequality as a complication.
Most people are unaware of a LLD given the ability to adjust and compensate. For larger discrepancies patients may experience:
1. Gait Abnormalities: Limping or an uneven walking pattern is a common symptom of LLD. Also known as a short leg gait
2. Back, Hip, or Knee Pain: The body's attempt to compensate for the leg length difference can lead to discomfort or pain in the lower back, hips, or knees.
3. Uneven Wear on Shoes: Over time, individuals with LLD may notice that one shoe wears out faster than the other due to uneven weight distribution.
A thorough history and physical examination will be carried out by your Orthopaedic Surgeon or Paediatrician. Examination will involve measurements of leg length, observation of gait, and assessment of posture and alignment.
Imaging Studies: X-rays or other imaging tests may be ordered to visualise the bones and confirm the extent of the leg length inequality. A specialised scan known as EOS will be ordered for accurate assessment of leg lengths and alignment.
It is important to know if a leg length discrepancy has been detected in a child there will serial visits and X-rays to track whether the difference is static or increasing as the child grows.
Treatment options will depend on what the discrepancy is or will be at the time of skeletal maturity (closing of growth plates). Treatments include:
1. Observation: In cases where the leg length difference is minimal and not causing significant symptoms, no treatment may be necessary, and regular monitoring may suffice.
2. Orthotic Devices: Shoe lifts or heel inserts can help to compensate for the leg length inequality and improve gait symmetry.
3. Physiotherapy: Specific exercises and stretches can be prescribed to address muscle imbalances, improve flexibility, and enhance overall function. It is important to know physiotherapy will not be able to lengthen the limb.
4. Surgical Interventions: In severe cases or when conservative measures fail, surgical procedures such as epiphysiodesis (halting growth in the longer limb) or limb lengthening may be considered to correct the discrepancy.
The prognosis of leg length discprenacy is very good. For the majority of patient who are able to detect a LLD they can usually get by with no intervention or a simple heel lift. For the bigger discrepancies then prognosis is determined by the degree of difference and the age of which the difference is detected. If LLD is detected in a young child then prognosis is much better given the increased number of years to utilise the power of natural growth and bone remodelling.
There is no preventing LLD.
Leg Length Discrepancy can vary in severity and impact individuals differently. Early diagnosis and appropriate management can help alleviate symptoms and prevent long-term complications. If you suspect you or your child may have LLD, please contact Dr Shales for assessment.
