Some babies and children have arms or legs of different lengths. This discrepancy may be present at birth or may occur later in life as the result of a bone break or an infection. Arm length discrepancies typically do not interfere with function or quality of life. However, leg length discrepancy (LLD) may cause a debilitating limp and require treatment.
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Types
- Acquired. A baby or a child may develop LLD after a bone breaks in the leg or the limb becomes infected.
- Congenital. A shinbone that is missing or short at birth is called a fibular hemimelia. A thighbone missing or short at birth is called a focal femoral deficiency. Excessive growth on one side of the body is called hemihypertrophy.
- Idiopathic. A baby may have LLD for no apparent reason.
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Symptoms
- Back pain
- Curvature in the back
- Difficulty walking
- Hip pain
- Tightness in the heel
- Walking on the toes
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Prevention
- There is no way to prevent LLD.
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Risk factors
- Bone diseases. Multiple hereditary exostoses, neurofibromatosis and Ollier disease may contribute to LLD.
- Bone infection. As the child grows, an infection may cause differences in the length of the legs.
- Bone injury. After a break, a child’s leg may grow more quickly as the bone heals. This may continue for years, resulting in a leg that is longer.
- Other existing health conditions. Inflammatory diseases like juvenile arthritis or neurological conditions may increase the likelihood of LLD.
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Diagnosis
- Medical history and review of symptoms. The healthcare provider will ask the patents and child, if he or she is old enough, about physical function.
- Physical exam. The child’s doctor may observe the way the child sits, stands and walks. A limp or walking on the toes may indicate LLD. The doctor will measure the child’s legs and may have him or her stand on a block to see how dramatic the discrepancy is.
- Imaging. The doctor may order an X-ray to capture precise measurements of the LLD. A CT scanogram may also be recommended.
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Treatment
- Conservative. A lift in the shoe may be used to manage mild LLD of about 2 centimeters or less.
- Epiphysiodesis. If the child is still growing, a surgeon may perform this outpatient procedure to compress the growth plate in your child’s leg.
- Surgical limb shortening. After the child has finished growing, a surgeon may shorten the longer leg by removing a portion of bone.
- Surgical limb lengthening. A surgeon may place an external fixator or a different device inside the bone to lengthen the leg. This option is usually recommended when the discrepancy is 5 centimeters or more.
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Follow-up care
- After surgery, the child’s doctor will consult with the patient and his or her family regularly to closely observe bone alignment and quality.
- Gentle exercise and physical therapy will help build strength and stability.