- About Us
- Dr. Mark Miller
- Limb Lengthening
Treatment Options for Limb Length Discrepancy
Frequently asked question - Limb Lengthening
When my daughter’s walking pattern changed, our pediatrician mentioned she may have leg length discrepancy. What are the treatment options for this?
Leg length discrepancy (LLD)—an unequal length in one’s legs—is a common condition seen by pediatric orthopedic specialists. We determine
whether treatment is necessary by location of discrepancy, the predicted
growth difference at skeletal maturity, and in your case, the goals of your
daughter and your family.
LLD can be caused from a congenital condition (present at birth), or can
develop over time from growth-plate (areas of growing tissue in children
and adolescents) injuries and/or infections of the bone and joints. LLD can
also develop as a consequence of cancer treatment.
LLD is evaluated and diagnosed by careful physical examination. We take
an X-ray of both legs from hips to ankles to calculate the difference in each
bone and to evaluate the health and presence of growth plates. Since an
adolescent’s growth plates develop at different rates, we sometimes take
an X-ray of the patient’s hand to determine the amount of growth remaining.
Based on the predicted leg-length difference at skeletal maturity,
recommended treatments may include shoe lifts, surgery to shorten the
longer leg, surgery to lengthen the shorter leg or a combination of the above.
Shortening of the longer leg is generally best for LLD between 0.5 and two
inches. This can be achieved either through closure of open growth plates at
an age predicted to equalize leg lengths, or closed femoral shortening if the
growth plates are closed. Both procedures allow for early weight bearing
and return to activities.
Lengthening of the shorter leg is generally reserved for LLD over two inches.
This lengthening can be achieved by moving segments of bone slowly apart
(1 mm per day) by an external fixator or a magnetically-driven internal rod.
This internal distraction rod is new technology, and is typically reserved for
use in femurs in children older than age 11 and in tibias over age 14. Postoperative
rehabilitation for both types of procedures can be strenuous, with frequent physical
therapy visits and limitation of activity over a period of six months.
We strive to educate patients and families on the treatment options and
predicted challenges in order to develop a treatment plan that meets each
patient’s goals and expectations. Have your daughter evaluated by a pediatric
orthopedic specialist. If she has LLD, ask your physician about all
treatment options available for her particular condition.