Georgette Brensinger

Foot Pain Diagnosis

Leg Length Discrepancy Treatment

Overview

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.Leg Length Discrepancy

Causes

Some children are born with absence or underdeveloped bones in the lower limbs e.g., congenital hemimelia. Others have a condition called hemihypertrophy that causes one side of the body to grow faster than the other. Sometimes, increased blood flow to one limb (as in a hemangioma or blood vessel tumor) stimulates growth to the limb. In other cases, injury or infection involving the epiphyseal plate (growth plate) of the femur or tibia inhibits or stops altogether the growth of the bone. Fractures healing in an overlapped position, even if the epiphyseal plate is not involved, can also cause limb length discrepancy. Neuromuscular problems like polio can also cause profound discrepancies, but thankfully, uncommon. Lastly, Wilms? tumor of the kidney in a child can cause hypertrophy of the lower limb on the same side. It is therefore important in a young child with hemihypertrophy to have an abdominal ultrasound exam done to rule out Wilms? tumor. It is important to distinguish true leg length discrepancy from apparent leg length discrepancy. Apparent discrepancy is due to an instability of the hip, that allows the proximal femur to migrate proximally, or due to an adduction or abduction contracture of the hip that causes pelvic obliquity, so that one hip is higher than the other. When the patient stands, it gives the impression of leg length discrepancy, when the problem is actually in the hip.

Symptoms

The effects of a short leg depend upon the individual and the extent of discrepancy. The most common manifestation if a lateral deviation of the lumbar spine toward the short side with compensatory curves up the spine that can extend into the neck and even impacts the TMJ. Studies have shown that anterior and posterior curve abnormalities also can result.

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

To begin a path torwards a balanced foundation and reduce pain from leg length discrepancy, ask your doctor about these Functional Orthotics and procedures. Functional Orthotics have been shown to specifically reduce pain from leg length inequality, support all three arches of the foot to create a balanced foundation, maximize shock absorption, add extra propulsion, and supply more stability, enable posture correction and long-term preventive protection. Will improve prolonged effectiveness of chiropractic adjustments. Shoe or heel Lifts, Correct the deficiencies that causes imbalances in the body.

LLD Shoe Inserts

how to increase height after 18

Surgical Treatment

The bone is lengthened by surgically applying an external fixation device to the leg. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins, or both. A small crack is made in the bone and the frame creates tension when the patient or family member turns its dial. This is done several times each day. The lengthening process begins approximately five to 10 days after surgery. The bone may lengthen 1 millimeter per day, or approximately 1 inch per month. Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly. The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.
Remove all ads