Overview
Although many of us assume our legs are the same length, it is very common for people to have one leg that is longer than the other. A leg length discrepancy (LLD) sounds alarming but people who have a discrepancy of 1cm may not even know their legs are differing lengths as often they don?t experience any problems. A Pedorthist will advise you if a leg length discrepancy or another foot or lower limb condition is the cause of your discomfort and develop a treatment plan for it.
Causes
Leg length discrepancies can be caused by: hip and knee replacements, lower limb injuries, bone diseases, neuromuscular issues and congenital problems. Although discrepancies of 2 cm or less are most common, discrepancies can be greater than 6 cm. People who have LLD tend to make up for the difference by over bending their longer leg or standing on the toes of their shorter leg. This compensation leads to an inefficient, up and down gait, which is quite tiring and over time can result in posture problems as well as pain in the back, hips, knees and ankles.
Symptoms
Faulty feet and ankle structure profoundly affect leg length and pelvic positioning. The most common asymmetrical foot position is the pronated foot. Sensory receptors embedded on the bottom of the foot alert the brain to the slightest weight shift. Since the brain is always trying to maintain pelvic balance, when presented with a long left leg, it attempts to adapt to the altered weight shift by dropping the left medial arch (shortening the long leg) and supinating the right arch to lengthen the short leg.1 Left unchecked, excessive foot pronation will internally rotate the left lower extremity, causing excessive strain to the lateral meniscus and medial collateral knee ligaments. Conversely, excessive supination tends to externally rotate the leg and thigh, creating opposite knee, hip and pelvic distortions.
Diagnosis
A qualified musculoskeletal expert will first take a medical history and conduct a physical exam. Other tests may include X-rays, MRI, or CT scan to diagnose the root cause.
Non Surgical Treatment
In an adult, we find that we can add a non compressive silicone heel lift to a shoe in increments of 3-4 mm maximum per week. Were we to give a patient with a 20 mm short leg, 20 mm of lift all at once, their entire body would rebel. The various compensations that the body has made, such as curvatures and shortening of muscles on the convex side of the curve, would make such a dramatic change not just noticeable, but painful. When we get close to balancing a patient by lifting a leg with heel inserts, then we perform another gait analysis and follow up xray. At that point, we can typically write them a final prescription to have their shoe modified. A heel lift is typically fine up to 7 mm. When it gets higher than that, the entire shoe must be modified. There are two reasons for this. The back of the shoe is generally too short to accommodate more than 7-8 mm inserted inside the shoes and a heel lift greater than 7 mm will lead to Achilles tendon shortening, which then creates it?s own panoply of problems.
leg length discrepancy hip pain
Surgical Treatment
Your child will be given general anesthetic. We cut the bone and insert metal pins above and below the cut. A metal frame is attached to the pins to support the leg. Over weeks and months, the metal device is adjusted to gradually pull the bone apart to create space between the ends of the bones. New bone forms to fill in the space, extending the length of the bone. Once the lengthening process is completed and the bones have healed, your child will require one more short operation to remove the lengthening device. We will see your child regularly to monitor the leg and adjust the metal lengthening device. We may also refer your child to a physical therapist to ensure that he or she stays mobile and has full range of motion in the leg. Typically, it takes a month of healing for every centimeter that the leg is lengthened.
Although many of us assume our legs are the same length, it is very common for people to have one leg that is longer than the other. A leg length discrepancy (LLD) sounds alarming but people who have a discrepancy of 1cm may not even know their legs are differing lengths as often they don?t experience any problems. A Pedorthist will advise you if a leg length discrepancy or another foot or lower limb condition is the cause of your discomfort and develop a treatment plan for it.
Causes
Leg length discrepancies can be caused by: hip and knee replacements, lower limb injuries, bone diseases, neuromuscular issues and congenital problems. Although discrepancies of 2 cm or less are most common, discrepancies can be greater than 6 cm. People who have LLD tend to make up for the difference by over bending their longer leg or standing on the toes of their shorter leg. This compensation leads to an inefficient, up and down gait, which is quite tiring and over time can result in posture problems as well as pain in the back, hips, knees and ankles.
Symptoms
Faulty feet and ankle structure profoundly affect leg length and pelvic positioning. The most common asymmetrical foot position is the pronated foot. Sensory receptors embedded on the bottom of the foot alert the brain to the slightest weight shift. Since the brain is always trying to maintain pelvic balance, when presented with a long left leg, it attempts to adapt to the altered weight shift by dropping the left medial arch (shortening the long leg) and supinating the right arch to lengthen the short leg.1 Left unchecked, excessive foot pronation will internally rotate the left lower extremity, causing excessive strain to the lateral meniscus and medial collateral knee ligaments. Conversely, excessive supination tends to externally rotate the leg and thigh, creating opposite knee, hip and pelvic distortions.
Diagnosis
A qualified musculoskeletal expert will first take a medical history and conduct a physical exam. Other tests may include X-rays, MRI, or CT scan to diagnose the root cause.
Non Surgical Treatment
In an adult, we find that we can add a non compressive silicone heel lift to a shoe in increments of 3-4 mm maximum per week. Were we to give a patient with a 20 mm short leg, 20 mm of lift all at once, their entire body would rebel. The various compensations that the body has made, such as curvatures and shortening of muscles on the convex side of the curve, would make such a dramatic change not just noticeable, but painful. When we get close to balancing a patient by lifting a leg with heel inserts, then we perform another gait analysis and follow up xray. At that point, we can typically write them a final prescription to have their shoe modified. A heel lift is typically fine up to 7 mm. When it gets higher than that, the entire shoe must be modified. There are two reasons for this. The back of the shoe is generally too short to accommodate more than 7-8 mm inserted inside the shoes and a heel lift greater than 7 mm will lead to Achilles tendon shortening, which then creates it?s own panoply of problems.
leg length discrepancy hip pain
Surgical Treatment
Your child will be given general anesthetic. We cut the bone and insert metal pins above and below the cut. A metal frame is attached to the pins to support the leg. Over weeks and months, the metal device is adjusted to gradually pull the bone apart to create space between the ends of the bones. New bone forms to fill in the space, extending the length of the bone. Once the lengthening process is completed and the bones have healed, your child will require one more short operation to remove the lengthening device. We will see your child regularly to monitor the leg and adjust the metal lengthening device. We may also refer your child to a physical therapist to ensure that he or she stays mobile and has full range of motion in the leg. Typically, it takes a month of healing for every centimeter that the leg is lengthened.