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.
Sometimes the cause of LLD is unknown, yet the pattern or combination of conditions is consistent with a certain abnormality. Examples include underdevelopment of the inner or outer side of the leg (hemimelias) or (partial) inhibition of growth of one side of the body of unknown cause (hemihypertrophy). These conditions are present at birth, but the limb length difference may be too small to be detected. As the child grows, the LLD increases and becomes more noticeable. In hemimelia, one of the two bones between the knee and the ankle (tibia or fibula) is abnormally short. There also may be associated foot or knee abnormalities. Hemihypertrophy or hemiatrophy are rare conditions in which there is a difference in length of both the arm and leg on only one side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This type of limb length is called idiopathic. While there is a cause, it cannot be determined using currect diagnostic methods.
If your child has one leg that is longer than the other, you may notice that he or she bends one leg. Stands on the toes of the shorter leg. Limps. The shorter leg has to be pushed upward, leading to an exaggerated up and down motion during walking. Tires easily. It takes more energy to walk with a discrepancy.
Leg length discrepancy may be diagnosed during infancy or later in childhood, depending on the cause. Conditions such as hemihypertrophy or hemiatrophy are often diagnosed following standard newborn or infant examinations by a pediatrician, or anatomical asymmetries may be noticed by a child's parents. For young children with hemihypertophy as the cause of their LLD, it is important that they receive an abdominal ultrasound of the kidneys to insure that Wilm's tumor, which can lead to hypertrophy in the leg on the same side, is not present. In older children, LLD is frequently first suspected due to the emergence of a progressive limp, warranting a referral to a pediatric orthopaedic surgeon. The standard workup for LLD is a thorough physical examination, including a series of measurements of the different portions of the lower extremities with the child in various positions, such as sitting and standing. The orthopaedic surgeon will observe the child while walking and performing other simple movements or tasks, such as stepping onto a block. In addition, a number of x-rays of the legs will be taken, so as to make a definitive diagnosis and to assist with identification of the possible etiology (cause) of LLD. Orthopaedic surgeons will compare x-rays of the two legs to the child's age, so as to assess his/her skeletal age and to obtain a baseline for the possibility of excessive growth rate as a cause. A growth chart, which compares leg length to skeletal age, is a simple but essential tool used over time to track the progress of the condition, both before and after treatment. Occasionally, a CT scan or MRI is required to further investigate suspected causes or to get more sophisticated radiological pictures of bone or soft tissue.
Non Surgical Treatment
Treatment for an LLD depends on the amount of difference and the cause, if known. The doctor will discuss treatment options carefully with you and your child before any decisions are made. It is important to note that treatment is planned with the child?s final height and leg lengths in mind, not the current leg lengths. Treatment is generally not needed if the child?s final LLD is predicted to be 2 centimeters or less at full height. However, the child should return to an orthopaedic doctor by age 10 for re-evaluation. Treatment is often recommended for LLDs predicted to be more than 2 centimeters at full height. If treatment is done, it usually doesn?t begin until the child starts walking. Possible treatment options include, A ?lift? in one shoe to level the child?s hips. This is often the only treatment needed for small discrepancies.
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In growing children, legs can be made equal or nearly equal in length with a relatively simple surgical procedure. This procedure slows down the growth of the longer leg at one or two growth sites. Your physician can tell you how much equalization can be gained by this procedure. 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 limb length discrepancy will gradually decrease as the opposite extremity continues to grow and "catch up." Timing of the procedure is critical. The goal is to reach equal leg length by the time growth normally ends. This is usually in the mid-to-late teenage years. Disadvantages of this option include the possibility of slight over-correction or under-correction of the limb length discrepancy. In addition, the patient's adult height will be less than if the shorter leg had been lengthened. Correction of significant limb length discrepancy by this method may make a patient's body look slightly disproportionate because of the shorter leg. In some cases the longer leg can be shortened, but a major shortening may weaken the muscles of the leg. In the thighbone (femur), a maximum of 3 inches can be shortened. In the shinbone, a maximum of 2 inches can be shortened.