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April 26 2015

preciousoutdoor90

Leg Length Discrepancy And An Operation

Overview

Leg length discrepancy, or as it has been alternatively termed, the short leg syndrome, is by far the most important postural asymmetry. Limb length discrepancy is simply defined as a condition where one leg is shorter than the other. If a substantial difference exists, disruptive effects on gait and posture can occur. Leg length discrepancy can be divided into two etiological groups. Structural. True shortening of the skeleton from congenital, traumatic or diseased origins. Functional. Development from altered mechanics of the lower body, such as foot hyperpronation or supination, pelvic obliquity, muscle/joint imbalances, poor trunk stabilization and deep fascial strain patterns.Leg Length Discrepancy

Causes

From an anatomical stand point, the LLD could have been from hereditary, broken bones, diseases and joint replacements. Functional LLD can be from over pronating, knee deformities, tight calves and hamstrings, weak IT band, curvature in the spine and many other such muscular/skeletal issues.

Symptoms

Back pain along with pain in the foot, knee, leg and hip on one side of the body are the main complaints. There may also be limping or head bop down on the short side or uneven arm swinging. The knee bend, hip or shoulder may be down on one side, and there may be uneven wear to the soles of shoes (usually more on the longer side).

Diagnosis

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

The way in which we would treat a LLD would depend on whether we have an anatomical or functional difference. To determine which one is causing the LLD you will need to get your legs measured. This is the easiest way to determine if it is anatomical or functional. With a functional LLD we must first determine the cause and treat the cause. Should the cause be one that is not correctable then we may need to treat the LLD as if it were an anatomical or may have to treat the opposite leg to improve one's gait. As for the anatomical LLD, we may start off with a heel lift only in the shoe and follow up to see if we will need to put the lift full sole on the bottom of the shoe. This is determined by the affects that a heel lift in one shoe may have on that knee. Should the LLD be more than 1/4 inch we usually recommend starting between 1/8 inch to 1/4 inch less than the actual amount and let the body adjust to the change and then raise up to the measured amount later.

LLD Shoe Inserts

Surgical Treatment

Differences of an inch-and-a-half to two inches may require epiphysiodesis (adjusting the growth of the longer side) or acute shortening of the other side. Differences greater than 2.5 inches usually require a lengthening procedure. The short bone is cut and an external device is applied. Gradual lengthening is done over months to allow the muscles and nerves accommodate the new length.

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