Leg Length Discrepancy Part 2: What are the Best Leg Length Discrepancy Treatment Modalities?

by | Jul 19, 2022 | General Chiropractic | 0 comments

Have you ever tried walking while wearing only one heel? If you have, then you know that it can be quite a struggle to walk across the room when your legs are uneven. Unfortunately, this is the struggle faced by those with a leg length difference. 

In our last article, we defined the different types of limb length inequality and mentioned both arm and leg length discrepancies. We also discussed different causes for limb length differences and briefly described the diagnosis process. 

This article will focus primarily on leg length differences. A lower limb length discrepancy, leg length discrepancy can make everyday tasks exceedingly challenging to perform. Having one short leg and one long leg can significantly impact one’s ability to move around or function normally. Luckily, we have numerous treatment options to help you battle against this disorder. 

A Quick Recap: What is a Leg Length Discrepancy?

Leg length discrepancy occurs when one leg is shorter than the other. There are several causes for leg length discrepancy, including: 

  • Congenital causes; 
  • Bone defects;
  • Bone diseases;
  • Bone infection; 
  • Tumors;
  • Broken leg bone that did not heal properly;
  • Osteoarthritis of the hip or knee;
  • Scoliosis;
  • Hip replacement surgery. 

A leg length discrepancy can be problematic, affecting one’s ability to walk or perform daily activities. It can also affect posture and increase the likelihood of other medical conditions such as arthritis, scoliosis, stress fractures, or knee problems. If the length discrepancy is greater than one-half inch, it requires medical attention. 

Leg Length Discrepancy Treatment

There are several treatment options for those suffering from leg length discrepancies. The best treatment option depends on the extent of the length discrepancy, the skeletal maturity, and the root cause of the disorder. Sometimes the discrepancy is treated by lengthening the shorter leg, while other times, it is treated by shortening the longer leg. 

Nonsurgical Treatment

Patients with limb length discrepancies that are milder (less than 1 inch) and do not suffer from a limb deformity are better suited for nonsurgical treatment. The most common nonsurgical option for leg length discrepancies is shoe lifts. 

Shoe Lift

A shoe lift is a type of orthotics fitted for the inside or outside of the shoe. It lifts the shoe and relieves pain from minor leg length discrepancies. In addition, the lifts make the patient’s legs an equal length so that the lower limb length discrepancy is no longer problematic. If lifts are ineffective at treating limb length discrepancy, they can be easily removed. 

Shoe lifts are prescribed by chiropractors who are well trained to prescribe treatments for conditions such as leg length discrepancies. Orthotics support patients with different leg lengths and help prevent knocked knees. However, if left untreated, functional misalignments such as length discrepancy can also result in hip and pelvic rotation. 

Surgical Treatment

If a leg length discrepancy is more severe or nonsurgical treatment proves ineffective, a patient may require limb length discrepancy surgery. Surgery can significantly benefit the long-term outcomes of those suffering from this disorder. 

There are different surgical options for leg length discrepancy. The best type of surgery is dependent on the patient’s skeletal maturity and the root cause of the disorder. The following are the four main types of limb length discrepancy surgeries: 

  • Epiphysiodesis;
  • Limb Lengthening Surgery; 
  • Limb Shortening Surgery. 

Epiphysiodesis

Epiphysiodesis is a surgical option for kids who are still growing with leg length discrepancy. In a relatively simple outpatient surgery, epiphysiodesis scrapes or compresses one or more growth plates in the longer leg. The growth plates are located at the end of the bones and are where new bone growth occurs. By using surgical plates and screws to halt the longer leg from growing, the shorter leg is given a chance to catch up. Once growth is complete, the shorter leg should be close to or equal in length to the longer leg. 

Limb Lengthening Surgery

A preferred leg length discrepancy treatment method, limb lengthening surgery allows a child’s legs to grow to their full length. After cutting the bone of the shorter leg, a surgeon performing limb lengthening surgery then applies an exterior fixator or internal device to slowly lengthen the leg bone and correct the deformity. 

Fixation of limb length discrepancies can be done either internally or externally through limb lengthening surgery. External fixation is the more traditional length discrepancy treatment method, used successfully for many years. After dividing the bone, a support structure is attached to the bones with pins. The limb lengthening process begins about a week after the fixation surgery and is performed manually by turning a dial on the external fixator. Turning the dial increases the space between the cut bones, allowing the new bone to slowly form. Through daily limb lengthening, the shorter leg will eventually become closer in length to the longer leg. 

While limb lengthening with an external fixator is very successful, it is challenging for some patients as it can be uncomfortable to sleep or wear clothing. Thus, some hospitals, such as the Children’s Hospital of Philadelphia, began experimenting with internal fixation for limb length discrepancies. Called the PRECICE® nail, this fixation has a magnetically controlled intramedullary limb lengthening nail. The internal nail allows patients to lengthen the long bones of their shorter leg without battling against external pins or wires.  

Limb Shortening Surgery

On the other hand, if a patient no longer experiences bone growth, then limb shortening surgery is a better surgical option. However, this surgery can only be performed on those with a mild or moderate leg length inequality (less than 3 centimeters in the thigh bone or 2 centimeters in the shin bone). Rather than focus on leg lengthening, this surgery works on shortening the normal leg. Orthopedists treat leg length discrepancy during this operation by removing a piece of bone from the middle of the longer leg. The surgeon then inserts a metal rod, plate, and screws to keep the bone in place during the length discrepancy healing process. 

We’re Looking Forward to Helping You at Our Chiropractic Offices in NJ! 

At the Bergen Chiropractic and Sports Rehabilitation Center, our chiropractic team, led by Dr. Gregory Doerr, follows the highest and most professional medical standards to provide superior chiropractic help. After all, our mission is to provide unparalleled patient care and services in a comfortable healing atmosphere. Contact us to learn more about our chiropractic services! Our chiropractic offices in Cliffside Park, Hackensack, and Fairfield, New Jersey, are ready to welcome you. Also, feel free to access our blog page for more information on chiropractic treatments!

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