Leg Length Discrepancy Shoe Wear

Overview

Some people have an ?apparent? LLD which may make the affected leg seem longer than the other leg. There are several factors that can contribute to this feeling. Most commonly, contractures or shortening of the muscles surrounding the hip joint and pelvis make the involved leg feel longer, even when both legs are really the same length. Additionally, contractures of the muscles around the lower back from spinal disorders (i.e. arthritis, spinal stenosis), curvatures of the spine from scoliosis, and deformities of the knee or ankle joint can make one leg seem longer or shorter. In the general public, some people have an ?apparent LLD? as long as one half inch but usually don?t notice it because the LLD occurs over time. A ?true? LLD is where one leg is actually longer than the other. Patients can have unequal leg lengths of 1/4? to 1/2? and never feel it too! You can also have combinations of ?True? and ?Apparent? LLDs. During total hip replacement surgery, the surgeon may ?lengthen? the involved leg by stretching the muscles and ligaments that were contracted, as well as by restoring the joint space that had become narrowed from the arthritis. This is usually a necessary part of the surgery because it also provides stability to the new hip joint. Your surgeon takes measurements of your leg lengths on x-ray prior to surgery. Your surgeon always aims for equal leg lengths if at all possible and measures the length of your legs before and during surgery in order to achieve this goal. Occasionally, surgeons may need to lengthen the operable leg to help improve stability and prevent dislocations as well improve the muscle function around the hip.Leg Length Discrepancy

Causes

A patient?s legs may be different lengths for a number of reasons, including a broken leg bone may heal in a shorter position, particularly if the injury was severe. In children, broken bones may grow faster for a few years after they heal, resulting in one longer leg. If the break was near the growth center, slower growth may ensue. Children, especially infants, who have a bone infection during a growth spurt may have a greater discrepancy. Inflammation of joints, such as juvenile arthritis during growth, may cause unequal leg length. Compensation for spinal or pelvic scoliosis. Bone diseases such as Ollier disease, neurofibromatosis, or multiple hereditary exostoses. Congenital differences.

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

A doctor will generally take a detailed medical history of both the patient and family, including asking about recent injuries or illnesses. He or she will carefully examine the patient, observing how he or she moves and stands. If necessary, an orthopedic surgeon will order X-ray, bone age determinations and computed tomography (CT) scans or magnetic resonance imaging (MRI).

Non Surgical Treatment

You and your physician should discuss whether treatment is necessary. For minor LLDs in adults with no deformity, treatment may not be necessary. Because the risks may outweigh the benefits, surgical treatment to equalize leg lengths is usually not recommended if the difference is less than one inch. For these small differences, your physician may recommend a shoe lift. A lift fitted to the shoe can often improve your walking and running, as well as relieve back pain caused by LLD. Shoe lifts are inexpensive and can be removed if they are not effective. They do, however, add weight and stiffness to the shoe.

LLL Shoe Insoles

Surgical Treatment

For discrepancies over five centimeters, more aggressive surgical procedures-specifically leg lengthening procedures-are typically required. The specifics of this operative procedure are beyond the scope of this informational page, but your child's physician will be able to discuss the details in reference to your child's specific problems when considered appropriate.

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