Leg length discrepancies (LLD) can have a number of causes and in more severe cases, lead to a number of life-long issues. Valley Children’s orthopaedic experts offer a wide range of individualized treatment options in a caring and family-centered environment.

 

LLD can be congenital, developmental or caused by an infection or trauma. These deformities can lead to crooked bones or joints which can cause issues with walking, joint issues and premature arthritis as well as cosmetic and social issues. Our comprehensive, multidisciplinary team includes orthopaedic specialists, physical therapists, social workers and other pediatric specialists focused on meeting your child’s individual needs.

 

 

Leg length discrepancy is the difference between the lengths of one leg compared to the other. Small discrepancies are very common and often go untreated. However, larger discrepancies can cause inefficient gait, chronic pain, back pain and degenerative joint changes. 

 

 

1.Knee deformities – bow legs, knock knee, tibia vara, post fracture or infection deformities

2.Congenital lower limb deficiencies – congenital short femur, proximal femoral focal deficiency, fibular hemimelia, tibial hemimelia

3.Foot deformities

4.Osteomyelitis (bone infection) 

5.Nonunion of fractures including congenital pseudarthrosis of the tibia

6.Bone defects following trauma, infection or tumor excision

7.Short residual limb following amputation

8.Joint contractures including pterygium 

9.Perthes disease, AVN, SCFE

 

 

If your child has a noticeable leg discrepancy, your orthopaedic specialist will determine whether action is necessary and if so, begin working with you on a treatment plan. Because children are still growing, leg length discrepancy may change. We can predict the limb length discrepancy at maturity and make recommendations based on that projection.

 

0-2cms: No treatment necessary

2-5cms: Shoe lift and limb shortening/lengthening of long leg

5-20cms: Limb lengthening (may be combined with other treatments) 

20cms or more: Limb lengthening or prosthetics 

 

The limb lengthening process can sound overwhelming, but Valley Children’s orthopaedic team is here to help you navigate this experience.  Our orthopaedic specialists are experienced in the most advanced surgical limb lengthening procedures.

 

1. Limb lengthening surgery:
During the lengthening surgery, an osteotomy is performed. An osteotomy is a surgical cut of the bone. Once the bone is separated, the fixator is applied.

After surgery, most children stay in the hospital for two to three days and work with a physical therapist to work on learning to get out of bed, move the joints, use a walker or crutches, transfer to the chair and toilet and use the stairs. Our nursing staff will teach pin care.

Lengthening will begin a few days to a week after surgery. The time after surgery and before the lengthening begins is known as the latency period. It is necessary to wait a few days before lengthening so that the callus (new bone) can form at the break site.

 

Lengthening is done manually with the external fixator and the rate is approximately one millimeter (mm) per day, but may be slower or faster depending on the tolerance of the bone and soft tissues.Lengthening with the intramedullary nail is done using an external remote control (ERC) device. During the first week, our team will train you and your child how to use the ERC device.

 

 

During this phase, the external or internal fixator will gradually lengthen the bone approximately one millimeter (mm) per day. Your child will usually begin outpatient physical therapy after you are discharged from the hospital. It is very important to the success of the lengthening process that you attend your child’s physical therapy appointments. Your physical therapist will teach you exercise to do with your child at home. Your involvement in your child’s therapy is crucial to its success – the more therapy your child receives, the better the result. Most parents and caregivers can become excellent therapists! 

 

Most children will see their orthopaedic doctor for a check-up every week to every other week during the distraction phase. It may be helpful to think of the lengthening process as a continuous surgery, one that does not end until the goal length is reached.

 

 

Once your child has reached their goal length, they enter the consolidation phase. No further adjustments are made to the fixator. The fixator will stay until the end of the consolidation phase to allow the newly-formed bone to harden. The total time in the external fixator is usually about 1 month for each centimeter of lengthening in children. Total fixator time is divided evenly between the distraction and consolidation phases.

 

Most children will see their orthopaedic doctor for a check-up once a month during the consolidation phase.

 

 

Once the lengthened bone heals, your child’s orthopaedic doctor will remove the external and check the strength of the bone. If the bone is strong, the external fixator is removed and your child can go back to his or her normal activities. If your child had an intrameduallary rod, once the goal length is reached, the rod is typically removed one year after it was placed as long as the bone is fully healed.