Overview
Leg length discrepancy (LLD) affects about 70% of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ? 0.07 BW) at the shorter limb compared to the longer limb (0.56 ? 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.
Causes
There are many causes of leg length discrepancy. Some include, A broken leg bone may lead to a leg length discrepancy if it heals in a shortened position. This is more likely if the bone was broken in many pieces. It also is more likely if skin and muscle tissue around the bone were severely injured and exposed, as in an open fracture. Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. A break in a child's bone through the growth center near the end of the bone may cause slower growth, resulting in a shorter leg. Bone infections that occur in children while they are growing may cause a significant leg length discrepancy. This is especially true if the infection happens in infancy. Inflammation of joints during growth may cause unequal leg length. One example is juvenile arthritis. Bone diseases may cause leg length discrepancy, as well. Examples are, Neurofibromatosis, Multiple hereditary exostoses, Ollier disease. Other causes include inflammation (arthritis) and neurologic conditions. Sometimes the cause of leg length discrepancy is unknown, particularly in cases involving underdevelopment of the inner or outer side of the leg, or partial overgrowth of one side of the body. These conditions are usually present at birth, but the leg length difference may be too small to be detected. As the child grows, the leg length discrepancy increases and becomes more noticeable. In underdevelopment, one of the two bones between the knee and the ankle is abnormally short. There also may be related foot or knee problems. Hemihypertrophy (one side too big) or hemiatrophy (one side too small) are rare leg length discrepancy conditions. In these conditions, the arm and leg on one side of the body are either longer or shorter than the arm and leg on the other side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This is known as an "idiopathic" difference.
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
On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.
Non Surgical Treatment
The object of treatment for leg length discrepancy is to level the pelvis and equalize the length of the two limbs. Inequalities of 2-2.5 centimeters can be handled with the following. Heel lifts/ adjustable heel lifts can be used inside a shoe where shoes have a full heel counter. Heel lifts may be added to the heel on the outside of the shoe along with an internal heel lift. Full platforms along the forefoot and rearfoot area of a shoe can be added. There are many different adjustable heel lifts available on the market. For treatment of a leg length discrepancy, consult your physician. They may refer you to a Physiotherapist or Chiropractor for determination of the type of LLD. A Certified Pedorthist (Canada) will treat a structural leg length discrepancy with a heel lift or in larger discrepancies a footwear modification.
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Surgical Treatment
The bone is lengthened by surgically applying an external fixation device to the leg. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins, or both. A small crack is made in the bone and the frame creates tension when the patient or family member turns its dial. This is done several times each day. The lengthening process begins approximately five to 10 days after surgery. The bone may lengthen 1 millimeter per day, or approximately 1 inch per month. Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly. The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.
Leg length discrepancy (LLD) affects about 70% of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ? 0.07 BW) at the shorter limb compared to the longer limb (0.56 ? 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.
Causes
There are many causes of leg length discrepancy. Some include, A broken leg bone may lead to a leg length discrepancy if it heals in a shortened position. This is more likely if the bone was broken in many pieces. It also is more likely if skin and muscle tissue around the bone were severely injured and exposed, as in an open fracture. Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. A break in a child's bone through the growth center near the end of the bone may cause slower growth, resulting in a shorter leg. Bone infections that occur in children while they are growing may cause a significant leg length discrepancy. This is especially true if the infection happens in infancy. Inflammation of joints during growth may cause unequal leg length. One example is juvenile arthritis. Bone diseases may cause leg length discrepancy, as well. Examples are, Neurofibromatosis, Multiple hereditary exostoses, Ollier disease. Other causes include inflammation (arthritis) and neurologic conditions. Sometimes the cause of leg length discrepancy is unknown, particularly in cases involving underdevelopment of the inner or outer side of the leg, or partial overgrowth of one side of the body. These conditions are usually present at birth, but the leg length difference may be too small to be detected. As the child grows, the leg length discrepancy increases and becomes more noticeable. In underdevelopment, one of the two bones between the knee and the ankle is abnormally short. There also may be related foot or knee problems. Hemihypertrophy (one side too big) or hemiatrophy (one side too small) are rare leg length discrepancy conditions. In these conditions, the arm and leg on one side of the body are either longer or shorter than the arm and leg on the other side of the body. There may also be a difference between the two sides of the face. Sometimes no cause can be found. This is known as an "idiopathic" difference.
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
On standing examination one iliac crest may be higher/lower than the other. However a physiotherapist, osteopath or chiropractor will examine the LLD in prone or supine position and measure it, confirming the diagnosis of structural (or functional) LLD. The LLD should be measured using bony fixed points. X-Ray should be taken in a standing position. The osteopath, physiotherapist or chiropractor will look at femoral head & acetabulum, knee joints, ankle joints.
Non Surgical Treatment
The object of treatment for leg length discrepancy is to level the pelvis and equalize the length of the two limbs. Inequalities of 2-2.5 centimeters can be handled with the following. Heel lifts/ adjustable heel lifts can be used inside a shoe where shoes have a full heel counter. Heel lifts may be added to the heel on the outside of the shoe along with an internal heel lift. Full platforms along the forefoot and rearfoot area of a shoe can be added. There are many different adjustable heel lifts available on the market. For treatment of a leg length discrepancy, consult your physician. They may refer you to a Physiotherapist or Chiropractor for determination of the type of LLD. A Certified Pedorthist (Canada) will treat a structural leg length discrepancy with a heel lift or in larger discrepancies a footwear modification.
how can i increase my height after 18?
Surgical Treatment
The bone is lengthened by surgically applying an external fixation device to the leg. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins, or both. A small crack is made in the bone and the frame creates tension when the patient or family member turns its dial. This is done several times each day. The lengthening process begins approximately five to 10 days after surgery. The bone may lengthen 1 millimeter per day, or approximately 1 inch per month. Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly. The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.
