If one scans the literature it readily becomes obvious that leg length discrepancy/asymmetry is a common finding. This fact has been a very controversial topic within chiropractic, and diagnostic rationales have been built around this very common finding.
The object of this column is to consider some of the causes of this discrepancy that the profession may have ignored or not been aware of.
LLDs are very common. Sometimes the cause isn?t known. But the known causes of LLD in children include, injury or infection that slows growth of one leg bone. Injury to the growth plate (a soft part of a long bone that allows the bone to grow). Growth plate injury can slow bone growth in that leg. Fracture to a leg bone that causes overgrowth of the bone as it heals. A congenital (present at birth) problem (one whole side of the child?s body may be larger than the other side). Conditions that affect muscles and nerves, such as polio.
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.
The evaluation of leg length discrepancy typically involves sequential x-rays to measure the exact discrepancy, while following its progression. In addition, an x-ray of the wrist allows us to more carefully age your child. Skeletal age and chronological age do not necessarily equal each other and frequently a child's bone age will be significantly different than his or her stated age. Your child's physician can establish a treatment plan once all the facts are known: the bone age, the exact amount of discrepancy, and the cause, if it can be identified.
Non Surgical Treatment
In an adult, we find that we can add a non compressive silicone heel lift to a shoe in increments of 3-4 mm maximum per week. Were we to give a patient with a 20 mm short leg, 20 mm of lift all at once, their entire body would rebel. The various compensations that the body has made, such as curvatures and shortening of muscles on the convex side of the curve, would make such a dramatic change not just noticeable, but painful. When we get close to balancing a patient by lifting a leg with heel inserts, then we perform another gait analysis and follow up xray. At that point, we can typically write them a final prescription to have their shoe modified. A heel lift is typically fine up to 7 mm. When it gets higher than that, the entire shoe must be modified. There are two reasons for this. The back of the shoe is generally too short to accommodate more than 7-8 mm inserted inside the shoes and a heel lift greater than 7 mm will lead to Achilles tendon shortening, which then creates it?s own panoply of problems.
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Surgery to shorten the longer leg. This is less involved than lengthening the shorter leg. Shortening may be done in one of two ways. Closing the growth plate of the long leg 2-3 years before growth ends (around age 11-13), letting the short leg catch up. This procedure is called an epiphysiodesis. Taking some bone from the longer leg once growth is complete to even out leg lengths. Surgery to lengthen the shorter leg. This surgery is more involved than surgery to shorten a leg. During this surgery, cuts are made in the leg bone. An external metal frame and bar are attached to the leg bone. This frame and bar slowly pull on the leg bone, lengthening it. The frame and bar must be worn constantly for months to years. When the frame and bar are removed, a leg cast is required for several months. This surgery requires careful and continued follow-up with the surgeon to be sure that healing is going well.