Leg Length Discrepancy in Children | Treatment

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What are the treatment options for leg length discrepancy?

There are a few different treatments for leg length discrepancy, some involve surgery and some don’t.

Your child’s orthopedic surgeon will talk with you about the options for your child based on:

  • your child's age, overall health and medical history
  • the size of the discrepancy
  • your child's tolerance for specific medications, procedures or therapies
  • your expectations or preferences

Some treatments used to equalize leg length are simple and safe. Others, especially leg-lengthening procedures, are complex and have the risk for complications

Considerations when planning leg length discrepancy treatment

Since children are growing, the goal of treatment is to correct the discrepancy that would be present at maturity. This means that careful analysis of your child's personal rate of growth is crucial. To estimate the discrepancy at maturity, your child's orthopedic surgeon may need to take many measurements of your child's growth over a period of one or two years before surgery can be considered.

It’s also important to note that the goal of treatment is not always to have legs of equal length. For example, some patients with neuromuscular conditions that involve muscle weakness or paralysis of the short leg may do best with an under-correction of one or two centimeters. This allows for clearing of the floor during the swing phase of the walking cycle.

Non-surgical treatments

If your child’s leg length discrepancy is mild, generally less than one inch, it is usually treated with non-surgical options.

Shoe lifts

This is an orthotic that is fitted to the child’s shoe. It can help the child walk and run and may also help with any back pain the child feels.

Prosthetics

These devices may work well for some patients with very large discrepancies who would not benefit from other lengthening or shortening procedures.

Leg-shortening surgery

Procedures to shorten the longer leg are usually recommended for leg length discrepancies that are expected to be between two and six centimeters when the child reaches maturity. Shortening procedures are generally considered safer and result in fewer complications than lengthening procedures.

Epiphysiodesis

This procedure slows the rate of growth of the long leg, allowing the short leg to catch up. It is performed on children who are not yet done growing. During the procedure, a bony ridge is created, usually by repositioning a block of bone in the region that tethers the growth plate, preventing future growth. Possible disadvantages of this procedure include the risk of a slight over- or under- correction of leg length and that the child may have a slightly shorter adult height.

Epiphyseal stapling

This procedure temporarily slows the rate of growth in the longer leg. Staples are surgically inserted on each side of the growth plate. Once the legs are of equal length, the staples are removed.

Bone resection

This operation involves removing a section of bone in the longer leg so the legs are equal length. It can be performed on adults or adolescents who are no longer growing.

Leg-lengthening surgery

Lengthening procedures are usually only used for discrepancies that are larger than four centimeters. Both lengthening surgeries take several months.

External fixation

During this surgery, the shorter leg bone is cut into two. A customized apparatus (called an external fixator) that encircles the bone is attached to the bone by pins.

Beginning a few days after surgery, the two ends of the bone are very gradually pulled apart by making slight adjustments to the apparatus each day. This leads to new bone formation between the two ends. Once the correct length is reached, the bone is given a chance to harden and the apparatus is surgically removed.

Internal fixation (PRECICE Nail)

For this procedure, the bone in the shorter leg is cut into two and the surgeon places a magnetic motorized nail in the bone. The bone then slowly lengthened using an external magnet.

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