How To Determine Differences In Leg Length
The only real way to assess a permanent, structural difference in leg length is through the use of an X-Ray or CT scan. This is because sometimes the appearance of uneven legs isnt due to an actual difference in leg length. According to Ryan Enke, M.D., a board-certified physical medicine and rehabilitation physician with OrthoIllinois, factors like spinal curvature can cause legs to seem uneven, even when theyre structurally the same. Likewise, temporary muscle imbalances can also cause one leg to appear shorter than the other.
To gain clues as to whether you might have a leg length discrepancy that deserves further assessment or treatment by a physical therapist or doctor, try this test with a friend.
If your ankles arent even, you could have uneven legs, or you could be dealing with muscle imbalances. To get a slightly more accurate assessment, flow through some simple range of motion exercises or yoga poses to loosen up, then repeat steps one through three.
How To Recognize Paralysis Caused By Polio
Paralysis usually begins when the child is small, often during an illness like a bad cold with fever and sometimes diarrhea.
- Paralysis may affect any muscles of the body, but is most common in the legs. Muscles most often affected are shown in the drawing.
- Paralysis is of the ‘floppy’ type . Some muscles may be only partly weakened, others limp or floppy.
- In time the affected limb may not be able to straighten all the way, due to shortening, or ‘contractures’, of certain muscles.
- The muscles and bones of the affected limb become thinner than the other limb. The affected limb does not grow as fast, and so is shorter.
- Unaffected arms or legs often become extra strong to make up for parts that are weak.
- Intelligence and the mind are not affected.
- Feeling is not affected.
‘Knee jerks’ and other tendon reflexes in the affected limb are reduced or absent. Also, the paralysis of polio is ‘floppy’ limbs affected by cerebral palsy often are tense and resist when straightened or bent .
- The paralysis does not get worse with time. However, secondary problems like contractures, curve of the backbone and dislocations may occur.
Of children who become paralyzed by polio:
30% recover completely in the first weeks or months.
30% have mild paralysis.
Even A Small Deviation In Leg Length Could Impact Joint Stability And Degenerative Disc And Joint Disease
University researchers in Australia and Spain combined to publish research in the Journal of Manipulative and Physiological Therapeutics that evaluated the correlation between mild leg length discrepancy and degenerative joint disease or osteoarthritis.
They looked at 235 adults, who went to the chiropractor for back pain. The researchers found a strong connection between leg length discrepancy and degenerative disc disease at the L5-s1 spinal segment and the L4-L5 spinal segment.
The researchers concluded that patients with hip and lower back pain should be evaluated for leg length discrepancy.
In Finland, doctors writing in the medical journal Acta Orthopaedica went back 29 years to show how different leg lengths affected patients over this near 30 year period.
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What Are The Causes Of Leg Length Discrepancies
LLDs are very common. Sometimes the cause isnt 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. This is a soft part of a long bone that allows the bone to grow. Growth plate injury can slow bone growth in that leg.
A break or fracture to a leg bone that causes overgrowth of the bone as it heals.
A problem that is present at birth . For example, one whole side of the childs body may be larger than the other side.
Conditions that affect muscles and nerves, such as polio.
Classification Of Leg Length Discrepancy
There are two types of limb length discrepancy
Structural limb length inequality. Its a physical shortening of one lower limb between the trochanter femoral major and the ankle mortise. Congenital conditions include mild developmental abnormalities found at birth or childhood, whereas acquired conditions include trauma, fractures, orthopedic degenerative diseases, and surgical disorders such as joint replacement. A systemic review evaluating the prevalence of LLD by radiographic measurements revealed that 90% of the normal population had some type of variance in bony leg length, with 20% exhibiting a difference of > 9 mm.
Non-structural shortening. It is a unilateral asymmetry of the lower extremity without any shortening of the osseous components of the lower limb. FLLD may be caused by an alteration of lower limb mechanics, such as joint contracture, static or dynamic mechanical axis malalignment, muscle weakness, or shortening. It is impossible to detect these faulty mechanics using a non-functional evaluation, such as radiography. FLLD can develop due to an abnormal motion of the hip, knee, ankle, or foot in any of the three planes of motion.
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The Problem Of Pelvic Tilt In Femoroacetabular Impingement
We have a very extensive article on Femoroacetabular Impingement. We will summarize some of the learning points of this article here.
Femoroacetabular Impingement or sometimes diagnosed simply as Hip Impingement is a condition where abnormal contact and rubbing of the ball and socket portion of the hip bones creates joint damaging friction. For some people, the rapid degeneration of the hip joint causes the formation of bone spurs. The bone spurs are there because the body is trying to create stability in a joint that has become unstable. The loss of stability can be traced to a weakening of the ligaments and tendons of the hip, low back, groin, and hamstring areas, and hip labrum degeneration.
What Causes Leg Length Discrepancy
Leg length discrepancy can be present at birth , but might not be noticeable until a child gets older. It also can develop when a child is older .
Causes of congenital leg length discrepancy include:
- fibular hemimelia
- focal femoral deficiency
Causes of acquired leg length discrepancy include:
- a broken leg bone
An idiopathic leg length discrepancy is one where the cause isn’t known.
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How Is Leg Length Discrepancy Treated
If a child has only a slight difference in leg length, a shoe lift can even things out. This may be all some kids need. But if the difference in leg length is more than 1 inch or gets worse as the child grows, surgery can help. Kids may need more than one surgery as they grow.
An option for kids who are still growing is epiphysiodesis . In this relatively simple outpatient surgery, one or two of the growth plates in the longer leg are scraped or compressed with surgical plate and screws. A growth plate is an area at the end of the bone where new growth happens. The surgery slows or stops the longer leg from growing so the shorter leg can catch up.
If a child has stopped growing, orthopedists can sometimes correct a leg length discrepancy by shortening the longer leg. This is done by removing a piece of bone from the longer leg.
Limb lengthening surgery also can be done. In this surgery, the shorter limb is lengthened through a device on the outside of the body or a device placed inside the bone . This surgery requires a stay in the hospital and weeks to months of follow-up care and rehabilitation.
How Are Leg Length Discrepancies Diagnosed
The healthcare provider carefully examines the child. He or she checks to be sure the legs are actually different lengths. This is because problems with the hip or back can make it seem like one leg is shorter, when both legs are the same length.
An X-ray of the childs legs is taken. During the X-ray, a long ruler is put in the image so an accurate measurement of each leg bone can be taken. Sometimes a CT scan is used.
If an underlying cause of the discrepancy is suspected, additional tests are done to further evaluate.
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Previous Trauma To A Bone In The Leg
A broken leg bone can lead to a limb length discrepancy if it heals in a shortened position. This is more likely to happen if the bone was broken in several places. It is also more likely to happen if the skin and muscle tissue around the bone were severely injured and exposed, as occurs in an open fracture. Alternatively, a break in a child’s bone through the growth plate can cause permanent damage, which may slow or stop growth in that area, resulting in a shorter leg.
In a child, a broken bone that does not involve the growth plate sometimes will grow faster for several years after healing, causing it to become longer than the bone on the opposite side. This type of overgrowth occurs most often in young children with femur fractures.
Functional Leg Length Discrepancy
You can do several things to correct uneven hips when the measured length of your legs is equal:
- Massage can help remove any knots and relax your muscles.
- Exercises that stretch the side with the tight muscles can improve the mobility and range of motion of your legs and hips. These are the main treatment for uneven hips.
- Exercises that strengthen your muscles are also helpful.
- Its also important to correct any bad posture, so the problem doesnt come back.
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Leg Length Discrepancy And Degenerative Joint Forces Straining The Hip
- If one leg is shorter than the other, the hip joints will be stressed as the leg-length discrepancy will cause an abnormal gait or walking motion. This is evidenced by the waddling gait of someone with a hip problem. This waddling gait helps remove pressure on the painful hip. The gait cycle is most efficient when the iliac crests are level, you have a straight pelvis, not a tilted pelvis. Unequal leg lengths cause the pelvis to move abnormally, this will cause stress on the pelvis and can include problems of Pelvic Floor Dysfunction, Pubic symphysis in Men, and Pelvic Girdle Pain.
Amputation And Prosthetic Fitting
In rare cases, when the affected limb is substantially shorter and cannot be suitably reconstructed, or when limb-lengthening procedures cannot be tolerated by the patient, amputation and prostheses may be considered.
Depending on which bone is affected, doctors may recommend an above-the-knee prosthesis with a mechanical knee , or a below-the-knee prosthesis .
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What Can Parents Do
Fixing leg length discrepancy can take many years. Parents and the orthopedic care team play a big role in treatment.
Here are things you can do:
- Talk to your child’s care team about treatment and healing. Ask questions. Find out what each surgery is for and how to care for your child afterward.
- Take your child to all scheduled medical appointments.
- If your child is old enough, talk about treatments and what to expect. Include older kids in surgery decisions when you can.
What Causes Differing Lengths Between The Legs
The cause of a leg length can vary the first step is to identify whether the LLD is functional or structural. Functional LLDs are created by a difference in the biomechanics between the feet, that causes a LLD when standing. When lying down, the leg length may appear similar or the same. A good example is having posterior tibial tendon dysfunction affecting the tendon on one foot, which can result in one foot being flatter than the other.
A structural LLD describes the difference in the physical length of the bones, usually the tibia or the femur. This can be measured both standing and when lying down.
In recent years, many more individuals have benefitted from life-changing joint replacement surgery. Generally, either a knee or hip joint that has been damaged via degenerative osteoarthritis or less commonly infection or trauma, is replaced using modern innovative surgical techniques and specialised joint prostheses. LLDs can be a complication of joint replacement surgery due to size differences in the prosthetic joint compared to the other natural joint. While your surgeon will make every effort to maintain the leg length that you had before surgery, there is no guarantee due to the intricate positioning of the new joint.
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Training To Prevent Temporary Imbalances
Of course, one of the best ways to avoid injuries is to develop habits that prevent them from occurring in the first place.
Temporary leg length discrepancies caused by muscle imbalances and weaknesses are reasonably easy to prevent, or even counteract, through cross-training. An athlete has to change what theyve been doing thats causing the problem, Plunk says. For instance, if running usually takes place on pavement, then it might be time to switch to grass or dirt. Or if youve made a point of consistently running fast, then mix it up with a slower pace or intervals. And if running hurts, switch to swimming or biking. The key is to identify the problem and make the change before it becomes debilitating.
Plunk also points out that learning and practicing new strengthening and stretching exercises, often with the assistance of a physical therapist, is a necessary solution. Because runners commonly run on one side of the road, placing more stress on one side of the body, they are more likely to end up with muscle imbalances that could lead to pain or injury. Physical therapists can help identify imbalances prescribe the exercises necessary to put you back on even footing.
What Is The Treatment For Short Leg Syndrome
To relieve the pain of a short leg whether the pain is in the feet, ankles, knees, hips, or lower back our goal is to equalize the length of both legs. We can accomplish this in several ways.
- Building up the sole and heel of your shoesThis technique is especially helpful for those people with large differences in their limb length. The problem with this treatment is that it can be a hassle to add a lift to all of your shoes.
- Adding a lift inside your shoeThis is the quickest and simplest method of adjusting for a short leg. The downside is that lifts can wear out quickly and raise only the heel rather than the entire foot. In addition, they do not compensate for the abnormal pronation that often occurs with a short leg. We will often start with in-shoe lifts and then move on to more definitive treatments later. We usually start treatment with this adjustable heel lift. It can be adjusted to 1/8, 1/4 and 3/8. If more lift is needed get more than one and stack the lifts on top of each other.
- Prescribing custom orthoticsCustom orthotics for short leg offer the advantage of treating both the short leg AND the abnormal pronation that usually occurs with limb length discrepancy. These comfortable medical devices, made from molds of your feet, will not wear down for years, thus saving you money and pain. Read here why orthotics from the Foot and Ankle Center are likely to be more effective than those from other clinics.
References Short Leg Syndrome
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Thoughts On Different Types Of Disabilities: List Of 21 Disabilities
Dear Sir,Am having no vision in my right eye as am having amblophia and very low vision in my left eyeAm I eligible for Disability Certificate.Regards.
I have a question. I am a teacher with several school related incidents / injuries at work concerning my right ankle, as well as a shoulder. At one time I slipped on water from AC unit overhead and shattered my right ankle. Another time, I fell on broken sidewalk when forced to exit the building through a door with no lights, that I wast familiar with exit, grass knew high. The last injury concerns the right shoulder and elbow, as I was trampled at work. I loss the use of my right hand and arm. I have regained use, but will always be weak with right hand due to ulnar nerve entrapment.
Please keep in mind that my work does not provide me with any workers comp nor does it follow restrictions from the surgeon.
My ankle restrictions: No moving furniture, no wet floors, breaks when standing , stooping, climbing, lifting, etc. Plus, personal: no running, jumping, moving furniture, no stooping, climbing, repelling, lifting, etc. In both cases, I must wear orthopedic shoes with inserts and an ankle brace at all times. My ankle is not stable, it is bone on bone, totally reconstructed, tendons and ligaments broke away with chipped ankle bone, tibia bossing was removed.
Am I covered under A.D.A? What should I do about my place of employment not following accommodations / restrictions??