Leg length difference

• Congenital: may be noticeable immediately after birth or gradually manifest with growth.
• Injury: bone fusion after fracture with shortening or elongation, damage to growth zones.
• Infectious process: damage to bones with growth areas causes a decrease in the function of growth cartilage and premature closure of growth areas.
• Diseases: neurofibromatosis, Olier disease, multiple exostosis chondrodysplasia, etc.
• Neurological disorders: due to a violation of innervation, nutrition and growth zone function are impaired.
• Hemigipertrophy or hemigipotrophy: when one side of the body is developed more or less. Cross-over also occurs when, for example, an increase is visible on the right cheek, left arm and right leg.
• Idiopathic causes: the exact cause is unknown.
• In addition, the influence of ionizing radiation, high temperatures (burns), and the use of drugs affecting growth zones have been proven to develop differences in the length of limbs.

The final diagnosis is made by the orthopedic surgeon after a clinical examination of the patient and X-ray examination.

On examination: claudication, the inclination of the pelvis towards the shortened limb, compensatory scoliotic deformity of the spine, knee joints are located at different levels. The length of the limbs is measured with a centimeter tape. To measure the length of the legs using natural bony protrusions, clearly visible on the eye and easily detected by palpation [2]. A more accurate method of measuring the difference in leg length is to put blocks with a certain height (0.25 cm, 0.5 cm, 1 cm, etc.) under a shortened limb until the pelvis is level in the horizontal plane.

Radiography: a topogram of the lower extremities is performed while standing and the total length and length of segments of the lower extremities are calculated.

Conservative treatment

With a difference in the length of the lower extremities up to 2 cm, it is recommended to wear orthopedic shoes, orthopedic insoles, heel pads that compensate for shortening.

Surgical treatment

• Extension of a limb segment in an external fixation apparatus ( Ilizarov apparatus ). In order to lengthen the bone, it is necessary to perform an osteotomy, stretch the fragments to the required length, and then achieve fusion at the site of the osteotomy. The treatment period takes from 6 to 9 months, taking into account the absence of complications. After dismantling the external fixation apparatus, as a rule, rehabilitation treatment courses are required.
• Blocking growth zones is a method of treating differences in the length of the lower extremities used in children during the growth period [3]. It is based on restraining the growth function of a longer limb. Segments continue to grow, but more slowly. A gradually shortened limb catches up with a healthy one. A distinctive feature of the method is the absence of a need to violate the integrity of the bone (osteotomy).

Exclude the use of vitamin preparations, in order to avoid stimulation of the growth of a larger limb. Massage is recommended exclusively on a smaller part of the body.

• Kaufman KR, Miller LS, Sutherland DH // J. Pediatr. Orthop. - 1996. Vol. 16, N 2. - P. 144-150.
• Marx V.O. Orthopedic diagnostics. Reference manual. - Minsk, "Science and Technology", 1978.
• WP Blount, GR Clarke // J. Bone Joint Surg. [Am.]. - 1949. - Vol. 31. - P. 464-478.