Leg length difference, cause and treatment

Leg length discrepancies often arise in childhood. A difference in leg length is not always immediately noticeable. Sometimes hip or back problems arise without noticing that the legs are not equal. The complaints often occur with a difference of more than 2 centimeters. Leg length difference can be congenital as a result of a vascular abnormality, but it can also be caused by an accident and osteoporosis. What is the right treatment for this?

Small leg length difference

Almost all people have a small difference in leg length. This is completely normal and actually goes unnoticed. Sometimes it is noticed, for example when riding, when the stirrups are custom made. The next person who sits in the saddle immediately notices that the stirrups hang unevenly in front of him or her. The difference between the two legs here is no more than 1 to 7 mm.

Symptoms

When the difference between the two legs is larger, from 8 mm, this is often noticed. There can be a small difference of 8 mm to 2 centimeters, but also a large difference of 2 cm to sometimes as much as 5 cm. The greater the difference, the more clearly noticeable this is. someone with a large leg length difference often stands with the short leg straight and the longer leg bent, with the hip sagging slightly. It is important to pay attention to this in children. A shorter difference is sometimes noticed by a crooked hip or crooked spine when standing.
Other symptoms include abnormal curvature of the spine and pelvic obliquity. This causes pain in the pelvis, hips or back. These joints are also subject to wear and tear more quickly. When walking, a clear waddling gait is sometimes visible. This depends on the extent of the leg length difference.

Cause

A leg length difference often occurs in childhood. Sometimes it is innate. The cause is most likely due to an increased blood supply in one leg, causing it to grow faster than the other leg. It often concerns a vascular abnormality that can be congenital, but can also develop later in life. However, a vascular abnormality has the greatest consequences at a younger age: until the age of 18, the bones are still in full growth, with the child making the greatest growth jumps, especially during the first four years.
Sometimes the leg cannot be used for a while. Consider an accident or an illness in one leg. The leg becomes inactive and the leg can shorten significantly. On the one hand, this has to do with muscle breakdown, and on the other hand, with bone decalcification or osteoporosis. Bone decalcification occurs because there is no longer any pressure on the bones, something that is constantly the case during exercise. This can occur at any age. Older people, who already have an increased risk of osteoporosis, are much more likely to experience leg shortening due to inactivity of one leg. When both legs become inactive, we often see an equal shortening of both legs. The difference is hardly noticeable.
Another cause of leg length discrepancy is the dislocated hip. This must be paid close attention when a sudden difference in leg length occurs. A doctor can detect this almost immediately. A hip becomes dislocated as a result of a fall or other accident, but also due to excessive mobility of the hip. This is called joint hypermobility. Finally, we would like to mention a bone fracture, where a difference in the length of the bones occurs as a result of this fracture.
The leg length difference does not always have to be a problem for him as he grows. This can also be in the knee, ankle or foot. The hip is also decisive.

Therapy

First of all, it must be determined what caused the leg length difference. In the event of a hip dislocation, it must of course be treated immediately. In children, it is examined how much height difference one can expect. If there is a small difference in length, no steps will be taken. If there is a difference in length of more than two centimeters, this can have unpleasant consequences and the doctor will proceed with treatment. It is possible to attach a growth plate. Damage to a growth plate can also sometimes be repaired, so that the leg can continue to grow normally. Other surgeries may be on the knee or ankle. Surgery is often only performed when the child is at least five years old.
A leg length difference at a later age cannot be remedied by addressing the growth plate. After all, the leg has long since grown. In many cases, raising the heel or sole is sufficient to resolve complaints. Surgery is only sometimes necessary in case of serious complaints. The long leg is shortened to the length of the shorter leg. People often have difficulty standing and walking afterwards, because the posture suddenly changes again. Her body has adapted to the height difference for years and now has to adapt to the correct proportion again. Physiotherapy can help with this. Hip complaints and back complaints as a result of the leg length difference can sometimes also be treated by a physiotherapist.

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  • Osteoporosis: pain and a crooked back
  • Broken leg: lower leg and upper leg
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