Leg Length Discrepancy

The symptoms vary depending on the cause of the condition. But in general, symptoms of leg length differences are pain in the pelvis and back, functional scoliosis, Achilles tendon shortening, and abnormal gait. Depending on the misalignment, if the knee joints are at different heights when walking, it can be experienced as annoying despite compensation with adapted shoes.

Several congenital conditions can cause leg length differences, such as dysplasias (achondroplasia, pseudoachondroplasia, trichorhinophalangeal syndrome/TRPS, spondyloepiphyseal dysplasia congenita, multiple epiphyseal dysplasias, etc.); dysmelia (proximal femoral focal deficiency/PFFD, tibia aplasia, congenital tibia pseudoarthrosis, fibula hemimelia, etc.); metabolic bone diseases (x-chromosome-linked hypophosphatemic rickets/XLH, Paget's disease, etc.); hemoglobinopathies (sickle cell anemia, thalassemia), hemihypertrophy, osteochondroma diseases (hereditary multiple osteochondromas, Ollier's disease, Trevor's disease, etc.) and many more. 

In many cases, no treatment is needed, and most people can benefit from insoles or adapted shoes to even out the leg length difference. In children, growth on the long side can sometimes be inhibited so that the short side has time to catch up and thus even out the difference. In fully grown adults, it is usually easiest to lengthen the short leg with callus distraction. 
 
The method involves surgery through a small skin and soft tissue incision. The skeleton is first divided, then an external frame is mounted, or an intramedullary lengthening nail is added inside the leg. About a week after the operation, when the skeleton has begun its healing process, the process of lengthening the leg can start. The method includes extending the leg by up to one millimeter a day until the desired length is reached. The extension itself does not cause much discomfort beyond what is associated with the procedure. However, frequent return visits and walking aids are usually needed for a longer period, often several months. With an external frame, the patient needs to make frequent dressing changes, especially at the beginning of the treatment. However, the advantage of this method is that the patient can start normal loading earlier than with an intramedullary lengthening nail.  
 
The entire process from surgery to completed treatment usually takes 6-12 months, depending on the magnitude of the extension, the patient's comorbidity, age, and other factors.  
 
For patients with leg length differences in combination with other misalignments in the leg, the misalignments are corrected simultaneously with the lengthening. 
 
The goal of treatment is always to improve the patient's function or prevent future problems. Treating misalignments or leg length differences is an individual decision, and we assess each patient based on their desires and symptoms before presenting a treatment proposal. At Karolinska Deformity Surgery, we have extensive experience correcting leg length differences and associated misalignments. Individual assessments are made at multidisciplinary conferences together with endocrinologists and representatives from clinical genetics for investigation, as well as with occupational and physiotherapists regarding rehabilitation.