Addressing Limb Length Discrepancy After Childhood Fractures

Leg length discrepancy caused by fractures?

Hello Doctor, I am 18 years old.
When I was in kindergarten, I fractured my right calf.
Once I healed and was able to walk, my parents noticed that my legs were of unequal length.
According to them, it was said that the injured bone would naturally grow longer than the uninjured one after a fracture, so they let it go.
However, as I have grown older, I have gradually felt the issues caused by the leg length discrepancy.
My left lower back tends to ache more easily than usual, which is a concern for me.
The length difference between my calves is approximately 1 to 1.5 centimeters.
I would like to ask the doctor if there are any other options for improvement besides using insoles in my left shoe or surgically lengthening the left calf bone.
Thank you!

Shuǐ lán sè bǎo tè píng, 10~19 year old female. Ask Date: 2005/02/01

Dr. Zhang Yuzhang reply Rehabilitation

Dear Water Blue Plastic Bottle,
The issues caused by leg length discrepancy primarily involve pelvic tilt and scoliosis, which can lead to secondary low back pain.
Generally, if the difference in leg length is less than half an inch, no specific treatment is required (however, if low back pain has already developed, correction is necessary).
For discrepancies of less than one inch that require correction, an insole can be used to elevate the shorter leg; for discrepancies greater than one inch, a heel lift should be added.
If the leg length difference is too significant and neither insoles nor heel lifts are sufficient for correction, surgical intervention should be considered.
In your case, simply adding an insole along with soft stretching exercises for the lower back should lead to improvement.
Problems that can be resolved with conservative treatment do not require surgical consideration.
Wishing you good health and all the best from Tainan Hospital!

Reply Date: 2005/02/01

More Info

Addressing limb length discrepancy after childhood fractures is a significant concern for many individuals who have experienced fractures during their developmental years. In your case, the discrepancy of 1 to 1.5 centimeters between your legs, particularly following a fracture in your right calf, can lead to various complications, including discomfort and postural issues, as you've already noted with your left hip feeling sore.
Firstly, it is essential to understand that limb length discrepancies can occur due to several factors, including the nature of the fracture, the healing process, and the growth potential of the affected bone. In children, bones have a remarkable ability to remodel and grow, especially when they are still in their growth phase. However, if a fracture occurs near the growth plate, it can potentially affect the growth of that bone, leading to discrepancies in limb length.

In your situation, it seems that the initial belief that the injured leg would grow longer than the uninjured leg did not hold true, which can happen in some cases but is not guaranteed. The growth patterns can vary significantly among individuals, and while some may experience compensatory growth, others may not.

Here are some options to consider for addressing your limb length discrepancy:
1. Orthotic Devices: As you mentioned, using shoe lifts or orthotic devices can help balance the length difference. This is often the simplest and least invasive approach to alleviate discomfort and improve posture.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can help you strengthen the muscles around your hips and legs, improve your posture, and develop strategies to manage any discomfort associated with the discrepancy.

3. Surgical Options: In more severe cases or when the discrepancy leads to significant functional impairment, surgical options may be considered. One common procedure is limb lengthening surgery, where the bone is gradually lengthened using a device. This is a complex procedure and requires careful consideration, as well as a commitment to a lengthy rehabilitation process.

4. Monitoring Growth: Since you are still young, it may be beneficial to have regular check-ups with an orthopedic specialist who can monitor your growth and assess whether the discrepancy is changing over time. Sometimes, as individuals continue to grow, the discrepancy may become less pronounced.

5. Addressing Postural Issues: Since you are experiencing discomfort in your left hip, it may be worthwhile to explore exercises that promote balance and strength in your lower body. This can help mitigate the effects of the discrepancy and improve your overall function.

6. Consultation with Specialists: It may also be helpful to consult with a pediatric orthopedic surgeon or a specialist in limb length discrepancies. They can provide a comprehensive evaluation and recommend the best course of action tailored to your specific situation.

In conclusion, while limb length discrepancy can be a source of concern, there are various strategies to manage and potentially correct the issue. It is crucial to work closely with healthcare professionals who can guide you through the options available and help you achieve the best possible outcome for your health and well-being. Remember, early intervention and a proactive approach can make a significant difference in managing limb length discrepancies effectively.

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