Can Physical Therapy Help with Leg Length Discrepancy Issues?

Leg length discrepancy

Hello Dr.
Chen: My uncle has a leg length discrepancy, which has become more severe.
He walks with his body leaning to one side.
Can rehabilitation therapy help? Does he need surgery?

peter, 20~29 year old female. Ask Date: 2006/12/24

Dr. Chen Xianchang reply Rehabilitation

1.
Actual measurement of leg length is required to determine if there is true leg length discrepancy or if it is caused by scoliosis.

2.
If the scoliosis is less than 20 degrees, rehabilitation is recommended.
If it is between 20 and 40 degrees, a Milwaukee brace along with rehabilitation is indicated.
If it exceeds 40 degrees, surgical correction is necessary.

3.
If the leg length discrepancy is greater than 2 centimeters, corrective shoes should be made with a lift on the shorter side.
If the discrepancy is 5 centimeters, in addition to corrective shoes, surgical tendon release may be required, followed by rehabilitation.

Reply Date: 2006/12/24

More Info

Leg length discrepancy (LLD) is a condition where one leg is shorter than the other, which can lead to various complications, including postural imbalances, gait abnormalities, and pain in the hips, knees, and lower back. Your uncle's situation, where he is experiencing increased severity in his condition and a noticeable tilt while walking, is indeed concerning and warrants a comprehensive evaluation.

Physical therapy can play a significant role in managing leg length discrepancies, especially in cases where the discrepancy is mild to moderate. The primary goals of physical therapy in this context include:
1. Improving Gait Mechanics: A physical therapist can assess your uncle's walking pattern and provide exercises to improve his gait mechanics. This may involve strengthening exercises for the muscles that support the pelvis and lower limbs, as well as flexibility exercises to ensure that all muscle groups are functioning optimally.

2. Postural Alignment: Physical therapists can help correct postural imbalances caused by LLD. They may use manual therapy techniques to realign the pelvis and spine, which can alleviate some of the discomfort associated with the discrepancy.

3. Strengthening Exercises: Strengthening the muscles around the hips, knees, and ankles can help compensate for the difference in leg length. This can reduce strain on the joints and improve overall stability.

4. Stretching and Flexibility: Tight muscles on one side of the body can exacerbate the effects of LLD. A physical therapist can develop a stretching program to improve flexibility and reduce muscle tension.

5. Orthotic Devices: In some cases, physical therapists may recommend the use of orthotic devices, such as shoe lifts, to help balance the leg lengths and improve walking mechanics. This can be particularly beneficial for individuals with a significant discrepancy.

However, it is essential to note that physical therapy may not be sufficient for everyone, especially if the leg length discrepancy is severe or if there are underlying structural issues. In such cases, surgical intervention may be necessary. Surgical options can include:
- Limb Lengthening Surgery: This procedure involves gradually lengthening the shorter leg using a device that applies tension to the bone. This is a complex procedure and requires careful consideration and planning.

- Realignment Surgery: If the discrepancy is due to deformities in the bones or joints, realignment surgery may be performed to correct these issues.

- Bone Reshaping: In some cases, reshaping the bones can help address the discrepancy.

Before deciding on surgery, it is crucial for your uncle to undergo a thorough evaluation by an orthopedic specialist. This evaluation will typically include imaging studies, such as X-rays or MRI, to assess the extent of the discrepancy and any associated issues.

In summary, physical therapy can be beneficial for managing leg length discrepancies, particularly for improving function and reducing discomfort. However, the decision to pursue surgical intervention should be made based on a comprehensive evaluation by a qualified healthcare professional. It is essential to consider all options and tailor the treatment plan to your uncle's specific needs and circumstances.

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