Limb Length Inequality

What You Need to Know

  • Fractures, trauma to a growth plate, infections and genetic conditions or syndromes can all cause limb length inequality in children.
  • Medical history, physical exam and X-rays are used to diagnose limb length inequality.
  • Treatment for limb length inequality depends on the condition’s severity and the amount of growing the child has left to do.
  • Nonoperative and operative treatment options are available.

What is limb length inequality?

Limb length inequality is when one leg or arm is shorter than the other. This can be caused by a previous fracture, trauma to a growth plate or a previous infection. Genetic conditions or syndromes can also result in one limb being longer than the other. While a difference in arm length doesn’t typically affect the function of the arms, a discrepancy in leg length can cause problems with walking and other activities.

Leg Length Inequality with Dr. Erin Honcharuk

What are the symptoms of limb length inequality?

  • Gait (pattern of walking) abnormality, such as a limp
  • Knee, hip or back pain
  • Apparent scoliosis (curvature of the spine)

Limb Length Inequality Diagnosis

A detailed medical history and physical examination will be performed by a pediatric orthopaedist if your doctor suspects that your child has limb length inequality.

The doctor will recommend a series of X-rays. Standing limb length X-rays are used to evaluate the length and angulation of each bone in the lower leg to determine where the length difference originates. Bone age X-rays are used to estimate how much growth remains — this helps determine the total limb length inequality and the timing of treatment.

Limb Length Inequality Treatment

Specific treatment plans should be tailored for each child’s unique condition. Several treatment options are available, based on the severity of the length inequality and remaining growth. If the leg length discrepancy is mild, a shoe lift or special orthopaedic shoes may be enough to treat the condition.

If the limb length inequality is moderate, more complex procedures may be needed. These may include slowing the growth of the longer leg permanently or temporarily with a physeal arrest or epiphysiodesis procedure to allow the bones in the short limb to catch up. Another approach is to lengthen the shorter leg by cutting the short bone into two segments and slowly pulling them apart to allow new bone to form between them.

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