Small limb length discrepancies are common in the general population and may not require any treatment.
Moderate or large limb length discrepancies can affect walking and long-term joint and spine health.
Shoe lifts can be considered to treat small differences or for temporary treatment in advance of planned surgery.
When there are moderate to large differences in the lengths of a child’s legs, a pediatric orthopedic surgeon can perform surgery to correct the condition.
Why do limb length differences happen?
Limb length differences can result from:
- Limb fractures or growth plate injuries.
- Differences in how a child’s legs grow or develop, before or after birth.
- Joint deformities.
- Muscle contracture (a shortened, tight muscle).
How are limb length differences corrected with surgery?
Depending on your child’s needs, a surgeon will perform one or more of the following procedures:
In a growing child, an epiphysiodesis (also known as growth plate fusion) is performed to slow the growth of the longer leg to allow the shorter leg to catch up in length. The timing of an epiphysiodesis is based on the expected leg length difference at the end of growth and the expected amount of growth remaining in the patient.
Through a small surgical incision, the surgeon causes the growth plate in the bone to become permanently inactive. Orthopedic surgeons can also do this procedure for children with deformities due to irregularities of the growth plate to prevent the deformity from worsening.
Surgery is usually done on an outpatient basis. After surgery, patients can bear weight immediately but should avoid high impact activities like running, jumping, and climbing for 6 weeks.
It is important to follow up regularly after surgery during your child's remaining growing years to make sure that limb lengths equalize as expected.
In a patient who is skeletally mature (done growing) or does not have enough growth remaining for an epiphysiodesis to be effective, shortening is an option.
The surgeon removes a section of bone from the longer extremity to even out the limbs and secures the bone with internal implants. The thighbone (femur) is more commonly shortened than the shinbone (tibia).
After shortening surgery, patients typically stay in the hospital 1-2 nights.
Weight bearing is usually allowed after surgery with crutches or a walker. The recovery period for shortening surgery is approximately 3 months before returning to full activities.
Limb length discrepancies may also be treated by lengthening the shorter extremity. Depending on the location of the difference, the thighbone (femur) or shinbone/smaller lower-leg bone (tibia/fibula) may be lengthened.
Bone lengthening can be achieved with external devices (external fixators) or internal implants. The decision for external or internal lengthening is based on the needs of the patient.
After limb lengthening surgery, patients typically stay in the hospital for 1-2 nights.
Lengthening is done at home in small increments (approximately 1 mm/day or 1/25 inch/day) starting 1-2 weeks after surgery. Lengthening occurs over multiple sessions per day. During limb lengthening, patients follow up every 1-2 weeks with their provider to check the progress of lengthening and joint motion. Following lengthening, the bone is allowed to heal. During the lengthening and bone healing phase (typical duration 4-6 months), patients are limited in their weightbearing to crutches and a walker. Daily exercises are required to maintain joint range of motion. Another surgery is required to remove the external fixator or internal implant.
What can we expect after limb difference surgery?
After limb difference surgery, to help healing and lessen your child’s discomfort, you should:
- Elevate your child’s knee and ankle above the level of the heart and apply ice. Do this for a week after surgery to help decrease swelling.
- Have your child use crutches or a walker and maintain weightbearing precautions as required based on the individual surgery.
- Give your child assistance, if necessary, to go up and down stairs.
What should we watch out for after limb difference surgery?
After epiphysiodesis, growth can occur faster or slower than predicted. If your child’s limb length difference visibly changes before your next scheduled visit, please contact your physician’s resource nurse so follow-up may occur sooner.
For complications to watch out for with limb lengthening via remote control, visit this page.
Questions or Concerns?
Contact your physician’s resource nurse or call Telehealth Nursing at 651-229-3890.
This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.