Why can leg lengths differ?
The causes of leg length discrepancy can be grouped under 3 main headings.
- Congenital (problems such as congenital short femur and underdevelopment associated with various syndromes)
- Growth disturbance (problems such as polio and growth plate arrest)
- Traumatic (problems such as malunion and nonunion)
At what leg length difference should surgery be considered?
When there is a leg length discrepancy, differences of up to about 2 cm can be comfortably tolerated by the patient. At this level, the problem can be solved with a simple shoe lift.
However, with shortening of more than 2 cm, patients will not easily adapt to wearing a shoe lift, and most do not want to continue with it in the long term.
This length difference needs to be corrected with surgical lengthening methods.
Does leg length discrepancy cause problems in other joints such as the hip and lower back?
A leg length difference changes the walking pattern and, with it, the distribution of load, which leads to secondary problems in the ankle, hip and lower back. Scoliosis and degenerative arthritis are seen in the lower back. It also leads to early deterioration of the hip and ankle cartilage. To compensate for the length difference, the foot may deepen its arch, which helps to make up some of the difference.
Is it possible to correct this difference without surgery?
There is no non-surgical method of lengthening. None of the products on the market that claim to increase height have FDA approval or a scientific basis.
Footwear compensation should be used only for length differences of less than 2 cm.
What methods are used to equalize leg lengths?
- Lengthening with an external fixator alone
- An intramedullary nail combined with an external fixator (combined technique, lengthening over a nail) (the method used by our team)
- Motorized nails
Does the method we use have any advantages over the other methods?
Of these three methods, motorized nails are the most convenient in terms of ease for both the patient and the surgeon; however, technical problems that can occasionally arise during lengthening, along with their high cost, limit their use.
Lengthening with an external device alone may be easy in terms of surgical technique, but it greatly reduces patient comfort. Because inserting a nail into the bone can cause secondary growth problems in patients younger than 14, this method is preferred in children.
With our preferred method, lengthening over a nail, the time the external device stays on the patient is greatly shortened, making it the best choice when cost and patient comfort are taken into account. Its only drawbacks are the difficulty of the surgical technique and the need for an assistant who can operate the fluoroscopy device competently and skillfully.
If the leg also has a curvature or deformity, can this be corrected along with the lengthening?
In a significant proportion of patients with leg length discrepancy, the legs also have a deformity, and this deformity is corrected, either acutely or gradually, when the lengthening system is put in place.
How many centimeters can a leg be lengthened?
A difference of 10 cm can be corrected in a single operation.
How long do lengthening and full recovery take?
The lengthening period, during which the external device is in place and which patients like least, lasts as many days as the amount of lengthening in millimeters plus 10. For 4 cm, that is 40 + 10 = 50 days. Healing of the lengthened segment takes as many months as the amount of lengthening in centimeters; for example, 4 months for 4 cm.
