Leg Length Discrepancy

Leg length discrepancy, or anisomelia, is defined as a condition in which paired limbs are noticeably unequal. When the discrepancy is in the lower extremities, it is known as leg length discrepancy (LLD). leg length discrepancy is a relatively common problem found in as many as 40-70% of the population.

Leg length discrepancies can be subdivided into two groups:

A leg length discrepancy can be present from early childhood or can develop later in life. Commonly, persons who develop LLD in later life, experience more problems with movement compared to those who have had LLD since childhood

Causes of Leg Length Discrepancy

The causes of leg length discrepancy are numerous and the course of LLD can be determined by the cause. Most leg length discrepancies are congenital or acquired.

Congenital

Acquired

Symptoms of Leg Length Discrepancy

Complications associated with LLD can be identified via functional symptoms such as gait and balance problems. Symptoms may include:

Furthermore, symptoms of LLD can also be associated with musculoskeletal disorders such as:

Treatment Options

How Can Children’s Orthotics Help?

At Children’s Orthotics, we have access to a wide range of devices that can assist in biomechanical function by helping to align, stabilise and assist movement.

Our team of qualified paediatric orthotists will formulate a treatment plan after careful evaluation through ongoing assessment, diagnosis, treatment and follow-up. Our plan of care will fit the needs of your child and your family through realistic goal setting, ongoing teaching and support.

Treatment of LLD is generally managed by considering the magnitude of the discrepancy and symptom severity.

Inside of footwear raise - Also known as a ‘in shoe’ lift, this is one of the most common interventions of LLD. It has many advantages, including being non-invasive, inexpensive, easily applied, and potentially removed if no longer required. The maximum thickness of raise that can be accommodated inside of a shoe is 7mm - 12mm and for a boot 8mm - 20mm, however this can be depended on shoe size.

Raise to sole of footwear - If the process of fitting the raise inside of the footwear is not possible or uncomfortable, then the raise can be integrated into the sole unit of footwear. This is done by splitting the sole unit in two and sandwiching a piece of lightweight and flexible material between, maintaining the original sole. The colour on material which is added can be colour matched. Children’s Orthotics make every effort to ensure the raise is as discreet as possible.

Combination raise - it is possible to divide some of the raise inside the footwear and some externally to the sole of footwear. This is often carried out for larger raises so the raise is less visible.

Custom made insoles - Custom made insoles are commonly used in conjunction with shoe lift to provide additional stability for the feet. This is advised for children who have excessive pronation (the foot rolling inwards) or supination (the foot rolling outwards) that could cause further problems

Custom made footwear - Custom made footwear has proven successful for those children with larger raises or who may also have foot and ankle deformities. Custom made footwear comes in many different designs, colours and styles.

Splints - A splint orthosis can be bespoke or off the shelf. They are static devices used to hold an anatomical part in a specific position to either reduce movement or encourage a specific positive. Splints can be used to stretch muscles suffering from tightness and to encourage the heel to make contact with the ground when walking/ standing.

What Might the Assessment Procedure Involve

Your orthotist will ask you questions about your child’s daily activities and medical history. The paediatric orthotist will undertake a gait examination and observe walking patterns, paying attention to movements at the affected joints and making observations of how the body moves.

It is widely recognised that an X-ray is the most definitive way to measure a leg length discrepancy however, an X-ray exposes a child to high amounts of radiation. A child’s leg length can often change during growth spurts so frequent X-rays pose health risks, plus they are impractical, expensive and unnecessary.

At Children’s Orthotics our orthotist’s are experienced at measuring and assessing leg length discrepancies without the use of an X-ray. This process is carried out by measuring from the bony anatomy of the pelvis down to the heel with a tape measure. The child will then stand with the shorter leg on a raised block of the measured thickness. The alignment of the shoulders, pelvis, knees and feet are then observed in standing and walking and any fine adjustments made. Although this process appears to be quite basic we achieve extremely reliable results and our methods are supported by external medical research papers.

Following this, your child’s raise options and goals will be discussed and a prescription made. Please bring any current footwear along to the appointment for reference. The orthotist will be able to advise on the most suitable types of footwear depending on the raise height, condition and individual circumstances.

Any devices that are required will be fabricated using materials chosen specifically to meet their requirements and then a fitting session arranged. All of our prescriptions and fittings are followed by a review to ensure that the treatment is effective and any fine adjustments can be made.

To get in touch or arrange an appointment, you can call us at 0330 088 3949 or email office@orthotics.co.uk.