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Leg Length Discrepancy Shoe Lift

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Although many of us assume our legs are the same length, it is very common for people to have one leg that is longer than the other. A leg length discrepancy (LLD) sounds alarming but people who have a discrepancy of 1cm may not even know their legs are differing lengths as often they don?t experience any problems. A Pedorthist will advise you if a leg length discrepancy or another foot or lower limb condition is the cause of your discomfort and develop a treatment plan for it.Leg Length Discrepancy

Causes

From an anatomical stand point, the LLD could have been from hereditary, broken bones, diseases and joint replacements. Functional LLD can be from over pronating, knee deformities, tight calves and hamstrings, weak IT band, curvature in the spine and many other such muscular/skeletal issues.

Symptoms

In addition to the distinctive walk of a person with leg length discrepancy, over time, other deformities may be noted, which help compensate for the condition. Toe walking on the short side to decrease the swaying during gait. The foot will supinate (high arch) on the shorter side. The foot will pronate (flattening of the arch) on the longer side. Excessive pronation leads to hypermobility and instability, resulting in metatarsus primus varus and associated unilateral juvenile hallux valgus (bunion) deformity.

Diagnosis

A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.

Non Surgical Treatment

Treatment of leg length inequality involves many different approaches, such as orthotics, epiphysiodesis, shortening, and lengthening, which can be used alone or combined in an effort to achieve equalization of leg lengths. Leg length inequality of 2 cm or less is usually not a functional problem. Often, leg length can be equalized with a shoe lift, which usually corrects about two thirds of the leg length inequality. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up. This needs to be done for every shoe worn, thus limiting the type of shoe that the patient can wear. Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift. The shoe looks unsightly, and often the patient complains of instability with such a large lift. A foot-in-foot prosthesis can be used for larger leg length inequalities. This is often done as a temporizing measure for young children with significant leg length inequalities. The prosthesis is bulky, and a fixed equinus contracture may result.

Leg Length Discrepancy

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Surgical Treatment

Surgical lengthening of the shorter extremity (upper or lower) is another treatment option. The bone is lengthened by surgically applying an external fixator to the extremity in the operating room. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins or both. A small crack is made in the bone and tension is created by the frame when it is "distracted" by the patient or family member who turns an affixed dial several times daily. The lengthening process begins approximately five to ten days after surgery. The bone may lengthen one millimeter per day, or approximately one inch per month. Lengthening may be slower in adults overall and in a bone that has been previously injured or undergone prior surgery. Bones in patients with potential blood vessel abnormalities (i.e., cigarette smokers) may also lengthen more slowly. The external fixator is worn until the bone is strong enough to support the patient safely, approximately three months per inch of lengthening. This may vary, however, due to factors such as age, health, smoking, participation in rehabilitation, etc. Risks of this procedure include infection at the site of wires and pins, stiffness of the adjacent joints and slight over or under correction of the bone?s length. Lengthening requires regular follow up visits to the physician?s office, meticulous hygiene of the pins and wires, diligent adjustment of the frame several times daily and rehabilitation as prescribed by your physician.

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