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Lower Extremity Disorders

Lower Extremity Disorders covers a multitude of disorders children may have in their lower extremities. This can include congenital defects, leg length discrepancy, and limb dificiency. Our team of specialists at Orthopaedic Institute for Children (OIC) evaluates each case to determine the specific disorder with a comprehensive assessment and diagnosis as well as a need for non-operative outcomes or operative management.

Leg Lengthening (Leg Length Discrepancy)
Children's legs are often slightly different in length, shape or size. The difference is usually slight enough not to cause any difficulty, but a significant difference may require treatment to prevent an abmormal walk.

The thighbone (femur) and shinbone (tibia) have growth areas, called growth plates, on both ends of the bones. If a growth plate is disturbed, one leg may grow slower than the other. Some causes of growth disturbance are infection, trauma, fractures, paralysis or occurances before birth.

Leg lengthening is a surgical procedure to lengthen bones, replace missing bone or correct bone structure deficiencies. Birth defects, bone infections, traumatic injurires, or neurological disorders can cause the discrepancy either at birth or during childhood development. During surgery, physicians may attach an external frame of up to six inches to encourage growth of the affected extremity or may surgically replace or correct bone structures.

There are generally two kinds of leg length discrepancies:

  • Structural discrepancy occurs when either the femur or tibia bone in one leg is actually shorter than the corresponding bone in the other leg.
  • Functional discrepancy occurs when the leg lengths are equal, but symmetry is altered somewhere above the leg, which in turn disrupts the symmetry of the legs. For example, development dislocation of the hip (DDH) can cause a functional discrepancy. In DDH, the top of the leg bone (femur) that is not properly positioned in the hip socket may hang lower than the femur on the other side, giving the appearance and symptoms of a leg length discrepancy.
Treatment of Leg Length Discrepancy
The decision to treat a leg length discrepancy depends on the amount of difference there will be when the child stops growing. Not all discrepancies need to be treated. For those that do, treatment type is determined by the amount of difference.

Since children are still growing, the goal of treatment is to correct the discrepancy that would be present at maturity and not the present/current discrepancy.

Not all children grow at the same rate, so careful analysis of a child's personal rate of growth is crucial. To estimate the discrepancy at maturity, the OIC pediatric orthopaedic physician may need to continually take measurements of a child's growth over a period of one or two years before any surgery can be considered.

Treatment may incude a shoe lift, a small surgery to slow down the growth of the longer leg, or surgery to lengthen or shorten a leg.

Our Team
At OIC, a team specializing in the lower extremity will see children in the clinic. This team includes the pediatric orthopaedic surgeon, nurse practitioner, physical therapist, social worker, and orthotist. The staff is also available to assist patients in applying for CCS. Our goal at OIC is to help each child function at the highest possible level.

Click here for patient education material on leg length discrepancy.