Leg length discrepancy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Synonyms and Keywords: Unequal leg length, leg length inequality, leg length alignment asymmetry

Overview

Leg length discrepancy is a medical condition where the legs are of different sizes. There are two main types of leg length inequalities. The first type is caused by the legs themselves being measurably different in length as seen in birth defects, broken leg or serious infection. The other, more common, type is refereed to as leg length alignment asymmetry, a condition where the short leg is unequal in length while in a supine or prone position. Leg length alignment asymmetry can be the result of hypertonicity in the musculature of the pelvis or leg.[1]

Classification

Structural Leg Length Discrepancy

Structural leg length discrepancy is caused by the legs themselves being measurably different in length, usually due to differences in the length of the femur in the thigh or the tibia and fibula bones in the lower leg. This may be a birth defect or it may occur after a broken leg, serious infection, or local damage to one of the growth plates in a leg.

Functional Leg Length Discrepancy

The other, more common, type is seen when the legs themselves are the same length, but due to neuromuscular injuries in the pelvis or upper leg, one leg or hip is held higher and tighter than the other (hypertonicity in the musculature of the pelvis or leg). These unequally tightened muscles cause the legs to seem to be different lengths, even though careful measurement would show equal lengths of the actual leg. This is called leg length alignment asymmetry and can be seen while lying down.[2]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Atherosclerosis, AV fistula, claudication of limb, Erdheim cystic medial necrosis, Freiberg's disease, hemangioma, hypertension, Klippel-Trenaunay-Weber syndrome, Leriche syndrome, limb ischemia, Parkes Weber syndrome, peripheral vascular disease, rheumatic disease
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Cellulitis, dermatomyositis
Drug Side Effect Avascular necrosis of the hip, myositis, serum sickness
Ear Nose Throat No underlying causes
Endocrine Arrest of physeal growth, hyperparathyroidism, juvenile osteoporosis
Environmental No underlying causes
Gastroenterologic Appendicitis, inflammatory bowel disease
Genetic Fibular hemimelia, Klippel-Trenaunay-Weber syndrome, osteochondritis dissecans, osteogenesis imperfecta, proteus syndrome, Russell-Silver syndrome, tarsal coalition, Upington disease
Hematologic Acute lymphoblastic leukemia, avascular necrosis of the hip, hemarthrosis, hemophilia, Kahler's disease, Langerhans' cell histiocytosis, leukemia, myelodysplasia, sickle-cell disease
Iatrogenic Hip replacement, immunization (intramuscular injection), osteostimulation, prosthetic hip replacement, radiation therapy, sympathectomy
Infectious Disease Acute rheumatic fever, athlete's foot, cellulitis, discitis, epididymitis, epidural abscess of the spine, gonoccoccal arthritis, hand-foot-mouth disease, iliac adenitis, inguinal lymphadenitis, juvenile chronic recurrent multifocal osteomyelitis, Lyme arthritis, meningitis, myositis, observation hip syndrome, orchitis, osteomyelitis, paronychia , pelvic abscess, pelvic inflammatory disease, perirectal abscess, poliomyelitis, psoas abscess, reactive arthritis, sacroiliitis, septic arthritis, transient synovitis of the hip
Musculoskeletal/Orthopedic Arthropathy, Baker's cyst, Blount's disease, chondroblastoma, chondromalacia of the patella, congenital club foot, congenital dysplasia of the hip, congenital limb aplasia, congenital limb hypoplasia, congenital pseudarthrosis of the tibia, congenital vertical talus, coxa vara, dermatomyositis, discitis, distraction, disuse muscle atrophy, dystonia, enchondroma, Erdheim cystic medial necrosis, fallen arches, fibular hemimelia, gait abnormality, genu recurvatum, greenstick fracture, healed fractures, hemihypertrophy, herniated vertebral disc, hip subluxation, hip contractures, hypermobility syndrome, hypervascularity after fracture, juvenile arthritis, juvenile osteoporosis, juvenile rheumatoid arthritis, Klippel-Trenaunay-Weber syndrome, Kohler disease, Legg-Calvé-Perthes syndrome, lumbar scoliosis, benign bone tumours, metastatic neuroblastoma, multiple hereditary exostoses, muscular dystrophy, Ollier's disease, open reduction and internal fixation of fractures, Osgood-Schlatter disease, osteoblastoma, osteochondritis dissecans, osteogenesis imperfecta, osteoid osteoma, osteosclerosis, osteostimulation, overuse syndrome, patellofemoral pain syndrome, plastic deformation in pediatric fractures, prolonged immobilization, proteus syndrome, proximal femoral focal deficiency, rheumatic disease, sciatica, Sever's disease, Sinding-Larsen-Johansson disease, skeletal dysplasia, SLE, slipped capital femoral epiphysis, spinal dysraphism, spondylolisthesis, tarsal synostosis, tendonitis, tenosynovitis, Upington disease
Neurologic Brain tumor, cerebral palsy, dystonia, hip contractures, lumbar scoliosis, meningitis, metastatic neuroblastoma, multiple sclerosis, neurofibromatosis, neurofibrosarcoma, peripheral neuropathy, poliomyelitis, sciatica
Nutritional/Metabolic Arrest of physeal growth, arthropathy, juvenile osteoporosis, lumbar scoliosis, obesity, rickets
Obstetric/Gynecologic Pelvic inflammatory disease
Oncologic Acute lymphoblastic leukemia, benign bone tumours, brain tumor, chondroblastoma, Ewings sarcoma, Langerhans' cell histiocytosis, leukemia, malignant bone tumors, malignant fibrous histiocytoma, metastatic neuroblastoma, neurofibrosarcoma, osteoblastoma, osteosarcoma, spinal cord tumour, tumour across epiphyseal plate
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Conversion disorder
Pulmonary No underlying causes
Renal/Electrolyte Wilm's tumor
Rheumatology/Immunology/Allergy Acute rheumatic fever, ankylosing spondylitis, arthropathy, Baker's cyst, dermatomyositis, Henoch-Schönlein purpura, herniated vertebral disc, inflammatory bowel disease, juvenile arthritis, juvenile rheumatoid arthritis, myositis, reactive arthritis, rheumatic disease, rheumatoid arthritis, sacroiliitis, serum sickness, SLE
Sexual Epididymitis, testicular torsion, orchitis
Trauma Ankle sprain, arthralgia, avascular necrosis of the hip, avulsion injury, child abuse, complex regional pain syndrome, contusion, coxa vara, discitis, femur fracture, fixed pelvic obliquity, foot foreign body, foot fractures, Freiberg's disease, greenstick fracture, hematoma of thigh, healed fractures, hemarthrosis, herniated vertebral disc, hip dislocation, hip subluxation, hypervascularity after fracture, testicular torsion, knee sprain, limb ischemia, malunion, muscle strain, femur fracture, nonunion, observation hip syndrome, open reduction and internal fixation of fractures, patellar dislocation, patellofemoral pain syndrome, periostitis, ruptured achilles tendon, sacroiliitis, Salter-Harris fracture, sciatica, spondylolisthesis, stress fracture, tendonitis, tenosynovitis, tibial fracture, toddler fracture
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. Knutson, G. A. "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry". Chiropractic & Osteopathy 2005, 13:12 doi:10.1186/1746-1340-13-12.
  2. Knutson, G. A."Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry". Chiropractic & Osteopathy, 2005, 13:12 doi:10.1186/1746-1340-13-12.
  3. Gurney, B. (2002). "Leg length discrepancy.". Gait Posture. 15 (2): 195–206. PMID 11869914. 
  4. Raczkowski, JW.; Daniszewska, B.; Zolynski, K. (2010). "Functional scoliosis caused by leg length discrepancy.". Arch Med Sci. 6 (3): 393–8. PMID 22371777. doi:10.5114/aoms.2010.14262. 
  5. Coppola, C.; Maffulli, N. (1999). "Limb shortening for the management of leg length discrepancy.". J R Coll Surg Edinb. 44 (1): 46–54. PMID 10079669. 
  6. Lee, DY.; Choi, IH.; Chung, CY.; Cho, TJ.; Lee, JC. (1997). "Fixed pelvic obliquity after poliomyelitis: classification and management.". J Bone Joint Surg Br. 79 (2): 190–6. PMID 9119840. 
  7. FERNANDEZDE VALDERRAMA, . (1963). "THE OBSERVATION HIP SYNDROME AND ITS LATE SEQUELAE.". J Bone Joint Surg Br. 45: 462–70. PMID 14065262. 

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