Leg length discrepancy

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

Causes

Life Threatening Causes

• Appendicitis
• Avascular necrosis of the hip
• Claudication of limb
• Herniated vertebral disc
• Hip dislocation
• Leriche syndrome
• Limb ischemia
• Meningitis
• Osteomyelitis
• Patellar dislocation
• Pelvic abscess
• Psoas abscess
• Septic arthritis
• Testicular torsion

Common Causes

• Avascular necrosis of the hip
• Cerebral palsy
• Congenital dysplasia of the hip
• Discitis
• Femur fracture
• Hip contractures
• Legg-Calvé-Perthes syndrome
• Lumbar scoliosis
• Malignant bone tumors
• Osteochondritis dissecans
• Osteomyelitis
• Salter-Harris fracture
• Septic arthritis
• Slipped capital femoral epiphysis
• Transient synovitis of the hip

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, 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

• Acute lymphoblastic leukemia
• Acute rheumatic fever
• Ankle sprain
• Ankylosing spondylitis
• Apophysitis
• Appendicitis
• Arrest of physeal growth
• Arthralgia
• Arthropathy
• Atherosclerosis
• Athlete's foot
• AV fistula
• Avascular necrosis of the hip
• Avulsion injury
• Baker's cyst
• Benign bone tumours
• Blount's disease
• Brain tumor
• Cellulitis
• Cerebral palsy
• Child abuse
• Chondroblastoma
• Chondromalacia patellae
• Claudication of limb
• Complex regional pain syndrome
• Congenital club foot
• Congenital dysplasia of the hip
• Congenital limb aplasia
• Congenital limb hypoplasia
• Congenital pseudarthrosis of the tibia
• Congenital vertical talus
• Contusion
• Conversion disorder
• Coxa vara
• Dermatomyositis
• Discitis
• Distraction
• Disuse muscle atrophy
• Dystonia
• Enchondroma
• Epididymitis
• Epidural abscess of the spine
• Erdheim cystic medial necrosis
• Ewings sarcoma
• Fallen arches
• Femur fracture
• Fibular hemimelia
• fixed pelvic obliquity
• Foot foreign body
• Foot fractures
• Freiberg disease
• Gait abnormality
• Genu recurvatum
• Greenstick fracture
• Gonoccoccal arthritis
• Hand-foot-mouth disease
• Healed fractures
• Hemangioma

• Hemarthrosis
• Hematoma of thigh
• Hemihypertrophy
• Hemophilia
• Henoch-Schonlein purpura
• Herniated vertebral disc
• Hip dislocation
• Hip replacement
• Hip subluxation
• Hip contractures
• Hypermobility syndrome
• Hyperparathyroidism
• Hypertension
• Hypervascularity after fracture
• Idiopathic
• Iliac adenitis
• Immunization (intramuscular injection)
• Inflammatory bowel disease
• inguinal lymphadenitis
• Juvenile arthritis
• Juvenile chronic recurrent multifocal osteomyelitis
• Juvenile osteoporosis
• Juvenile rheumatoid arthritis
• Kahler's disease
• Klippel-Trenaunay-Weber syndrome
• Knee sprain
• Kohler disease
• Langerhans' cell histiocytosis
• Legg-Calvé-Perthes syndrome
• Leriche syndrome
• Leukemia
• Limb ischemia
• Lumbar scoliosis
• Lyme arthritis
• Malignant bone tumors
• Malignant fibrous histiocytoma
• Malunion
• Meningitis
• Metastatic neuroblastoma
• Multiple hereditary exostoses
• Multiple sclerosis
• Muscle strain
• Muscular dystrophy
• Myelodysplasia
• Myositis
• Neck of femur fracture
• Neurofibromatosis
• Neurofibrosarcoma
• Nonunion
• Obesity
• Observation hip syndrome
• Ollier's disease
• Open reduction and internal fixation of fractures
• Orchitis
• Osgood-Schlatter disease
• Osteoblastoma
• Osteochondritis dissecans

• Osteogenesis imperfecta
• Osteosclerosis
• Osteostimulation
• Osteosarcoma
• Osteoid osteoma
• Osteomyelitis
• Overuse syndrome
• Parkes Weber syndrome
• Paronychia
• Patellar dislocation
• Patellofemoral pain syndrome
• Pelvic abscess
• Pelvic inflammatory disease
• Periostitis
• Peripheral neuropathy
• Peripheral vascular disease
• Perirectal abscess
• Plastic deformation in pediatric fractures
• Poliomyelitis
• Prolonged immobilization
• Prosthetic hip replacement
• Proteus syndrome
• Proximal femoral focal deficiency
• Psoas abscess
• Radiation therapy
• Reactive arthritis
• Rheumatic disease
• Rheumatoid arthritis
• Rickets
• Ruptured achilles tendon
• Russell-Silver syndrome
• Sacroiliitis
• Salter-Harris fracture
• Sciatica
• Septic arthritis
• Serum sickness
• Sever's disease
• Sickle-cell disease
• Sinding-Larsen-Johansson disease
• Skeletal dysplasia
• SLE
• Slipped capital femoral epiphysis
• Spinal cord tumor
• Spinal dysraphism
• Spondylolisthesis
• Stress fracture
• Sympathectomy
• Tarsal coalition
• Tarsal synostosis
• Tendonitis
• Tenosynovitis
• Testicular torsion
• Tibial Fracture
• Toddler fracture
• Transient synovitis of the hip
• Upington disease
• Wilm's tumor

References

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