In appropriate patients, orthopedic limb lengthening surgery can be used to increase the length of the shorter leg to be even with that of the other.
Best Exercises for Leg Length Discrepancy
Some people are born with one leg longer than the other. In other cases, injury or illness causes a discrepancy in leg length that may progress over time. This isn’t necessarily something to worry about, as a little variation is normal and likely won’t lead to any health issues.
However, greater variations can be cause for concern. People with a leg length difference of 2 centimeters or more have a greater risk for developing osteoarthritis — a form of arthritis characterized by the breaking down of cartilage in joints — in their hip or knee, which can lead to loss of movement in affected joints and other conditions.
Certain exercises and stretches may help minimize leg length discrepancy and ease any related symptoms. As with most forms of exercise, you should begin slowly and increase power only if it’s comfortable for your body to do so.
Exercises to Help Leg Length Discrepancy
Side Kicks
High-impact exercises can cause physical strain, which isn’t always a bad thing. Physical force can cause micro strains on your bones, which results in incremental changes in bone mass and length — especially if the exercise is repeated over time.
One exercise that can put this kind of strain on your affected leg bones is side kicking into the air. To get the most out of this exercise, do multiple sets daily. If you want to increase the overall impact, slightly raise the height of your kicks. To decrease the impact, lower your leg height.
Step 1: Stand with your back straight and your feet shoulder length apart. Bend your arms and put your hands into fists, and then hold them in a defensive position near your chest.
Step 2: Lean your body weight onto your longer leg. While taking a deep breath in, bend and lift your shorter leg until it’s at the same length as your hip. Keep your foot pointed straight ahead.
Step 3: While breathing out, kick your bent leg out and to the side of your body, so that your leg becomes fully flexed and your foot is still at the same height.
Step 4: Return to your initial position, and repeat.
Quadriceps Lifts With Walker
People with hip dysplasia who undergo total hip arthroplasty (hip replacement surgery) are at higher risk for developing leg length discrepancy. This research-backed exercise is intended for people who have recently had this procedure and are currently in recovery. You will need a walker.
Step 1: Stand upright to ensure your back is straight.
Step 2: Move the walker one step ahead of your body.
Step 3: Raise the leg on your non-operative side until your knee is flexed at a 90-degree angle. Hold this position for three seconds, and then put your foot back to the floor.
Step 4: Move the walker another step ahead and repeat with the leg on your operative side.
Step 5: For best results, repeat this cycle 20 to 30 times, three to six times daily during your recovery period.
Hamstring Stretch
Non-surgical interventions for leg length discrepancy sometimes involve stretching the muscles in the lower half of your body, such as:
- Hip adductors (groin muscles)
- Hamstrings
- Piriformis (a muscle in your buttocks near the top of the hip joint)
- Iliopsoas (hip flexor)
To lengthen your hamstrings, you can do the following stretching exercise:
Step 1: Lie down on the floor with your back to the ground.
Step 2: Leave the longer leg on the ground and put your shorter leg up against a wall, keeping the leg elongated and not bent at the knee. You should be close enough to the wall that you feel a stretch in the back of your raised leg.
Step 3: Hold this position for 30 seconds and then repeat the stretch three times, three days a week.
Safety Considerations
When doing these exercises, you should feel a gentle stretch or comfortable tension, but not discomfort or pain. If any of them cause pain, make accommodations by reducing the number of repetitions you do or lowering your intensity.
Be sure to reach out to your doctor if you experience any negative side effects after completing these exercises.
Show Sources
Arthritis and Rheumatology: “Brief Report: Leg Length Inequality and Hip Osteoarthritis in the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative.”
European Cells and Materials: “Mechanical Loading and How It Affects Bone Cells: The Role of the Osteocyte Cytoskeleton in Maintaining Our Skeleton.”
International Research Journal of Engineering, IT & Scientific Research: “Relationship between length of leg and strength of leg muscle to frequency of straight kicks.”
Journal of Athletic Training: “Standing and Supine Hamstring Stretching Are Equally Effective.”
Journal of International Medical Research: “Post-THA gait training to improve pelvic obliquity and decrease leg length discrepancy in DDH patients: a retrospective study.”
Two Legs Are Not in the Same Length: Causes and Remedies
Do you think that your one leg is shorter than the other? Differences in leg lengths, shoes sizes, and eyeglasses prescriptions are common. What matters is the extent of the difference. Should you be worried about one leg longer than the other? You should seek help if the difference is significant. This condition is also referred to as leg length asymmetry. Many people ignore this asymmetry, yet it is a major cause for ankle, hip, knee and back pains. Athletes are at high risk of this condition. The symptoms, classifications, causes and treatments of leg length asymmetry are outlined below.
Symptoms
Some people have insignificant discrepancies in leg lengths, which may not cause back pains. In such cases, the difference is below 5 millimeters. Any difference above 5 millimeters will cause lower back pains. If the difference is above 9 millimeters, your risk of suffering an episode of pains in your lower back is six times greater. Some of the symptoms of leg length asymmetry include:
- Poor posture
- Problems with your way of walking
- An observable difference in the length of your legs
- Knee, hip, ankle and lower back pains
2 Types of One Leg Longer than the Other
There are two kinds of conditions where one leg is longer than the other. Each of these classifications is outlined in this section.
1. Structural Short Leg Syndrome
This condition occurs when legs have actual differences in length. These differences are caused by differences in the length of fibula and tibia bones that are located in the lower leg. Differences in the length of femur and birth defects will cause structural differences too. Other causes include broken legs, damages of the growth palates and infections.
2. Functional Short Leg Syndrome
Functional short leg syndrome is a condition in which both legs have the same length but one leg appears shorter than the other because of the postural changes in the pelvis and hips. The postural changes may result from neuromuscular injuries in the leg or pelvis. Consequently, one hip or leg is held tighter and higher. The condition is also called leg length alignment asymmetry.
Watch the video below to know how to check leg length:
Why One Leg Is Simply Longer Than the Other?
There are many reasons why you may have the condition of one leg longer than the other.
1. Injuries to a Leg Bone
Injuries to a bone in the leg may cause leg length discrepancies if the injuries heal in a shortened position, especially if the injury breaks the bone into many pieces. They may also results if muscle and skin tissues surrounding the bone are exposed and injured severely. When a child’s bone is broken, it grows faster after healing and becomes longer than the uninjured bone. The growth maybe slower if the bone breaks through its growth center at the end of a bone and this leads to a shorter leg.
2. Bone Disease
Children that suffer from bone infections may have significant discrepancies in the length of their legs. The risk is high if the infections occur at infancy. Joints inflammation such as juvenile arthritis causes leg length differences.
Some other bone diseases that cause unequal leg lengths include ollier disease, multiple hereditary exostoses, neurofibromatosis, neurologic conditions and arthritis.
How to Deal With Leg Length Discrepancy
If you have one leg longer than the other, you can use surgical and non-surgical treatments to rectify the condition. These treatment options are discussed below.
1. Nonsurgical Treatment
Minor or insignificant differences in limb length do not require treatment because the risks of treatment are higher than the benefits. Doctors do not recommend surgical treatments when length discrepancies are below one inch. Instead, they recommend a shoe lift where the patient inserts a lift in his or her shoe. The lift makes running and walking more comfortable. It may relieve back pains that result from unequal leg lengths. The advantage of shoe lifts is that they are inexpensive and the patient can remove them if they are ineffective.
If your uneven legs are functional, you should learn how to align your hips and learn to walk correctly and normally. Watch this video to learn why you have functional uneven legs and how to align an uneven hip line:
2. Surgical Treatment
In this surgical procedure, a physician slows down the growth of the longer leg using two small incisions on the knee. The incisions are done under X-ray control at two growth sites. The results of this procedure are not immediate but the difference in leg length decreases gradually as the legs grow. The shorter leg will grow in length and catch up with the longer leg. The success of this procedure depends on the timing. The two legs must have the same length by the time the patient reaches mid to late teenage. Normal growth ends at this age.
The shortcomings associated with this procedure include over or under correction of the length discrepancies. The procedure may reduce the patient’s height in adulthood, which would have been higher if the shorter leg was lengthened. In addition, the patient may appear disproportionate if the discrepancy was significant.
An alternative way is shortening the longer leg, which is referred to as osteotomy. However, a major reduction in length weakens the leg’s muscles. Three inches of femur or the thighbone can be shortened at most. Two inches of the shinbone can be shortened at most. This procedure is recommended when a patient has reached his or her skeletal maturity. It is also recommended when the limb length discrepancy is severe.
In this procedure, the bone is lengthened by using a fixation device. This device is applied on the external part of the shorter leg. This device has a scaffold-like frame, which is connected to the leg bone using pins, wires and sometimes both. The next procedure is to make a small crack in the bone. The external frame creates tension when the caregiver or the patient turns the frame’s dial. It is done several times in a day.
The lengthening process starts 5-10 days after surgery. The bone’s length increases by a millimeter daily or by an inch in a month. The process is slower if the bone had previous injuries or operations. It is slower for cigarette smokers and patients prone to blood vessel conditions.
The patient wears the frame for three months until the bone is strong enough. The risks involved include stiff joints, infections from wires and pins, and over or under correction of limb length. The procedure requires consistent consultation with the physician, rehabilitation, adjusting the frame several times daily, and cleaning the areas near wires and pins.
Leg Length Discrepancy
Limb length differences, in which one arm or leg is shorter than the other, can be debilitating and lead to other medical problems, such as back, shoulder, hip or knee pain. Although limb length discrepancies can affect the arms and hands, leg length discrepancies are more common. Leg length discrepancy can be a problem for adults or children and can be caused by a congenital or acquired problems. Many patients with significant length differences will benefit from limb lengthening surgery.
Two HSS patients with corrected leg length discrepancies, before and after surgery.
- What is a leg length discrepancy?
- What causes one leg to be longer than the other?
- How much leg length discrepancy is normal?
- How do you measure leg length discrepancy?
- What problems can leg length discrepancy cause?
- How do you fix leg length discrepancy?
What is a leg length discrepancy?
A leg length discrepancy (one leg shorter than the other), is also called anisomelia or short-leg syndrome. This condition can affect both children and adults.
What causes one leg to be longer than the other?
Most cases of unequal leg length are congenital conditions (those people are born with). But other, acquired cases may be caused by traumas or infections that damage bone growth plates, poorly healed bone fractures, or bone tumors, all of which can affect growth and cause one leg to be shorter than the other. For example, it is a common issue among people who have survived a polio (poliovirus) infection.
Congenital conditions that cause leg length discrepancies
- Fibular hemimelia. Also called longitudinal fibular deficiency, this is where a person is born with an underdeveloped or missing fibula bone.
- Congenital short femur, this is a severe shortening or complete absence of the femur bone.
- Hemiatrophy, in which one side of the body grows significantly smaller than normal and in relation to the other side. This may be seen in in children with Russell-Silver syndrome.
- Hemihypertrophy (also called hemihyperplasia). This is where one side of the body grows significantly larger than normal and in relation to the other side. One form of this congenital condition is called Beckwith-Wiedermann syndrome.
Acquired conditions that cause leg length discrepancies
- In children, damage to a growth plate can cause a bone to stop growing prematurely, leading to leg length discrepancy and deformity. Growth plate damage is often a result of:
- Severe traumas to a bone – such as a fracture occurring from a car accident, high fall or other extreme-force impact injuries.
- Bone infections (osteomyelitis). Many kinds of superficial infections (such as Staphylococcus aureas or “staph”) can travel through the bloodstream to form a deep infection in a joint or bone growth plate, since there is significant blood flow in these areas. Younger children whose immune systems have not fully developed are especially susceptible to bone infections.
- Benign bone tumors such as simple bone cyst or enchondromas or osteochondromas can affect the growth plate and inhibit growth resulting in limb shortening and deformity.
- Fibrous dysplasia – in which fibrous tissue incorrectly grows in place of bone tissue, weakening and/or deforming the bone. This type of noncancerous tumor often affects the femur (thighbone), tibia (shinbone) or humerus (upper arm bone).
- Neurofibromatosis.
- Ollier disease. In this condition, cysts or tumors called enchondromas, which are formed from cartilage tissue, develop in the bone marrow in close proximity to cartilage of the growth plate.
Leg length discrepancy before surgery, wearing a lengthening external fixator, and after surgery.
How much leg length discrepancy is normal?
A leg length discrepancy of less than 10 mm is often well tolerated and rarely requires surgical treatment. Having a 10-mm or greater difference in leg length creates an asymmetry in the body that may cause lower back pain, hip pain and other problems.
How do you measure leg length discrepancy?
Leg length discrepancy is measured on both physical examination using the block method and with standing, full-length X-rays.
What problems can leg length discrepancy cause?
Having legs of unequal length creates an imbalance in posture and gait (the manner in which a person walks) that places stress on the low back and hip. This places stress on the lower back, hip, knee and ankle, which can lead to premature joint degeneration (osteoarthritis). In some cases, it can also lead to functional scoliosis.
How do you fix leg length discrepancy?
In appropriate patients, orthopedic limb lengthening surgery can be used to increase the length of the shorter leg to be even with that of the other.
Articles on treatments for leg length discrepancy
Learn about limb lengthening orthopedic surgery options for children and adults in these articles.
- Limb Lengthening – An Overview
- Limb Lengthening for the Pediatric Patient
- Limb (Leg) Deformity Reconstruction for the Pediatric Patient
Articles on conditions related to leg length discrepancy
Learn about various conditions that may cause a leg length discrepancy.
- Tibial Pseudarthrosis: Incorrect Healing After a Pediatric Fracture of the Lower Leg
- Blount’s Disease: An Overview
- Osteogenesis Imperfecta: A Multidisciplinary Approach to Treatment in Children
- Bowlegs and Normal Growth and Development of the Legs and Knees
- Knock Knees in the Pediatric Patient
- Osteochondroma: Types, Causes, Symptoms and Treatments
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