Unequal leg length
As a leg length difference of the potential difference in length of the legs, so the lower extremity of the hip is called to walk in medicine. Smaller differences are not in need of treatment, since most people show small asymptomatic leg length differences. Only at a difference of 6-7 mm, a treatment should be considered. Leg length differences in children need to be monitored and treated under certain circumstances. Often they disappear but in the course of further growth.
Basically, one can distinguish between an anatomical and a functional leg length difference.
Anatomical leg length difference
True leg length difference due to differing side length of the hip and / or lower leg: Possible causes:
- Innate: congenital dislocation of the hip
- Coxa vara
- Dysplasia epiphysealis hemimelica Crohn Trevor
- Club foot
- Ollier 's disease
- Multiple cartilaginous exostoses disease
- Partial gigantism in Klippel Trenaunay - Weber syndrome, Proteus syndrome
- Peripheral longitudinal hypoplasia
- Proximal Femurdefekt
- Osteomyelitis
- Septic coxitis
- Cerebral palsy ( rare anatomical, frequent contractures )
- Poliomyelitis ( paralysis during growth)
- Fracture episode after fractures
- Injuries to the epiphyseal plate
- Solitary exostosis
- Fibrous dysplasia
- Hemangioma, lymphangioma, mixed tumors
- Osteitis fibrosa cystica generalisata
- M. Neurofibromatosis of Recklinghausen
- Giant cell tumors
- Leg deformity ( knock-knee, bow-leg )
- Femoral head necrosis
- Perthes disease
- After teenager Hüftkopflösung
Functional leg length difference
Without anatomical length difference due to:
- Contractures in the hip (increased flexion, adduction or abduction).
- Contractures in the knee.
- Equinus.
Diagnostics
The investigation of the issue of leg length difference occurs in the context of the physical examination routinely by assessment of the iliac crest. Since this asymmetry of the pelvic skeleton can play with a role can also be effected clinically a direct length calculation between anterior inferior iliac spine on the knee joint gap to the outer ankle.
For clinical delineation, whether a leg length difference concerns the upper or the lower leg, both legs at the knee are bent at about 120 °, so that the shins are almost vertical. In the side-view is then detects an excess length of the femur and in the front view of an excess length of the tibia. However, often find themselves particularly in idiopathic leg length differences of both the under-and the thigh.
Radiologically, an exact length determination can be made on full leg still pictures with an integrated or landscaped scale.
Health Consequences
Since the legs are the basis of our structural analysis, a large difference in leg length can cause changes in body posture or in the spine, but also attract a secondary equinus by itself. Due to the inclination of the pelvis, there is a more or less severe scoliosis, ie sideways curvature of the spine. Although the human body has possibilities for compensation, yet most painful changes are in large differences in leg length result. The compensation can be done in two ways:
- Tip- Toeing: Runaway on the toes of the leg reduce the influence is reduced. Some women even practice with pumps this gait.
- Shoe increases
Therapy
Length differences and treatment methods:
- < Three inches by orthopedic shoe dressing ( heel lift with sole compensation and shoe inserts )
- 3-12 inches by orthopedic bespoke shoes or custom-made shoes with liners or Fußbettungsorthesen
- > 12 inches by floor shoes or orthopedic technology lower extremity orthoses or, in extreme cases and where adequate medical indication and operationally.
Elderly patients often have arthritic hip joints, so that in the course of the arthritic joint changes the patient first a functional leg length difference ( by evasion of pain ) and after a total hip replacement surgery (TEP = total endoprosthesis = Hüftkopfersatz ) often show an anatomical leg length difference at the compensation orthopedic shoe soles is possible.