Leg length discrepancy: Difference between revisions
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{{SK}} Unequal leg length, leg length inequality, leg length alignment asymmetry | |||
==Overview== | ==Overview== | ||
Leg length discrepancy is a medical condition where the [[leg]]s 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 defect]]s, [[fracture|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]].<ref>[http://www.chiroandosteo.com/content/13/1/12 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.</ref> | |||
==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 [[trauma|broken leg]], serious [[infection]], or local damage to one of the [[growth plate]]s 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 [[human pelvis|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.<ref>Knutson, G. A.[http://www.chiroandosteo.com/content/13/1/12 "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}}.</ref> | |||
==Causes== | ==Causes== | ||
===Life Threatening Causes === | ===Life Threatening Causes === | ||
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | |||
*[[Appendicitis]] | *[[Appendicitis]] | ||
*[[Aortoiliac occlusive disease |Leriche syndrome]] | |||
*[[Aortoiliac occlusive disease | Leriche syndrome | |||
*[[Meningitis]] | *[[Meningitis]] | ||
*[[Osteomyelitis]] | *[[Osteomyelitis]] | ||
*[[Pelvic abscess]] | *[[Pelvic abscess]] | ||
*[[Psoas abscess]] | *[[Psoas abscess]] | ||
*[[Septic arthritis]] | *[[Septic arthritis]] | ||
*[[Testicular torsion]] | *[[Testicular torsion]] | ||
===Common Causes=== | ===Common Causes=== | ||
*[[Avascular necrosis | Avascular necrosis of the hip]] | *[[Avascular necrosis | Avascular necrosis of the hip]] | ||
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*[[Septic arthritis]] | *[[Septic arthritis]] | ||
*[[Slipped capital femoral epiphysis]] | *[[Slipped capital femoral epiphysis]] | ||
*[[Transient synovitis | Transient synovitis of the hip]] | *[[Transient synovitis | Transient synovitis of the hip]]<ref name="Gurney-2002">{{Cite journal | last1 = Gurney | first1 = B. | title = Leg length discrepancy. | journal = Gait Posture | volume = 15 | issue = 2 | pages = 195-206 | month = Apr | year = 2002 | doi = | PMID = 11869914 }}</ref><ref name="Raczkowski-2010">{{Cite journal | last1 = Raczkowski | first1 = JW. | last2 = Daniszewska | first2 = B. | last3 = Zolynski | first3 = K. | title = Functional scoliosis caused by leg length discrepancy. | journal = Arch Med Sci | volume = 6 | issue = 3 | pages = 393-8 | month = Jun | year = 2010 | doi = 10.5114/aoms.2010.14262 | PMID = 22371777 }}</ref><ref name="Coppola-1999">{{Cite journal | last1 = Coppola | first1 = C. | last2 = Maffulli | first2 = N. | title = Limb shortening for the management of leg length discrepancy. | journal = J R Coll Surg Edinb | volume = 44 | issue = 1 | pages = 46-54 | month = Feb | year = 1999 | doi = | PMID = 10079669 }}</ref> | ||
===Causes by Organ System=== | ===Causes by Organ System=== | ||
{|style="width:82%; height:100px" border="1" | {|style="width:82%; height:100px" border="1" | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atherosclerosis]], [[AV fistula]], [[Peripheral arterial disease | claudication of limb]], [[Cystic medial necrosis|Erdheim cystic medial necrosis]], [[Freiberg's disease]], [[hemangioma]], [[hypertension]], [[Klippel-Trenaunay-Weber syndrome]], [[Aortoiliac occlusive disease | Leriche syndrome]], [[limb ischemia]], [[Parkes Weber syndrome]], [[peripheral vascular disease]], [[rheumatic disease]] | |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atherosclerosis]], [[AV fistula]], [[Peripheral arterial disease | claudication of limb]], [[Cystic medial necrosis|Erdheim cystic medial necrosis]], [[Osteochondritis|Freiberg's disease]], [[hemangioma]], [[hypertension]], [[Klippel-Trenaunay-Weber syndrome]], [[Aortoiliac occlusive disease | Leriche syndrome]], [[limb ischemia]], [[Parkes Weber syndrome]], [[peripheral vascular disease]], [[rheumatic disease]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Dermatologic''' | | '''Dermatologic''' | ||
|bgcolor="Beige"| [[Cellulitis ]], [[dermatomyositis]] | |bgcolor="Beige"| [[Cellulitis]], [[dermatomyositis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Epiphyseal plate |Arrest of physeal growth]], [[hyperparathyroidism]], [[juvenile osteoporosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal/Orthopedic''' | | '''Musculoskeletal/Orthopedic''' | ||
|bgcolor="Beige"| [[Arthropathy]], [[Baker's cyst]], [[Blount's disease]], [[chondroblastoma]], [[Chondromalacia patellae|chondromalacia of the patella]], [[Club foot|congenital club foot]], [[Hip dysplasia (human) | congenital dysplasia of the hip]], [[Amelia (birth defect)|congenital limb aplasia]], [[Dysmelia|congenital limb hypoplasia]], [[Neurofibromatosis type I|congenital pseudarthrosis of the tibia]], [[Rocker bottom foot|congenital vertical talus]], [[coxa vara]], [[dermatomyositis]], [[discitis]], [[distraction]], [[Muscle atrophy|disuse muscle atrophy]], [[dystonia]], [[enchondroma]], [[Cystic medial necrosis|Erdheim cystic medial necrosis]], [[fallen arches]], [[Hemimelia | fibular hemimelia]], [[gait abnormality]], [[genu recurvatum]], [[greenstick fracture]], [[Bone healing|healed fractures]], [[hemihypertrophy]], [[Spinal disc herniation|herniated vertebral disc]], [[Subluxation|hip subluxation]], [[Contracture|hip contractures]], [[hypermobility syndrome]], [[Bone fracture|hypervascularity after fracture]], [[juvenile arthritis]], [[juvenile osteoporosis]], [[juvenile rheumatoid arthritis]], [[Klippel-Trenaunay-Weber syndrome]], [[Kohler disease]], [[Legg-Calvé-Perthes syndrome]], [[Scoliosis | | |bgcolor="Beige"| [[Arthropathy]], [[Baker's cyst]], [[Blount's disease]], [[chondroblastoma]], [[Chondromalacia patellae|chondromalacia of the patella]], [[Club foot|congenital club foot]], [[Hip dysplasia (human) | congenital dysplasia of the hip]], [[Amelia (birth defect)|congenital limb aplasia]], [[Dysmelia|congenital limb hypoplasia]], [[Neurofibromatosis type I|congenital pseudarthrosis of the tibia]], [[Rocker bottom foot|congenital vertical talus]], [[coxa vara]], [[dermatomyositis]], [[discitis]], [[distraction]], [[Muscle atrophy|disuse muscle atrophy]], [[dystonia]], [[enchondroma]], [[Cystic medial necrosis|Erdheim cystic medial necrosis]], [[fallen arches]], [[Hemimelia | fibular hemimelia]], [[gait abnormality]], [[genu recurvatum]], [[greenstick fracture]], [[Bone healing|healed fractures]], [[hemihypertrophy]], [[Spinal disc herniation|herniated vertebral disc]], [[Subluxation|hip subluxation]], [[Contracture|hip contractures]], [[hypermobility syndrome]], [[Bone fracture|hypervascularity after fracture]], [[juvenile arthritis]], [[juvenile osteoporosis]], [[juvenile rheumatoid arthritis]], [[Klippel-Trenaunay-Weber syndrome]], [[Kohler disease]], [[Legg-Calvé-Perthes syndrome]], [[Scoliosis | lumbar scoliosis]], [[Bone tumor|benign bone tumours]], [[Neuroblastoma|metastatic neuroblastoma]], [[multiple hereditary exostoses]], [[muscular dystrophy]], [[Ollier's disease]], [[ORIF|open reduction and internal fixation of fractures]], [[Osgood-Schlatter disease]], [[osteoblastoma]], [[osteochondritis dissecans]], [[osteogenesis imperfecta]], [[Osteoma|osteoid osteoma]], [[osteosclerosis]], [[osteostimulation]], [[Repetitive strain injury|overuse syndrome]], [[Chondromalacia patellae|patellofemoral pain syndrome]], [[Bone fracture|plastic deformation in pediatric fractures]], [[Paralysis|prolonged immobilization]], [[proteus syndrome]], [[proximal femoral focal deficiency]], [[rheumatic disease]], [[sciatica]], [[Sever's disease]], [[Osgood-Schlatter disease|Sinding-Larsen-Johansson disease]], [[skeletal dysplasia]], [[SLE]], [[slipped capital femoral epiphysis]], [[Spina bifida|spinal dysraphism]], [[spondylolisthesis]], [[Tarsal coalition|tarsal synostosis]], [[tendonitis]], [[tenosynovitis]], [[Upington disease]] | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Bone tumor|benign bone tumours]], [[brain tumor]], [[chondroblastoma]], [[Ewings sarcoma]], [[Langerhans' cell histiocytosis]], [[leukemia]], [[Bone tumor|malignant | |bgcolor="Beige"| [[Acute lymphoblastic leukemia]], [[Bone tumor|benign bone tumours]], [[brain tumor]], [[chondroblastoma]], [[Ewings sarcoma]], [[Langerhans' cell histiocytosis]], [[leukemia]], [[Bone tumor|malignant bone tumors]], [[malignant fibrous histiocytoma]], [[Neuroblastoma|metastatic neuroblastoma]], [[neurofibrosarcoma]], [[osteoblastoma]], [[osteosarcoma]], [[spinal cord]] [[tumour]], [[Epiphyseal plate|tumour across epiphyseal plate]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Rheumatology/Immunology/Allergy''' | | '''Rheumatology/Immunology/Allergy''' | ||
|bgcolor="Beige"| [[Acute rheumatic fever]], [[ankylosing spondylitis ]], [[arthropathy]], [[Baker's cyst]], [[dermatomyositis]], [[Henoch-Schönlein purpura]], [[Spinal disc herniation|herniated vertebral disc]], [[inflammatory bowel disease]], [[juvenile arthritis]], [[juvenile rheumatoid arthritis]], [[myositis]], [[reactive arthritis]], [[rheumatic disease]], [[rheumatoid arthritis]], [[sacroiliitis]], [[serum sickness]], [[SLE]] | |bgcolor="Beige"| [[Acute rheumatic fever]], [[ankylosing spondylitis]], [[arthropathy]], [[Baker's cyst]], [[dermatomyositis]], [[Henoch-Schönlein purpura]], [[Spinal disc herniation|herniated vertebral disc]], [[inflammatory bowel disease]], [[juvenile arthritis]], [[juvenile rheumatoid arthritis]], [[myositis]], [[reactive arthritis]], [[rheumatic disease]], [[rheumatoid arthritis]], [[sacroiliitis]], [[serum sickness]], [[SLE]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Trauma''' | | '''Trauma''' | ||
|bgcolor="Beige"| [[Ankle sprain ]], [[arthralgia]], [[Avascular necrosis | avascular necrosis of the hip]], [[Avulsion fracture|avulsion injury]], [[child abuse]], [[complex regional pain syndrome]], [[contusion]], [[coxa vara]], [[discitis]], [[femur]] [[fracture]], [[ | |bgcolor="Beige"| [[Ankle sprain]], [[arthralgia]], [[Avascular necrosis | avascular necrosis of the hip]], [[Avulsion fracture|avulsion injury]], [[child abuse]], [[complex regional pain syndrome]], [[contusion]], [[coxa vara]], [[discitis]], [[femur]] [[fracture]], [[Polio|fixed pelvic obliquity]], [[Foreign body|foot foreign body]], [[Bone fracture|foot fractures]], [[Osteochondritis|Freiberg's disease]], [[greenstick fracture]], [[Hematoma|hematoma of thigh]], [[Bone fracture|healed fractures]], [[hemarthrosis]], [[Spinal disc herniation|herniated vertebral disc]], [[hip dislocation]], [[Subluxation|hip subluxation]], [[Bone fracture|hypervascularity after fracture]], [[testicular torsion]], [[knee sprain]], [[limb ischemia]], [[Bone fracture|malunion]], [[muscle strain]], [[femur fracture]], [[Fracture nonunion|nonunion]], [[Transient synovitis|observation hip syndrome]], [[ORIF|open reduction and internal fixation of fractures]], [[patellar dislocation]], [[Chondromalacia patellae|patellofemoral pain syndrome]], [[periostitis]], [[Achilles tendon|ruptured achilles tendon]], [[sacroiliitis]], [[Salter-Harris fracture]], [[sciatica]], [[spondylolisthesis]], [[stress fracture]], [[tendonitis]], [[tenosynovitis]], [[Bone fracture classification|tibial fracture]], [[toddler fracture]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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*[[Femur fracture]] | *[[Femur fracture]] | ||
*[[Hemimelia | Fibular hemimelia]] | *[[Hemimelia | Fibular hemimelia]] | ||
*[[ | *[[Polio|Fixed pelvic obliquity]]<ref name="Lee-1997">{{Cite journal | last1 = Lee | first1 = DY. | last2 = Choi | first2 = IH. | last3 = Chung | first3 = CY. | last4 = Cho | first4 = TJ. | last5 = Lee | first5 = JC. | title = Fixed pelvic obliquity after poliomyelitis: classification and management. | journal = J Bone Joint Surg Br | volume = 79 | issue = 2 | pages = 190-6 | month = Mar | year = 1997 | doi = | PMID = 9119840 }}</ref> | ||
*[[Foreign body|Foot foreign body]] | *[[Foreign body|Foot foreign body]] | ||
*[[Bone fracture|Foot fractures]] | *[[Bone fracture|Foot fractures]] | ||
*[[Freiberg disease]] | *[[Osteochondritis|Freiberg disease]] | ||
*[[Gait abnormality]] | *[[Gait abnormality]] | ||
*[[Genu recurvatum]] | *[[Genu recurvatum]] | ||
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*[[Fracture nonunion|Nonunion]] | *[[Fracture nonunion|Nonunion]] | ||
*[[Obesity]] | *[[Obesity]] | ||
*[[Transient synovitis|Observation hip syndrome]] | *[[Transient synovitis|Observation hip syndrome]]<ref name="FERNANDEZDE VALDERRAMA-1963">{{Cite journal | last1 = FERNANDEZDE VALDERRAMA | first1 = . | title = THE OBSERVATION HIP SYNDROME AND ITS LATE SEQUELAE. | journal = J Bone Joint Surg Br | volume = 45 | issue = | pages = 462-70 | month = Aug | year = 1963 | doi = | PMID = 14065262 }}</ref> | ||
*[[Ollier's disease]] | *[[Ollier's disease]] | ||
*[[ORIF|Open reduction and internal fixation of fractures]] | *[[ORIF|Open reduction and internal fixation of fractures]] | ||
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*[[Tenosynovitis]] | *[[Tenosynovitis]] | ||
*[[Testicular torsion]] | *[[Testicular torsion]] | ||
*[[Bone fracture classification|Tibial | *[[Bone fracture classification|Tibial fracture]] | ||
*[[Toddler fracture]] | *[[Toddler fracture]] | ||
*[[Transient synovitis | Transient synovitis of the hip]] | *[[Transient synovitis | Transient synovitis of the hip]] | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Crowdiagnosis]] | |||
[[Category:Musculoskeletal Disease]] | [[Category:Musculoskeletal Disease]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Physical examination]] | [[Category:Physical examination]] | ||
[[Category:Up-To-Date]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} |
Latest revision as of 18:06, 9 June 2015
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.
- Appendicitis
- Leriche syndrome
- Meningitis
- Osteomyelitis
- 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[3][4][5]
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ 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.
- ↑ 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.
- ↑ Gurney, B. (2002). "Leg length discrepancy". Gait Posture. 15 (2): 195–206. PMID 11869914. Unknown parameter
|month=
ignored (help) - ↑ Raczkowski, JW.; Daniszewska, B.; Zolynski, K. (2010). "Functional scoliosis caused by leg length discrepancy". Arch Med Sci. 6 (3): 393–8. doi:10.5114/aoms.2010.14262. PMID 22371777. Unknown parameter
|month=
ignored (help) - ↑ 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. Unknown parameter
|month=
ignored (help) - ↑ 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. Unknown parameter
|month=
ignored (help) - ↑ FERNANDEZDE VALDERRAMA, . (1963). "THE OBSERVATION HIP SYNDROME AND ITS LATE SEQUELAE". J Bone Joint Surg Br. 45: 462–70. PMID 14065262. Unknown parameter
|month=
ignored (help)