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

Common Causes

• Avascular necrosis of the hip
• Cerebral palsy
• Congenital dysplasia of the hip
• Discitis
• Femur fracture
• Hip tightness and contracture
• 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 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), prosthetic hip replacement, radiation therapy, sympathectomy
Infectious Disease	Acute rheumatic fever, cellulitis , discitis, epididymitis, epidural abscess of the spine, foot infection, 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, 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, healed fractures, hemiatrophy, hemihypertrophy, herniated vertebral disc, hip subluxation, hip tightness and contracture, 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, osteochondritis dissecans, osteogenesis imperfecta, osteoid osteoma, overuse syndrome, patellofemoral pain, plastic fracture, prolonged immobilization , proteus syndrome, proximal femoral focal deficiency, rheumatic disease, sciatica, Sever disease, Sinding-Larsen-Johansson disease, skeletal dysplasia, SLE, slipped capital femoral epiphysis, spinal dysraphism, spondylolisthesis, tarsal synostosis, tendonitis, tenosynovitis , torsional deformities , Upington disease
Neurologic	Brain tumor, Cerebral palsy, Dystonia, Hip tightness and contracture, 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, Ewings sarcoma, Langerhans' cell histiocytosis , Leukemia, Malignant Bone tumors, Malignant fibrous histiocytoma, Metastatic neuroblastoma, Neurofibrosarcoma, Osteogenic sarcoma, Sclerotic lesion of L5 pedicle , Spinal cord tumor, Tumors across epiphysis
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 cyst, Dermatomyositis, Henoch-schonlein purpura, Herniated vertebral disc, Inflammatory bowel disease, Juvenile arthritis, Juvenile rheumatoid arthritis, Myositis, Reactive arthritis, Rheumatic disease, Rheumatoid arthritis, Sacroilitis, Serum sickness, SLE
Sexual	Epididymo-orchitis, Intermittent torsion of testis
Trauma	Ankle sprain , Arthralagia , 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, Fracture stimulation, Freiberg disease, Haematoma of thigh , Healed fractures, Hemarthrosis, Herniated vertebral disc, Hip dislocation , Hip subluxation, Hypervascularity after fracture, Intermittent torsion of testis, Knee sprain, Limb ischaemia, Malunion, Muscle strain, Neck of femur fracture, Non union, Observation hip syndrome, Open reduction and internal fixation of fractures, Overriding fractures, Patellar dislocation, Patellofemoral pain, Periostitis, Ruptured achilles tendon, Sacroilitis, Salter-harris fracture, Sciatica, Spondylolisthesis, Stress fracture, Tendonitis, Tenosynovitis , Tibial Fracture, Toddler's 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
• Arthralagia
• Arthropathy
• Atherosclerosis
• AV fistula
• Avascular necrosis of the hip
• Avulsion injury
• Baker cyst
• Benign bone tumours
• Blount disease
• Brain tumor
• Cellulitis
• Cerebral palsy
• Child abuse
• Chondromalacia of the patella
• Chondromalacia patellae
• Claudication of limb
• Complex regional pain syndrome
• Congenital club foot
• Congenital dysplasia of 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
• Foot infection
• Fracture stimulation
• Freiberg disease
• Gait abnormalities
• Genu recurvatum
• Gonoccoccal arthritis
• Haematoma of thigh
• Hand-foot-mouth disease
• Healed fractures
• Hemangioma

• Hemarthrosis
• Hemiatrophy
• Hemihypertrophy
• Hemophilia
• Henoch-Schonlein purpura
• Herniated vertebral disc
• Hip dislocation
• Hip replacement
• Hip subluxation
• Hip tightness and contracture
• Hypermobility syndrome
• Hyperparathyroidism
• Hypertension
• Hypervascularity after fracture
• Idiopathic
• Iliac adenitis
• Immunization (im shot)
• Incomplete fracture: buckle, greenstick
• Inflammatory bowel disease
• Inguinal lymphadenitis
• Intermittent torsion of testis
• Juvenile arthritis
• Juvenile chronic recurrent multifocal osteomyelitis
• Juvenile osteoporosis
• Juvenile rheumatoid arthritis
• Kahler disease
• Klippel-trenaunay-weber syndrome
• Knee sprain
• Kohler disease
• Langerhans' cell histiocytosis
• Legg-calve-perthes disease
• 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
• Non union
• Obesity
• Observation hip syndrome
• Ollier disease
• Open reduction and internal fixation of fractures
• Orchitis
• Osgood-Schlatter disease
• Osteochondritis dissecans
• Osteogenesis imperfecta

• Osteogenic sarcoma
• Osteoid osteoma
• Osteomyelitis
• Overriding fractures
• Overuse syndromes
• Parkes weber syndrome
• Paronychia
• Patellar dislocation
• Patellofemoral pain
• Pelvic abscess
• Pelvic inflammatory disease
• Periostitis
• Peripheral neuropathy
• Peripheral vascular disease
• Perirectal abscess
• Plastic fracture
• Poliomyelitis
• Poor posture
• 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
• Sclerotic lesion of L5 pedicle
• Septic arthritis
• Serum sickness
• Sever 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
• Tibial Fracture
• Toddler's fracture
• Torsional deformities
• Transient synovitis of the hip
• Tumors across epiphysis
• Upington disease
• Wilm's tumor

References

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