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]

Overview

Leg length discrepancy refers to a medical condition where the legs are of different sizes. One form is leg length alignment asymmetry, a condition where the short leg is unequal in length while in a supine or prone position. The causes can be either anatomical in nature as seen in short bones due to growth or an accident, or neuromuscular due to hypertonicity in the musculature of the pelvis or leg.^[1]

Causes

Life Threatening Causes

Common Causes

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

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.
↑ 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)

Template:WikiDoc Sources

[1] 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-2002-2] Gurney, B. (2002). "Leg length discrepancy". Gait Posture. 15 (2): 195–206. PMID 11869914. Unknown parameter |month= ignored (help)

[Raczkowski-2010-3] 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-1999-4] 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-1997-5] 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-1963-6] 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)

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