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Affordable Treatments for All Types of Limb Length Discrepancies

Limb-Length-Discrepancies

Limb Length Discrepancies or LLD in short, are differences between lengths of lower and/or upper arms and/or lower legs. Except for in extreme cases LLD causes little or no problem in the functioning of arms. However, it is the length differences within the legs which often cause discrepancies in the way people walk. Quite often, limb length discrepancy may only be a mild variation between two sides of the body. Nevertheless, this is not an unusual phenomenon in the general population. Like for example, a study revealed that 32% of 600 military recruits showed a 0.5 inch to 0.75 inch difference between their leg lengths. This is normally a common percentage of variation which requires no type of treatment. But greater differences may require treatments simply because significant difference is able to affect well-being & quality of life of LLD patients.

More about Limb Lengthening Discrepancy

There are many causes for limb length discrepancy. They are normally divided into three groups. First congenital LLD which affects right from birth; Secondly developmental LLD which is normally caused due to a disease in childhood or an injury which has slowed or damaged the growth plates of bones; & thirdly post-traumatic LLD which is caused from a fracture leading to shortening of bone ends. However, there also are three ways to equalize LLD in patients. Firstly, by using a shoe lift, secondly, by shortening the long leg & lastly, by lengthening the short leg.

How Limb Length Discrepancy Patients React to Treatments

Most LLD patients normally do not like wearing shoe lifts which are greater than 0.75 inches (2 cm). Therefore, for limb length discrepancies which are greater than 0.75 inches but less than 2 inches (5 cm), shortening of the longer limb can be considered especially for patients who are tall. This can easily be accomplished in growing children through a small & minimally invasive & uncomplicated procedure known as Epiphysiodesis. This eventually also means surgically closing one or more than one growth plates. Since children have one growth plate at each end of tibia & femur & fibula, this will not stop the entire growth of leg. It will however, effectively slow down growth of long leg by a predictable amount & allow the short leg to catch up with the longer one. Moreover, if this procedure is performed at too late or too early stage of age, too little or too much correction will respectively. It is therefore essentially important for doctors to accurately calculate the right age which is best suited for Epiphysiodesis procedure.

Causes for Limb Length Discrepancy

There are many causes for limb length discrepancy to occur among people. Some of the most common are listed below.

  • Congenital LLDCases pertaining to congenital LLD often present the most challenging & difficult situations for performing lengthening procedures & should therefore only be treated by experts within the field having significant experience with lengthening procedures of developmental & post-traumatic limb length discrepancies. Amount of LLD is frequently large in congenital cases & which also proportionally & progressively increases with time. Moreover, presently there are no known ways of accelerating growth rate of the shorter leg. Adding to these problems concerning the bone, soft tissues are usually contracted & thickened & therefore make them resist growing & stretching from the process of lengthening. Ankles, knees and/or hips may also be unstable, deformed and/or underdeveloped. All of these factors must be properly considered & addressed in order to avoid irreversible damage to muscles, nerves, joints, bones & tissues.
  • Developmental LLDThis category includes limb length discrepancies caused by conditions like injury to growth plates & growth arrest, polio, multiple osteochondromas, Ollier’s disease, clubfoot, spina bifida, cerebral palsy, radiation & infection. Developmental LLD often has associated deformities. However, most of these cases can be effectively treated by one or two lengthening procedures. In case deformities are present, they can also be corrected at the same time as the lengthening procedure. In some special cases like neonatal sepsis of the hip due to which the hip joint is destroyed by infection within the first year of the patient’s life, doctors not just lengthen the leg but also involve reconstructing the hip with a special technique known as the pelvic support osteotomy. This procedure allows surgeons to recreate near normal hip function in a situation where otherwise a destroyed or absent hip joint existed.
  • Malunion – Post-traumatic LLDThis limb length discrepancy generally remains after a fractured has healed in a shortened position. Most post-traumatic LLD cases are found to occur in adults & most of them can be effectively corrected with just a single lengthening procedure. Any associated deformity can also be corrected at the same time along with this operation. Many post-traumatic LLD patients can also be successfully treated by lengthening over nail or through the fully implantable nail method.

Other Causes for Limb Length Discrepancies

Other causes for LLD include arthritis (inflammation) & neurological conditions. Quite often other causes of limb length discrepancy are unknown, particularly in LLD cases involving underdevelopment of inner or outer sides of legs, or partial overgrowth of any one side of the body. Moreover, these conditions are usually present at the time of birth, but limb length difference may be too small in order to be detected. This limb length discrepancy generally increases so as to become more noticeable as the child grows. In cases of underdevelopment, it is found that one or two bones between the ankle & the knee is abnormally short. Along with this there also may be some relative knee or foot problem.

Limb Length Discrepancy Conditions

Hemiatrophy (one side too small) or Hemihypertrophy (one side too big) are some of the rare conditions of limb length discrepancies. Arm & leg on any one side of the body in this condition are either shorter or longer than arm & leg of other side of the body. There also may be some differences between two sides of the face as well. Moreover, in some cases no cause has been found for this kind of limb length discrepancies & is therefore known as an ‘idiopathic’ difference.

Diagnosis of Limb Length Discrepancy

All limb length discrepancies can be measured by physicians during a physical examination and/or through X-rays. Most often, physicians measure the level of hips when children are standing barefoot. Series of measured wooden blocks are placed under the short leg of LLD patient until the hips are at level. Patients are also subjected to undergo X-ray imaging in case physicians believe that more precise measurements are required. Physicians may also repeat physical examinations & X-rays every 6 months to an year in growing children in order to see if limb length discrepancy has increased or remained the same during this time as the child grew up. Limb length discrepancies are also detected on screening examinations for scoliosis (curvature of spine). However, limb length discrepancy does not cause scoliosis in patients.

Symptoms of Limb Length Discrepancy

Effects of limb length discrepancy however vary from one patient to another depending upon the size & cause of the difference. Difference of 3.5 – 4 percent of total length of leg, which is about 4 cm in an average adult, is likely to cause noticeable abnormalities while walking. This kind of difference may often require the patient to exert more effort in walking. There also exists a controversy about effects of limb length discrepancy causing back pain in patients. Some studies reveal that people having limb length discrepancy show greater incidence of having lower back pain along with an increased susceptibility to injuries as well. Nevertheless, quite a few other studies do not endorse this finding.

Treatment Procedures for Limb Length Discrepancies

  • Nonsurgical TreatmentThis is an ideal method of treatment for minor cases of limb length discrepancies in patients with no deformities where surgery may not be necessary. Since risks generally outweigh benefits, surgery to equalize leg lengths is typically not recommended in cases where the difference is lesser than 1 inch. Physicians generally would recommend a shoe lift for such small differences. Lift which is fitted to the shoe will most often improve walking & running as well & even be able to relieve back pain which may be caused by limb length discrepancy. Moreover, shoe lifts are inexpensive & can also be conveniently discarded in case they prove ineffective.
  • Surgical TreatmentLegs can either be made equal or near equal in children who are still growing through a relatively simple surgical procedure. This procedure is designed to slow down growth of the long leg at one or two sites of growth. Physicians will let patients know as to how much equalization can effectively be gained with help of this surgical intervention. This procedure is usually performed under control of X-ray through very small incisions which are made in the knee area. However, this procedure will not cause any immediate correction in length of the leg. Instead, LLD will gradually decrease as the shorter leg will continue to grow & eventually catch-up with the leg that has undergone surgery.
  • Timing the Surgical ProcedureTiming of the surgical intervention is critical to success. However, goal of surgery is to reach equal leg length by the time growth of the bone ends normally. Most likely, this is in the mid to late teenage ears of children. Disadvantage of this surgical option includes possibility of over-correction or under-correction of limb length discrepancy. Additionally, adult height of the patient will be less than normal in case the shorter leg has been lengthened. Moreover, correction of significant leg length discrepancy through this method can make the patient’s body appear slightly disproportionate due to the shorter leg. In some LLD cases, the longer leg can also be shortened. However, a major shortening may sometimes weaken the muscles of the leg. Maximum of 3 inches can be shortened in the femur (thighbone) & a maximum of 2 inches can be shortened in the shinbone.
  • Surgical Lengthening for LLD PatientsLengthening of the shorter leg is another choice through surgery for LLD patients. Bone length is enhanced by surgical application of an external fixation device to the leg. External fixator or a scaffold-like frame is connected to the bone with pins or wires or both. Small crack or gap is created in bone & the frame generates tension whenever the patient of an associate family member turns the dial. This is normally done several times every day. Lengthening process generally begins approximately 5 – 10 days following surgery. With help of this procedure bone may lengthen about 1 millimeter every day or approximately about 1 inch every month. Lengthening through this procedure may however be slower in bones which were previously injured. This process may also be slower in case the leg was operated upon earlier. Bones in LLD patients with potential blood vessel abnormalities, like in cigarette smokers, may also need to be lengthened much slower. External fixator is only worn until the bone is strong enough to safely support the patient. Usually, this takes about 3 months of time for every inch of growth. Several factors like health, age, smoking & participation in rehabilitation can also affect the amount of time which is required for bone growth.

Risk of Surgical Procedures

  • Infection at site of pins & wires
  • Stiffness of adjacent joints
  • Slight over-correction or under-correction of bone length

Caring After Limb Length Discrepancy Surgical Procedures

  • Scheduled follow-up visits to physician’s office
  • Meticulous cleaning of areas around wires & pins
  • Diligent adjustment of frame several times everyday
  • Proper rehabilitation as prescribed by physicians

Physicians who are well experience in techniques of limb lengthening will explain the available treatment options including risks & benefits of procedures in detail. LLD patients in consultation with their physicians can subsequently decide which type of treatment is best suited for individual requirements.

Types of Congenital Limb Length Discrepancies

At IndianMedTrip, we perhaps have one of the world’s largest experience & most successful results in lengthening & reconstruction of congenitally short tibia & femur. This procedure is clinically known as Lengthening Reconstruction Surgery or LRS in short. Congenital shortening of femur is medically referred to as PFFD or Proximal Femoral Focal Deficiency. Another name for this condition is CFD or Congenital Femoral Deficiency. Congenital shortening of tibia is most often associated with partial or complete absence of smaller adjacent fibula bone. This is medically termed Fibular Hemimelia. Tibial Hemimelia is congenital shortening of leg segment with which either part or all of tibia is missing. Other types of congenital shortening which affect femur & tibia are called Hemihypertrophy & Hemiatrophy. LLD patients with these conditions usually have milder amount of shortening. Posteromedial bowing of tibia is another type of congenital shortening which is associated with characteristic deformities of foot & tibia. However, each of these types of congenital LLD shortenings requires a different kind of approach in order to perform leg lengthening reconstruction surgery.

Affordable Treatment for Limb Length Discrepancy with IndianMedTrip

At IndianMedTrip we have successfully treated most of the above mentioned types of congenital limb length discrepancies. Our physicians start by accurately predicting amount of LLD which will be present when the child reaches the end of skeletal maturity. Doctors will also identify all deformities & instabilities of joint which are present in the patient. Based upon this information IndianMedTrip physicians will organize a treatment strategy for reconstruction of the limb which may include ankle, foot, knee and/or hip as the first step. Lengthening reconstruction surgery often involves one or more than one operations. However, most cases of congenital LLD can effectively be treated with lengthening & reconstruction procedures. In many cases of congenital LLD, our physicians prefer to start with lengthening & reconstruction surgery prior to the patient reaching 4 years of age, & quite often by 2 years of age.

Alternative Methods of Treatment for Limb Length Discrepancies

Alternative methods of treatment undertaken by IndianMedTrip associated doctors include operations designed to modify or amputate the affected limb so that it can more easily be fitted into a prosthesis which can effectively be lengthened in order to equalize LLD as the child keeps growing. This procedure is called prosthetic Reconstruction Surgery or PRS & includes operations like Van Ness Rotationplasty & Syme Amputation techniques. Although this may not be the best option for a majority of LLD patients, it is most ideal treatment option for most severely deficient LLD cases in which one or more joints are missing. IndianMedTrip lengthening reconstruction surgery results for both tibia & femur & even extremely large cases of LLD are excellent & provide exemplary function after treatments with preservation & quite often with improvement in joint function as well.

Seamless Services Offered by IndianMedTrip

IndianMedTrip is globally reputed & one of the fastest growing medical tourism companies in South Asia providing an extensive range of affordable healthcare services to people from all over the world. Seamless services offered by IndianMedTrip start with the first telephonic conversation with the patient & move on to identifying the best doctor & the ideal hospital facility for treatment. Other services offered by IndianMedTrip include assistance in obtaining medical visas, warm reception of the patient & his/her accomplice at airport on arrival, convenient local travel facility, comfortable accommodation options including budget or luxury hotels or serviced apartments, scheduled appointments with doctors & medical procedures without any waiting period, exotic recuperative vacations at reasonable costs, follow-up evaluation checks & a pleasant farewell at airport while the patient is successfully heading back home.

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