From the Research
For a pediatric patient with a lower limb length discrepancy (LLD) of 1.1 cm, observation and monitoring is the recommended initial approach as this degree of discrepancy is generally considered mild and often well-tolerated. This approach is supported by the most recent and highest quality study available, which suggests that small discrepancies (under 2 cm) typically cause minimal functional impairment, and the body can often compensate effectively without significant intervention 1.
Key Considerations
- For symptomatic cases, a simple heel lift of approximately 5-8 mm (not the full 1.1 cm) in the shoe of the shorter limb can effectively address any gait abnormalities or back pain.
- The lift should be gradually introduced, starting with 3-5 mm and increasing as tolerated.
- Regular follow-up every 6-12 months is essential to monitor the discrepancy as the child grows, as LLD can change during growth spurts.
- Radiographic assessment using standing scanograms or CT scanograms should be performed annually to track progression.
Surgical Intervention
- Surgical intervention such as epiphysiodesis (growth plate arrest) of the longer limb is rarely indicated for discrepancies under 2 cm but may be considered if the discrepancy is projected to increase significantly 1.
- The decision to treat is always elective and should be discussed with each patient individually, considering the extent of the discrepancy and other factors.
Physical Therapy
- Physical therapy focusing on core strengthening, flexibility, and gait training can help manage any compensatory mechanisms.
- This approach can help minimize the risk of long-term musculoskeletal disturbances and improve overall quality of life.
Evidence Base
- The evidence base on the indications for treatment of leg-length discrepancy is poor, with only informal consensus recommendations available 1.
- However, the most recent study suggests that a conservative approach is often the best initial strategy, with surgical intervention reserved for more severe cases or those with significant projected growth 1.