From the Research
For a pediatric patient with a lower limb length discrepancy (LLD) of 1.1 cm, referral to orthopedics is generally not necessary as this is considered a mild discrepancy that typically doesn't require surgical intervention. Observation and non-surgical management are appropriate for discrepancies less than 2 cm, as supported by the most recent study 1. Consider providing a shoe lift of approximately 0.5-0.75 cm (not the full 1.1 cm) to help with symptom management if the child is experiencing discomfort, gait abnormalities, or back pain. Some key points to consider in the management of LLD include:
- Regular monitoring every 6-12 months is important to assess whether the discrepancy is static or progressive, especially during growth spurts, as noted in 2.
- If the discrepancy increases beyond 2 cm, causes significant symptoms despite conservative management, or if there are associated deformities, then referral to pediatric orthopedics would be warranted.
- The reason for conservative management is that mild discrepancies often don't cause functional limitations, and the body can typically compensate through minor pelvic tilt and other natural adjustments, as discussed in 3.
- Additionally, in growing children, discrepancies may change over time, making observation an important component of care, as highlighted in 4 and 5. It's also worth noting that most individuals can tolerate upwards of a 2 cm discrepancy without significant symptoms, as reported in 1. However, a constellation of symptoms such as joint pain, arthritis, alterations in oxygen consumption/heart rate, and low back pathology can occur later on in adulthood, emphasizing the importance of early diagnosis and management in the pediatric population.