Leg length discrepancy—treatment indications and strategies

Leg length differences affect many people to varying degrees. There are no evidence-based studies on the need for treatment.
The cause of a leg length difference is usually a leg shortening. The influence of leg length differences on pain and long-term consequences in the musculoskeletal system is controversially discussed. A clear association with back pain is questionable, but a small increase in the incidence of gonarthrosis is likely. The evidence base for the indication of a therapy of leg length differences is poor. There are only informal consensus recommendations. The spectrum of therapeutic options includes a variety of conservative and surgical measures. The extent of a progressive leg length difference in the growth age can be estimated by predictive algorithms to an accuracy of 2 cm. In addition to insoles, shoe elevations and orthoses, a surgically induced growth retardation by blocking the epiphyseal joints near the knee joint or an extension by means of osteotomy and subsequent distraction of the bone callus by fully implantable or external devices can be considered. Changes in the length of the bone lead to considerable stress on the soft tissues. In case of an expected leg length difference of more than 5 cm, an initial leg extension can be discussed already during growth.
Whether a conservative or surgical therapy should be performed, has to be considered individually with the patient. The extent of the leg length difference does not determine the treatment method. The therapy decision is therefore always elective.
Vogt B, Gosheger G, Wirth T, Horn J, Rödl RDtsch Arztebl Int 2020; 117: 405-11; DOI: 10.3238/arztebl.2020.0405 (german original)
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